Hepatology International

, Volume 9, Issue 1, pp 84–92 | Cite as

Non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI as a predictor of outcomes for early-stage HCC

  • Hidenori Toyoda
  • Takashi Kumada
  • Toshifumi Tada
  • Yasuhiro Sone
  • Atsuyuki Maeda
  • Yuji Kaneoka
Original Article



In patients with hepatocellular carcinoma (HCC), gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) often identifies non-hypervascular hypointense hepatic nodules during the hepatobiliary phase, but their prognostic significance is unclear. We conducted a prospective observational study to investigate the impact of non-hypervascular hypointense hepatic nodules detected by Gd-EOB-DTPA-enhanced MRI on the outcome of patients with early-stage HCC.


Post-treatment recurrence and survival rates were analyzed in 138 patients with non-recurrent, early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0 or A] and Child-Pugh A liver function according to the presence of non-hypervascular hypointense nodules on pretreatment Gd-EOB-DTPA-enhanced MRI.


Non-hypervascular hypointense hepatic nodules were detected in 51 (37.0 %) patients with early-stage HCC on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrence rates were significantly higher in patients with non-hypervascular hypointense nodules (p < 0.0001). Based on a multivariate analysis, the presence of non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI was independently associated with an increased recurrence rate, independent of tumor progression or treatment (p = 0.0005). The survival rate was significantly lower in patients with non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI (p = 0.0108).


In patients with early-stage typical HCC (BCLC 0 or A), the presence of concurrent non-hypervascular hypointense hepatic nodules in the hepatobiliary phase of pretreatment Gd-EOB-DTPA-enhanced MRI is an indicator of higher likelihood of recurrence after treatment and may be a marker for unfavorable outcome.


Hepatocellular carcinoma Early stage Gd-EOB-DTPA-enhanced MRI Non-hypervascular hypointense nodules Recurrence Survival 



Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid


Magnetic resonance imaging


Hepatocellular carcinoma




Multidetector-row computed tomography


Barcelona Clinic Liver Cancer


American Association for the Study of Liver Diseases


Radiofrequency ablation




Lens culinaris agglutinin-reactive alpha-fetoprotein


Des-gamma-carboxy prothrombin


CT during hepatic arteriography


Transarterial chemoembolization


Alanine amonotransferase activity

Supplementary material

12072_2014_9553_MOESM1_ESM.pdf (42 kb)
Supplementary material 1 (PDF 42 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2014

Authors and Affiliations

  • Hidenori Toyoda
    • 1
  • Takashi Kumada
    • 1
  • Toshifumi Tada
    • 1
  • Yasuhiro Sone
    • 2
  • Atsuyuki Maeda
    • 3
  • Yuji Kaneoka
    • 3
  1. 1.Department of GastroenterologyOgaki Municipal HospitalOgakiJapan
  2. 2.Department of RadiologyOgaki Municipal HospitalOgakiJapan
  3. 3.Department of SurgeryOgaki Municipal HospitalOgakiJapan

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