European Radiology

, Volume 26, Issue 10, pp 3728–3736 | Cite as

Hypovascular hypointense nodules on hepatobiliary phase without T2 hyperintensity on gadoxetic acid-enhanced MR images in patients with chronic liver disease: long-term outcomes and risk factors for hypervascular transformation

  • Yong Seek Kim
  • Ji Soo SongEmail author
  • Hyun Kyung Lee
  • Young Min Han
Magnetic Resonance



To evaluate the long-term outcomes and imaging features associated with hypervascularization of hypovascular nodules that show T2 iso-/hypointensity and hypointensity on hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) images in patients with chronic liver disease.

Materials and methods

Sixty patients and 114 nodules, which were hypovascular and iso-/hypointense on T2-weighted images and hypointense on HBP of gadoxetic acid-enhanced MRI, were included. We evaluated the effect of baseline clinical features, baseline MR features and growth rate on subsequent hypervascularization.


Twenty-seven nodules in 21 patients transformed to hypervascular hepatocellular carcinoma (HCC). Using multivariate Cox analysis, T1 hyperintensity (hazard ratio [HR] = 2.69, P = 0.021), previous history of HCC (HR = 2.64, P = 0.021), and initial nodule size (HR = 1.09, P = 0.046) were identified to be associated with hypervascularization. The growth rate of nodules was a more powerful determinant of subsequent hypervascularization than baseline clinical and MR features. At long-term follow-up after >3 years, only one nodule with T1 isointensity showed hypervascularization.


Careful follow-up or diagnostic procedures, such as biopsy, should be considered for up to 3 years after detection of hypointense nodules on HBP with T1 hyperintensity or a higher growth rate.

Key Points

T1 hyperintensity is a baseline MR predictive factor for subsequent hypervascularization.

A higher growth rate is a more powerful determinant of subsequent hypervascularization.

Management of patients with these predictive factors requires more attention.


Magnetic resonance imaging Gadoxetic acid Hepatocellular carcinoma Hypervascular transformation Hepatocarcinogenesis 



Hepatobiliary phase


Hepatocellular carcinoma


Magentic resonance


Transarterial chemoembolization



The scientific guarantor of this publication is Ji Soo Song. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This paper was supported by the Fund of Biomedical Research Institute, Chonbuk National University Hospital. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Yong Seek Kim
    • 1
  • Ji Soo Song
    • 1
    • 2
    Email author
  • Hyun Kyung Lee
    • 1
    • 2
  • Young Min Han
    • 1
    • 2
  1. 1.Department of RadiologyChonbuk National University Medical School and HospitalJeonju-siKorea
  2. 2.Research Institute of Clinical MedicineChonbuk National University–Biomedical Research Institute of Chonbuk National University HospitalChonbukKorea

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