Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

Abstract

Purpose To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. Materials and methods This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). Results On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development. Conclusion Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

Qualitative assessment of EOB-GD-DTPA and Gd-BT-DO3A MR contrast studies in HCC patients and colorectal liver metastases

“…Several studies performed in patients with chronic liver disease have evaluated the relationships between Gd-EOB-DTPA enhancement of the liver parenchyma and the Child-Pugh classification, indocyanine green retention rate clearance, and liver fibrosis [31–38]. MRI-based indices using the signal intensity measured 20 min after Gd-EOB-DTPA injection, relative enhancement of the liver, increase rate of the liver-to-muscle ratio, liver-to-muscle ratio and liver-to-spleen ratio have all been proposed for the evaluation of liver function [31–39]. However, MRI signal intensity is not an absolute value and it may depend on different parameters so that the quantitative comparison of signal intensity between the images before and after contrast enhancement may not be correlated in a straightforward manner.…”

“…Another limits of this study in related to the non-evaluation of the role of DWI in the HCC and metastasis assessment [39–42]. DWI has been applied to liver imaging as an excellent tool for detection and characterization of focal liver lesions.…”

Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS)

“…Eighty‐two percent of high‐grade dysplastic nodules and 76% of early HCCs demonstrate HBP hypointensity . Furthermore, in a multivariate analysis HBP hypointensity was an independent predictor of early HCC, adjusting for arterial phase hyperenhancement (APHE), restricted diffusion, and lesion size …”

“…27 Furthermore, in a multivariate analysis HBP hypointensity was an independent predictor of early HCC, adjusting for arterial phase hyperenhancement (APHE), restricted diffusion, and lesion size. 28,29 HBP hypointense nodules without APHE constitute an entity that is unique to HBA MRI. On pathologic assessment, 74% of such nodules are HCCs and 10% are dysplastic nodules.…”

A Recent Short Review in Non-Invasive Magnetic Resonance Imaging on Assessment of HCC Stages: MRI Findings and Pathological Diagnosis

“…The Gd-EOB-DTPA enhancement rate reaches the highest point after 20 min from the injection and stays at the liver for several hours. Thus, the image can take after 20 min [49] .…”