Hypovascular hypointense nodules on hepatobiliary phase without T2 hyperintensity on gadoxetic acid-enhanced MR images in patients with chronic liver disease: long-term outcomes and risk factors for hypervascular transformation

• DOI: 10.1007/s00330-015-4146-9
• Publication Date: 2015-12-15T14:10:05Z
• Authors: Yong Seek Kim; Ji Soo Song; Hyun Kyung Lee; Young Min Han
• Keywords: Adult; Gadolinium DTPA; Male; Carcinoma, Hepatocellular; Neovascularization, Pathologic; Biopsy; Liver Neoplasms; Contrast Media; Middle Aged; Prognosis; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Disease Progression; Humans; Female; Precancerous Conditions; Aged; Proportional Hazards Models; Retrospective Studies

To evaluate the long-term outcomes and imaging features associated with hypervascularization of hypovascular nodules that show T2 iso-/hypointensity and hypointensity on hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) images in patients with chronic liver disease.Sixty patients and 114 nodules, which were hypovascular and iso-/hypointense on T2-weighted images and hypointense on HBP of gadoxetic acid-enhanced MRI, were included. We evaluated the effect of baseline clinical features, baseline MR features and growth rate on subsequent hypervascularization.Twenty-seven nodules in 21 patients transformed to hypervascular hepatocellular carcinoma (HCC). Using multivariate Cox analysis, T1 hyperintensity (hazard ratio [HR] = 2.69, P = 0.021), previous history of HCC (HR = 2.64, P = 0.021), and initial nodule size (HR = 1.09, P = 0.046) were identified to be associated with hypervascularization. The growth rate of nodules was a more powerful determinant of subsequent hypervascularization than baseline clinical and MR features. At long-term follow-up after >3 years, only one nodule with T1 isointensity showed hypervascularization.Careful follow-up or diagnostic procedures, such as biopsy, should be considered for up to 3 years after detection of hypointense nodules on HBP with T1 hyperintensity or a higher growth rate.• T1 hyperintensity is a baseline MR predictive factor for subsequent hypervascularization. • A higher growth rate is a more powerful determinant of subsequent hypervascularization. • Management of patients with these predictive factors requires more attention.