Serial MR imaging of small arterially-enhancing liver lesions in patients with chronic liver disease

Pornpim Korpraphong, John R. Leyendecker, Charles F. Hildebolt, Vamsri Narra, Klongtae Ty Bae, Jeffrey J. Brown

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the significance of small arterially-enhancing liver lesions seen with magnetic resonance imaging (MRI) in patients with chronic liver disease. Material and Method: Our institutional review board approved this retrospective study, without requiring informed consent. Over a two-year period, 258 consecutive patients with cirrhosis or chronic hepatitis underwent multiphase three-dimensional, gadolinium-enhanced, breath-hold gradient-echo MRI. From this group, 29 patients underwent at least one follow-up MR study. When a small (≤ 20 mm) arterially-enhancing lesion was detected, the maximum diameter, shape, signal intensities (T1-weighted and T2-weighted), and pattern of enhancement were evaluated to assess the associations between the imaging appearance on initial MR exam and subsequent behavior on follow-up imaging. Statistical testing was performed with JMP Statistical Software (SAS, Inc., Cary, NC) and StatXact 7 Statistical Software for Exact Nonparmetric Inference (Cytel, Inc. Cambride, MA). Results: Sixty-five small (≤ 20 mm) arterially-enhancing lesions were detected in 29 patients. Ten of 65 lesions (15%) in nine patients were subsequently proven to represent hepatocellular carcinoma (HCC), while the remaining lesions either disappeared (46) or remained stable in size (9). Of the 10 lesions subsequently proven to represent HCC, eight lesions converted from hypo- or isointense to hyperintense on subsequent T2-weighted MRI (p < 0.001), seven lesions converted from hyper- or isointense to hypointense on subsequent T1-weighted images (p < 0.001), seven lesions demonstrated growth on subsequent MRI exam (mean increase in mean diameter = 1.4 cm), and five lesions subsequently developed rim enhancement that was not initially present. Conclusion: Small, arterially-enhancing lesions detected with MRI have a low likelihood of representing HCC, and MRI follow-up of such lesions is a reasonable approach. Lesions that increase in size, convert to hypointense on subsequent T1W images, convert to hyperintense in T2W images, or develop rim enhancement on follow-up MRI images are concerning and should prompt consideration of intervention.

Original languageEnglish (US)
Pages (from-to)548-555
Number of pages8
JournalJournal of the Medical Association of Thailand
Volume92
Issue number4
StatePublished - Apr 1 2009

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Liver Diseases
Chronic Disease
Magnetic Resonance Imaging
Liver
Hepatocellular Carcinoma
Software
Research Ethics Committees
Gadolinium
Chronic Hepatitis
Informed Consent
Fibrosis
Retrospective Studies
Growth

Keywords

  • Carcinoma
  • Chronic disease
  • Hepatocellular
  • Liver diseases
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Serial MR imaging of small arterially-enhancing liver lesions in patients with chronic liver disease. / Korpraphong, Pornpim; Leyendecker, John R.; Hildebolt, Charles F.; Narra, Vamsri; Bae, Klongtae Ty; Brown, Jeffrey J.

In: Journal of the Medical Association of Thailand, Vol. 92, No. 4, 01.04.2009, p. 548-555.

Research output: Contribution to journalArticle

Korpraphong, Pornpim ; Leyendecker, John R. ; Hildebolt, Charles F. ; Narra, Vamsri ; Bae, Klongtae Ty ; Brown, Jeffrey J. / Serial MR imaging of small arterially-enhancing liver lesions in patients with chronic liver disease. In: Journal of the Medical Association of Thailand. 2009 ; Vol. 92, No. 4. pp. 548-555.
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abstract = "Objective: To determine the significance of small arterially-enhancing liver lesions seen with magnetic resonance imaging (MRI) in patients with chronic liver disease. Material and Method: Our institutional review board approved this retrospective study, without requiring informed consent. Over a two-year period, 258 consecutive patients with cirrhosis or chronic hepatitis underwent multiphase three-dimensional, gadolinium-enhanced, breath-hold gradient-echo MRI. From this group, 29 patients underwent at least one follow-up MR study. When a small (≤ 20 mm) arterially-enhancing lesion was detected, the maximum diameter, shape, signal intensities (T1-weighted and T2-weighted), and pattern of enhancement were evaluated to assess the associations between the imaging appearance on initial MR exam and subsequent behavior on follow-up imaging. Statistical testing was performed with JMP Statistical Software (SAS, Inc., Cary, NC) and StatXact 7 Statistical Software for Exact Nonparmetric Inference (Cytel, Inc. Cambride, MA). Results: Sixty-five small (≤ 20 mm) arterially-enhancing lesions were detected in 29 patients. Ten of 65 lesions (15{\%}) in nine patients were subsequently proven to represent hepatocellular carcinoma (HCC), while the remaining lesions either disappeared (46) or remained stable in size (9). Of the 10 lesions subsequently proven to represent HCC, eight lesions converted from hypo- or isointense to hyperintense on subsequent T2-weighted MRI (p < 0.001), seven lesions converted from hyper- or isointense to hypointense on subsequent T1-weighted images (p < 0.001), seven lesions demonstrated growth on subsequent MRI exam (mean increase in mean diameter = 1.4 cm), and five lesions subsequently developed rim enhancement that was not initially present. Conclusion: Small, arterially-enhancing lesions detected with MRI have a low likelihood of representing HCC, and MRI follow-up of such lesions is a reasonable approach. Lesions that increase in size, convert to hypointense on subsequent T1W images, convert to hyperintense in T2W images, or develop rim enhancement on follow-up MRI images are concerning and should prompt consideration of intervention.",
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AU - Korpraphong, Pornpim

