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Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images.

Methods

In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules.

Results

The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule’s initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01).

Conclusions

Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination.

Key Points

• Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules

• The risk of hypervascularization in a nodule increased with large size

• Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AFP:

Alpha-fetoprotein

CE-CT:

Contrast-enhanced computed tomography

CT:

Computed tomography

CTAP:

Computed tomography during arterial portography

CTHA:

Computed tomography during hepatic arteriography

DN:

Dysplastic nodule

HCC:

Hepatocellular carcinoma

HP:

Hepatocyte phase

MRI:

Magnetic resonance imaging

OATP:

Organic anion transporter

PIVKA-II:

Protein induced by vitamin K absence or antagonist II

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

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Acknowledgments

The scientific guarantor of this publication is Tomoaki Ichikawa. 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. The authors state that this work has not received any funding.

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.

Methodology: retrospective, diagnostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan

    Katsuhiro Sano, Tomoaki Ichikawa, Utaroh Motosugi, Shintaro Ichikawa & Hiroyuki Morisaka

  2. Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan

    Katsuhiro Sano, Tomoaki Ichikawa & Hiroyuki Morisaka

  3. First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan

    Nobuyuki Enomoto

  4. First Department of Surgery, University of Yamanashi, Yamanashi, Japan

    Masanori Matsuda & Hideki Fujii

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  1. Katsuhiro Sano
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Correspondence to Katsuhiro Sano.

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Sano, K., Ichikawa, T., Motosugi, U. et al. Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis. Eur Radiol 27, 518–525 (2017). https://doi.org/10.1007/s00330-016-4423-2

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  • DOI: https://doi.org/10.1007/s00330-016-4423-2

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