Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features

  • Kazuto KozakaEmail author
  • Satoshi Kobayashi
  • Norihide Yoneda
  • Azusa Kitao
  • Kotaro Yoshida
  • Dai Inoue
  • Takahiro Ogi
  • Wataru Koda
  • Yasunori Sato
  • Toshifumi Gabata
  • Osamu Matsui



To determine the imaging and clinicopathological features of MRI doughnut-like nodules (HBP-doughnut nodules), hyperintense at the hepatobiliary phase (HBP) after injection of gadoxetic acid (EOB) and without arterial-phase hyperenhancement (APHE) in cirrhotic liver.


The Institutional Review Board approved this retrospective study and informed consent was waived. We enrolled 309 consecutive patients with liver cirrhosis who were examined by EOB-MRI, dynamic CT, and angiography-assisted CT between 2008 and 2012 and searched for HBP-doughnut nodules. We evaluated imaging characteristics including haemodynamics and signal intensity of MRI, pathological findings, and frequency of malignant transformation.


One hundred and one HBP-doughnut nodules without APHE were identified in 18 patients (6%), including seven of 59 (12%) patients with hepatitis-B-virus-related, nine of 230 (3.9%) with hepatitis-C-virus-related, and two of 33 (6.1%) with alcoholic cirrhosis. All nodules showed enhancement peaks in the portal phase, the same or increased intranodular portal supply on CT during arterial portography, and the same or decreased intranodular arterial supply on CT during hepatic arteriography. On T2-weighted and diffusion-weighted images, 37 (36%) and 24 (24%) nodules, respectively, showed hyperintensity predominantly in the central area. Three nodules were diagnosed by fine needle biopsy as non-neoplastic hepatic nodules. Ninety-three of 101 (92%) nodules in 16 patients were followed up during an observation period of 1163 ± 902 days (range 57–2920 days), and none showed malignant transformation.


HBP-doughnut nodules without APHE in cirrhotic liver were not infrequent. None became malignant. We propose calling them ‘multiacinar cirrhotic nodules’ based on the classification by an International Working Party.

Key Points

• HBP-doughnut nodules without APHE were seen in 6% of patients with liver cirrhosis.

• The enhancement peak of HBP-doughnut nodules without APHE was in the portal phase, which reflected the fact that they were supplied predominantly by the portal vein, based on angiography-assisted CT findings.

• None of the HBP-doughnut nodules without APHE in cirrhotic liver became malignant, and in conjunction with limited pathological features, they may be corresponding to multiacinar cirrhotic nodules in the International Working Party classification.


Diagnosis Magnetic resonance imaging Gadolinium Multidetector computed tomography 



Arterial-phase hyperenhancement


CT during arterial portography


CT during hepatic arteriography


Diffusion-weighted images


Gadoxetic acid


Focal nodular hyperplasia


Hepatobiliary phase


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


Idiopathic portal hypertension


Large regenerative nodule


Nodular regenerative hyperplasia


Organic anion transporter polypeptide


Regenerative nodule


T1-weighted images


T2-weighted images



We thank Cathel Kerr, Ph.D., and Libby Cone, M.D., M.A., from Edanz Group ( for editing drafts of this manuscript.


This study has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Toshifumi Gabata, M.D., Ph.D.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Approval was obtained from the Institutional Review Board of Kanazawa University Graduate School of Medical Sciences, Japan.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6329_MOESM1_ESM.docx (86 kb)
ESM 1 (DOCX 86 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Kazuto Kozaka
    • 1
    Email author
  • Satoshi Kobayashi
    • 2
  • Norihide Yoneda
    • 1
  • Azusa Kitao
    • 1
  • Kotaro Yoshida
    • 1
  • Dai Inoue
    • 1
  • Takahiro Ogi
    • 1
  • Wataru Koda
    • 1
  • Yasunori Sato
    • 3
  • Toshifumi Gabata
    • 1
  • Osamu Matsui
    • 1
  1. 1.Department of RadiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
  2. 2.Department of Radiological Technology, School of Health Sciences, College of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
  3. 3.Department of Human PathologyKanazawa University Graduate School of Medical SciencesKanazawaJapan

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