AU - Leyendecker, John R.

AU - Hildebolt, Charles F.

AU - Narra, Vamsri

AU - Bae, Klongtae Ty

AU - Brown, Jeffrey J.

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N2 - Objective: To determine the significance of small arterially-enhancing liver lesions seen with magnetic resonance imaging (MRI) in patients with chronic liver disease. Material and Method: Our institutional review board approved this retrospective study, without requiring informed consent. Over a two-year period, 258 consecutive patients with cirrhosis or chronic hepatitis underwent multiphase three-dimensional, gadolinium-enhanced, breath-hold gradient-echo MRI. From this group, 29 patients underwent at least one follow-up MR study. When a small (≤ 20 mm) arterially-enhancing lesion was detected, the maximum diameter, shape, signal intensities (T1-weighted and T2-weighted), and pattern of enhancement were evaluated to assess the associations between the imaging appearance on initial MR exam and subsequent behavior on follow-up imaging. Statistical testing was performed with JMP Statistical Software (SAS, Inc., Cary, NC) and StatXact 7 Statistical Software for Exact Nonparmetric Inference (Cytel, Inc. Cambride, MA). Results: Sixty-five small (≤ 20 mm) arterially-enhancing lesions were detected in 29 patients. Ten of 65 lesions (15%) in nine patients were subsequently proven to represent hepatocellular carcinoma (HCC), while the remaining lesions either disappeared (46) or remained stable in size (9). Of the 10 lesions subsequently proven to represent HCC, eight lesions converted from hypo- or isointense to hyperintense on subsequent T2-weighted MRI (p < 0.001), seven lesions converted from hyper- or isointense to hypointense on subsequent T1-weighted images (p < 0.001), seven lesions demonstrated growth on subsequent MRI exam (mean increase in mean diameter = 1.4 cm), and five lesions subsequently developed rim enhancement that was not initially present. Conclusion: Small, arterially-enhancing lesions detected with MRI have a low likelihood of representing HCC, and MRI follow-up of such lesions is a reasonable approach. Lesions that increase in size, convert to hypointense on subsequent T1W images, convert to hyperintense in T2W images, or develop rim enhancement on follow-up MRI images are concerning and should prompt consideration of intervention.

AB - Objective: To determine the significance of small arterially-enhancing liver lesions seen with magnetic resonance imaging (MRI) in patients with chronic liver disease. Material and Method: Our institutional review board approved this retrospective study, without requiring informed consent. Over a two-year period, 258 consecutive patients with cirrhosis or chronic hepatitis underwent multiphase three-dimensional, gadolinium-enhanced, breath-hold gradient-echo MRI. From this group, 29 patients underwent at least one follow-up MR study. When a small (≤ 20 mm) arterially-enhancing lesion was detected, the maximum diameter, shape, signal intensities (T1-weighted and T2-weighted), and pattern of enhancement were evaluated to assess the associations between the imaging appearance on initial MR exam and subsequent behavior on follow-up imaging. Statistical testing was performed with JMP Statistical Software (SAS, Inc., Cary, NC) and StatXact 7 Statistical Software for Exact Nonparmetric Inference (Cytel, Inc. Cambride, MA). Results: Sixty-five small (≤ 20 mm) arterially-enhancing lesions were detected in 29 patients. Ten of 65 lesions (15%) in nine patients were subsequently proven to represent hepatocellular carcinoma (HCC), while the remaining lesions either disappeared (46) or remained stable in size (9). Of the 10 lesions subsequently proven to represent HCC, eight lesions converted from hypo- or isointense to hyperintense on subsequent T2-weighted MRI (p < 0.001), seven lesions converted from hyper- or isointense to hypointense on subsequent T1-weighted images (p < 0.001), seven lesions demonstrated growth on subsequent MRI exam (mean increase in mean diameter = 1.4 cm), and five lesions subsequently developed rim enhancement that was not initially present. Conclusion: Small, arterially-enhancing lesions detected with MRI have a low likelihood of representing HCC, and MRI follow-up of such lesions is a reasonable approach. Lesions that increase in size, convert to hypointense on subsequent T1W images, convert to hyperintense in T2W images, or develop rim enhancement on follow-up MRI images are concerning and should prompt consideration of intervention.

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