Hypervascular transformation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid–enhanced MRI: long-term follow-up in a surveillance cohort

Hyo Jung Park, Tae Young Lee, So Yeon Kim, Min Ju Kim, Amit G. Singal, So Jung Lee, Hyung Jin Won, Jae Ho Byun, Young Suk Lim

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: With the increasing use of gadoxetic acid–enhanced MRI for HCC surveillance, hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) are frequently encountered. We investigated the rate of these nodules with hypervascular transformation, which suggests hepatocarcinogenesis, by using a prospectively collected longitudinal surveillance cohort data. Methods: This study included 382 prospectively enrolled patients at high risk for developing HCC who underwent 1–3 rounds of bi-annual surveillance gadoxetic acid–enhanced MRI. MRI was analyzed to detect HBP hypointense nodules without APHE. Follow-up dynamic CTs and MRIs were evaluated to detect hypervascular transformation of the nodules. Cox proportional hazards regression analyses were used to find predictors for hypervascular transformation. Results: A total of 76 HBP hypointense nodules without APHE were found in 48 patients, giving a prevalence of 12.6% (48/382). The mean nodule size was 10.8 mm, with 43.4% (33/76) being ≥ 10 mm. Over a median follow-up of 78.6 months, 19 nodules (25.0%) showed hypervascular transformation, all of which demonstrated typical imaging features of HCC. On multivariable Cox-regression analysis, size (≥ 10 mm) was the only independent predictor of hypervascular transformation (hazard ratio, 3.31; 95% confidence interval, 1.21–9.05). The cumulative incidence of hypervascular transformation at 12 and 60 months of nodules ≥ 10 mm was 12.3% and 50.4%, respectively, while that of nodules < 10 mm was 2.5% and 13.9%, respectively. Conclusions: About half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC at 5 years of follow-up, indicating the necessity for cautious monitoring with an augmented and extended follow-up schedule for these nodules. Key Points: • The prevalence of HBP hypointense nodules without APHE was 12.6% in a prospectively recruited population at high risk of developing HCC. • Nodule size ≥ 10 mm was significantly associated with hypervascular transformation, and approximately half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC during 5 years of follow-up. • Given the risk of malignant transformation, HBP hypointense nodules ≥ 10 mm without APHE should be closely monitored.

Original languageEnglish (US)
JournalEuropean Radiology
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Gadolinium DTPA
  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Magnetic resonance imaging
  • Surveillance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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