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Kupffer phase image of Sonazoid-enhanced US is useful in predicting a hypervascularization of non-hypervascular hypointense hepatic lesions detected on Gd-EOB-DTPA-enhanced MRI: a multicenter retrospective study

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

It remains unknown whether Kupffer-phase images in Sonazoid-enhanced ultrasonography (US) can be used to predict hypervascularization of borderline lesions. Therefore, we aimed to clarify whether Kupffer-phase images in Sonazoid-enhanced ultrasonography can predict subsequent hypervascularization in hypovascular borderline lesions detected on hepatobiliary-phase gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging.

Methods

From January 2008 to March 2012, 616 low-intensity hypovascular nodules were detected in hepatobiliary-phase images of Gd-EOB-DTPA-enhanced MRI at nine institutions. Among these, 167 nodules, which were confirmed as hypovascular by Gd-EOB-DTPA-enhanced MRI and Sonazoid-enhanced US, were evaluated in this study. Potential hypervascularization factors were selected based on their clinical significance and the results of previous reports. The Kaplan–Meier model and log-rank test were used for univariate analysis and the Cox regression model was used for multivariate analysis.

Results

The cumulative incidence of hypervascularization of borderline lesions was 18, 37, and 43 % at 1, 2, and 3 years, respectively. Univariate analyses showed that tumor size (p = 0.0012) and hypoperfusion on Kupffer-phase images in Sonazoid-enhanced US (p = 0.004) were associated with hypervascularization of the tumor. Multivariate analysis showed that tumor size [HR: 1.086, 95 % confidence interval = 1.027−1.148, p = 0.004] and hypo perfusion on Kupffer-phase images [HR: 3.684, 95 % confidence interval = 1.798−7.546, p = 0.0004] were significantly different.

Conclusions

Kupffer-phase images in Sonazoid-enhanced US and tumor diameter can predict hypervascularization of hypointense borderline lesions detected on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI.

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Abbreviations

HCC:

Hepatocellular carcinoma

US:

Ultrasonography

CT:

Dynamic computed tomography

MRI:

Magnetic resonance imaging

DNs:

Dysplastic nodules

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid

T2WI:

T2-weigthed images

CTHA:

CT during hepatic arteriography

HRs:

Hazard ratios

CIs:

Confidence intervals

CTAP:

CT during arterial portography

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan

    Tatsuo Inoue & Masatoshi Kudo

  2. Department of Diagnostic Radiology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan

    Tomoko Hyodo & Takamichi Murakami

  3. Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan

    Keiko Korenaga & Atsushi Higaki

  4. Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan

    Keiko Korenaga

  5. Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan

    Yasuharu Imai

  6. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Takeshi Suda

  7. Division of Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Toru Takano

  8. Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan

    Kennichi Miyoshi & Masahiko Koda

  9. Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Japan

    Hironori Tanaka & Hiroko Iijima

  10. Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

    Hironori Tanaka

  11. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan

    Hironori Ochi & Masashi Hirooka

  12. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Kazushi Numata

Authors
  1. Tatsuo Inoue
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  2. Tomoko Hyodo
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  13. Hironori Ochi
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  15. Kazushi Numata
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  16. Masatoshi Kudo
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Correspondence to Tatsuo Inoue.

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Inoue, T., Hyodo, T., Korenaga, K. et al. Kupffer phase image of Sonazoid-enhanced US is useful in predicting a hypervascularization of non-hypervascular hypointense hepatic lesions detected on Gd-EOB-DTPA-enhanced MRI: a multicenter retrospective study. J Gastroenterol 51, 144–152 (2016). https://doi.org/10.1007/s00535-015-1094-8

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  • DOI: https://doi.org/10.1007/s00535-015-1094-8

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