Hypovascular Nodules in Patients with Chronic Liver Disease: Risk Factors for Development of Hypervascular Hepatocellular Carcinoma

Hyodo, Toru; Murakami, Takamichi; Imai, Yumiko; Okada, Masahiro; Hori, Masatoshi; Kagawa, Yuki; Kogita, Sachiyo; Kumano, Seishi; Kudo, Masatoshi; Mochizuki, Takashi

doi:10.1148/radiol.12112677

Cited by 131 publications

(129 citation statements)

References 39 publications

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“…Well-differentiated HCCs tend to be slow growing, whereas moderately and poorly differentiated HCCs are fast growing, although there is overlap in the reported TVDTs of HCCs with varying degrees of differentiation (93,97,98). Imaging features associated with shorter TVDT include APHE (92,(99)(100)(101), presence of "washout" (100,102), T2 hyperintensity (99), and diameter less than 1 cm at baseline (94,103).…”

Section: Review: Li-rads Major Features For Hepatocellular Carcinoma mentioning

confidence: 99%

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.q RSNA, 2017 Online supplemental material is available for this article.An Tang REVIEW: LI-RADS Major Features for Hepatocellular Carcinoma DiagnosisTang et al selection of five major features was based on expert opinion, the literature review was performed to ensure that imaging-based diagnostic criteria were able to achieve near-100% specificity for the noninvasive diagnosis of HCC. This review focused on the evidence supporting the inclusion of imaging features and did not attempt to gather evidence on the composition of the LI-RADS diagnostic algorithm and probability of HCC for different combinations of criteria (other than the hallmark combination of APHE and washout appearance) in the LI-RADS diagnostic table.Each subgroup was charged with developing key research questions and then critically reviewing the literature to answer research questions thematically related to its assigned topic. Search StrategyThe PICO (patient population, intervention, comparison, and outcome) format frequently used in structured reviews does not lend itself well to studies of diagnostic performance. Rather than using PICO-style questions to guide the searches, therefore, the subgroups formulated free-form questions in advance with feedback from the other subgroups. A total of 10 questions were formulated under the framework and with the understanding that their answers would inform recommendations for removing or continuing to include the corresponding LI-RADS features. After the questions were formulated, each subgroup searched the PubMed develop a standardized Liver Imaging Reporting and Data System (LI-RADS) for interpretation, reporting, and data collection of imaging studies in patients at risk for developing HCC (1). The committee was composed mainly of diagnostic radiologists, but also hepatologists, surgeons, patho...

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Section: Review: Li-rads Major Features For Hepatocellular Carcinoma mentioning

confidence: 99%

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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“…Hypointense lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI that show nonhypervascularity on dynamic imaging are commonly encountered, and it is recommended that these lesions be monitored closely due to their potential for malignancy and transitioning to HCC through a multistep progression of hepatocarcinogenesis [21,22,23]. Several studies have reported the outcome of patients with these hypointense lesions [22,23,24,25,26,27,28,29]; however, only a small number of such cases have been reported and all were from a single center. The present investigation was a longitudinal retrospective nationwide study that examined the natural outcome of nonhypervascular lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.…”

Section: Introductionmentioning

confidence: 99%

Hypovascular Hepatic Nodules Showing Hypointense on the Hepatobiliary-Phase Image of Gd-EOB-DTPA-Enhanced MRI to Develop a Hypervascular Hepatocellular Carcinoma: A Nationwide Retrospective Study on Their Natural Course and Risk Factors

Inoue¹,

Hyodo

Murakami

et al. 2013

Dig Dis

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Objective: We aimed to investigate the natural outcome of nonhypervascular lesions detected in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI by performing a longitudinal study retrospectively enrolled in a nationwide manner. Methods: Between February 2008 and March 2011, 224 patients with 504 nodules that were diagnosed as nonhypervascular by imaging were recruited from institutions that participated in the present study. We examined the natural outcome of nonhypervascular lesions and evaluated the risk factors. Results: Of the 504 nodules, 173 (34.3%) showed hypervascular transformation. The overall cumulative incidence of hypervascular transformation was 14.9% at 12 months and 45.8% at 24 months. Multivariate analysis using the Cox regression model revealed previous treatment history for hepatocellular carcinoma (HCC; relative risk = 1.498; p = 0.036, 95% CI 1.03-2.19) and hyperintensity on T2-weighted images (relative risk = 1.724; p = 0.015, 95% CI 1.11-2.67) were identified as independent factors for hypervascular transformation. Conclusions: Patients who have a previous treatment history for HCC and with hypointense nodules showing hyperintensity on T2-weighted images need careful follow-up because of the high incidence of hypervascular transformation.

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“…In patients with chronic liver disease, hypovascular nodules detected on enhanced computed tomography or ethoxybenzyl diethylenetriamine magnetic resonance imaging, most of which are dysplastic nodules or early HCC, have the potential to progress to hypervascular HCC (19,20). Therefore, the American Association for the Study of Liver Disease Practice Guidelines recommends the early detection of HCC followed by appropriate treatment (21).…”

Section: Discussionmentioning

confidence: 99%

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Midorikawa¹,

Takayama²,

Higaki³

et al. 2016

Japanese Journal of Clinical Oncology

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Objective: Early diagnosis and treatment of cancer may contribute substantially to complete cure, but it remains unknown whether treatment of early hepatocellular carcinoma can actually result in cure. This study was performed to clarify the cancer risk of the background liver after treating early hepatocellular carcinoma. Methods: Early hepatocellular carcinoma is defined as very well-differentiated cancer containing Glisson's triad. The cumulative incidence of classical hepatocellular carcinoma, hypervascular liver cancer detected on imaging studies, after resection of early hepatocellular carcinoma positive for anti-hepatitis C antibody (early hepatocellular carcinoma group, n = 105) was compared with that in patients with chronic liver disease positive for anti-hepatitis C antibody (control group, n = 751) and propensity score-matched patients after resection of classical hepatocellular carcinoma (classical hepatocellular carcinoma group, n = 105). Results: After a median follow-up of 4.8 years (range, 0.3-15.0), the cumulative incidence of classical hepatocellular carcinoma at 5 years was 56.9% (95% confidence interval, 44.2-67.7%) in the early hepatocellular carcinoma group and 70.6% (52.5-81.8%) in the classical hepatocellular carcinoma group as compared with 4.6% (2.8-6.4%) in the control group. The risk of the development of classical hepatocellular carcinoma in the early hepatocellular carcinoma group was significantly higher than that in the control group (hazard ratio, 17.5; 95% confidence interval, 12.1-25.3; P < 0.001) and significantly lower than that in the classical hepatocellular carcinoma group (hazard ratio, 0.60; 0.41-0.89; P = 0.010). However, the cumulative incidence of second primary hepatocellular carcinoma in patients with one early hepatocellular carcinoma did not differ significantly from that in patients with two or more early hepatocellular carcinoma lesions (hazard ratio, 1.50; 0.85-2.65; P = 0.157). Conclusions: Treatment of early hepatocellular carcinoma cannot provide complete cure due to the substantial risk of developing classical hepatocellular carcinoma.

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Hypovascular Nodules in Patients with Chronic Liver Disease: Risk Factors for Development of Hypervascular Hepatocellular Carcinoma

Cited by 131 publications

References 39 publications

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Hypovascular Hepatic Nodules Showing Hypointense on the Hepatobiliary-Phase Image of Gd-EOB-DTPA-Enhanced MRI to Develop a Hypervascular Hepatocellular Carcinoma: A Nationwide Retrospective Study on Their Natural Course and Risk Factors

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

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