Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Abstract

Background & Aims: Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient’s prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence.Method: Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study.Results: All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a “classical” enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria.Conclusions: Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.Abbreviations. ADC: Apparent diffusion coefficient; CT: Computed tomography; DEB-TACE: drug-eluting beads transarterial chemoembolization; DWI: Diffusion-weighted imaging; Gd-EOB-DTPA: acidum gadoxeticum; HCC: hepatocellular carcinoma; HBV: hepatitis virus B; HCV: hepatitis virus C; HDV: hepatitis virus D; IN-OPP: in-phase and out-of-phase; mRECIST: modified Response Evaluation Criteria in Solid Tumors; MRI: Magnetic resonance imaging; ROI: region of interest; TACE: Transarterial chemoembolization; WI: weighted imaging.

Emerging Applications of Some Important Natural Compounds in the Field of Oncology

“…Moreover, when associated, genistein can increase the apoptosis-inducing efficacy of photodynamic therapy on thyroid cancer cells, inhibiting proliferation and increasing reactive oxygen species (ROS) levels [2]. Hepatocellular carcinoma Hepatocellular carcinoma (HCC) is one of the most lethal cancers, with common recurrences after treatment, and relatively difficult to diagnose at small sizes or in particular subtypes [13,47]. HCC commonly develops on liver cirrhosis, this disorder adding further complications such as variceal bleeding, ascites, cardiomyopathy, and hepatic encephalopathy [62,70].…”

The Role of Matrix Metalloproteinases in the Epithelial-Mesenchymal Transition of Hepatocellular Carcinoma

“…With a mortality of 9.1% worldwide, HCC is the fifth most common cancer and is considered a significant global health burden, by itself and through its potential unnoticeable or overt complications [2–4]. With recent progress, diagnosis hindrances of rare or atypical forms of HCC have been surmounted, and novel therapies appear promising in complementing the available resources for managing this disease [5–7]. However, a better understanding of the underlying pathological mechanisms in the development of HCC may uncover more efficient ways to limit tumor growth and dissemination.…”

Hyperintense nodule-in-nodule on hepatobiliary phase arising within hypovascular hypointense nodule: Outcome and rate of hypervascular transformation

“…A recent study performed by Kang et al [35] showed a low tumor recurrence rate during long term follow-up after RFA treatment of inner nodules. Conversely, Scheau et al [36] reported 9 patients with nodule-in-nodule architecture, all with progressive disease on MRI follow-up examination performed one month after TACE. In our population we had two patients with a second nodule-in-nodule architecture appearing as hyperintense on HBP 258 and 459 days after treatment (RFA or TACE, respectively).…”