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Management of subcentimetre arterially enhancing and hepatobiliary hypointense lesions on gadoxetic acid-enhanced MRI in patients at risk for HCC

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To investigate the significance of subcentimetre (≤1 cm) arterially enhancing and hepatobiliary hypointense lesions (SAELs) observed on gadoxetic acid-enhanced magnetic resonance imaging (MRI) of patients at risk of hepatocellular carcinoma (HCC).

Methods

A SAEL was defined as a subcentimetre hypervascular nodule exhibiting a hepatobiliary phase defect on gadoxetic acid-enhanced MRI. We included 52 SAELs from 46 patients in a HCC surveillance population. The HCC reference standard was pathologic confirmation or a nodule >1 cm with typical imaging features of HCC at follow-up imaging. The malignancy rate and HCC-favourable imaging findings of SAELs were evaluated.

Results

The malignancy rate among SAELs was 57.7% (30/52). At diagnosis, all SAELs that progressed to overt HCC were treatable with curative intention. Venous or late dynamic phase washout was more frequently observed with malignant SAELs than with benign SAELs (57.7% vs. 30.6%; P = 0.01). If SAELs exhibiting washout were considered as HCC, sensitivity, specificity, and positive predictive value was 83.3%, 50%, and 69.4%, respectively.

Conclusion

Among patients at risk of HCC, SAELs on gadoxetic acid-enhanced MRI exhibited high malignant potential. However, close observation may be an appropriate strategy for isolated SAELs. A washout appearance may be helpful for predicting malignancy.

Key Points

• Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images.

• Screening frequently detects subcentimetre arterially enhancing and hepatobiliary hypointense lesions (SAELs).

• A majority of SAELs progressed to overt HCC within 2 years.

• A venous-phase washout appearance correlated significantly with malignancy in SAELs.

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Abbreviations

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

HBP:

Hepatobiliary phase

SAEL:

Subcentimetre arterially enhancing and hepatobiliary hypointense lesion

TACE:

Transarterial chemoembolisation

AFP:

Alpha-fetoprotein

T2WI:

T2-weighted image

DWI:

Diffusion-weighted image

LI-RADS:

Liver Imaging Reporting and Data System

LCSGJ:

Liver Cancer Study Group of Japan

KLCSG-NCC:

Korean Liver Cancer Study Group and the National Cancer Center

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, South Korea

    Chae Jung Park, Chansik An, Jin-Young Choi & Myeong-Jin Kim

  2. Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

    Sumi Park

Authors
  1. Chae Jung Park
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  2. Chansik An
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  3. Sumi Park
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Correspondence to Myeong-Jin Kim.

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The scientific guarantor of this publication is Myeong-Jin Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Park, C.J., An, C., Park, S. et al. Management of subcentimetre arterially enhancing and hepatobiliary hypointense lesions on gadoxetic acid-enhanced MRI in patients at risk for HCC. Eur Radiol 28, 1476–1484 (2018). https://doi.org/10.1007/s00330-017-5088-1

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  • DOI: https://doi.org/10.1007/s00330-017-5088-1

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