Non-Hypervascular Hypointense Hepatic Nodules during the Hepatobiliary Phase of Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI as a Risk Factor of Intrahepatic Distant Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma

Abstract

Background: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI have been reported to be associated with intrahepatic distant recurrence (IDR) after hepatectomy or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). IDR is categorized into hypervascular transformation of non-hypervascular hypointense hepatic nodules and new intrahepatic recurrence. The aim of this study was to evaluate the relationship between non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI and IDR after RFA, focusing on new intrahepatic recurrence. Methods: Ninety-one consecutive patients with 115 HCCs undergoing pretreatment Gd-EOB-DTPA-enhanced MRI and RFA for treatment of HCC were enrolled. Results: Of the 91 patients who underwent RFA for HCC, 24 had non-hypervascular hypointense hepatic nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrences were observed in 15 and 19 patients with and without non-hypervascular hypointense hepatic nodules, respectively. Of the 15 recurrences in patients with non-hypervascular hypointense hepatic nodules, 10 patients had new intrahepatic recurrences. The cumulative incidence of new intrahepatic recurrence was significantly higher in patients with non-hypervascular hypointense hepatic nodules than in those without non-hypervascular hypointense hepatic nodules (p < 0.0001). Multivariate analysis revealed that the presence of non-hypervascular hypointense hepatic nodules and Child-Pugh score were independent risk factors for new intrahepatic recurrence. Conclusions: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were a useful predictive factor for IDR, particularly for new intrahepatic recurrence, after RFA.

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

“…Previous studies have shown that very early‐ and early‐stage HCC patients with hypovascular hepatic nodules showed significantly higher rates of HCC recurrence, including not only hypervascularization of hypovascular hepatic nodules, but also new intrahepatic recurrence after radiofrequency ablation in relation to enhanced hepatocarcinogenesis of the background liver . In the present study, we expected that enhanced hepatocarcinogenesis of the background liver might be associated with a short TTTR in patients with hypovascular hepatic nodules.…”

“…Previous studies have shown that very early-and earlystage HCC patients with hypovascular hepatic nodules showed significantly higher rates of HCC recurrence, including not only hypervascularization of hypovascular hepatic nodules, but also new intrahepatic recurrence after radiofrequency ablation in relation to enhanced hepatocarcinogenesis of the background liver. 24,27,28 In the present study, we expected that enhanced hepatocarcinogenesis of the background liver might be associated with a short TTTR in patients with hypovascular hepatic nodules. However, no significant differences were observed in the patterns of TACE refractoriness, which included new intrahepatic recurrence with hyper-vascularization of a hypovascular hepatic nodule, an ineffective TACE response, and the appearance of vascular invasion or extrahepatic spread, between patients with and without hypovascular hepatic nodules.…”

“…[18][19][20][21] Recently, the presence of hypovascular hepatic nodules in very early-and early-stage HCC patients has been reported to be a significant risk factor for recurrence and a poor prognosis after curative treatment, such as radiofrequency ablation or hepatectomy. [22][23][24][25][26][27][28] These results suggest that the presence of hypovascular hepatic nodules might indicate a high potential for hepatocarcinogenesis in the background liver. However, the clinical significance of hypovascular hepatic nodules coexisting with intermediate-stage HCC for TACE treatment has not been established.…”

“…Generally, borderline hepatocellular nodules or early HCCs, such as high‐grade dysplastic nodules and well‐differentiated HCCs, appear as hypovascular hepatic nodules on screening with various dynamic imaging modalities, which have been developed to have diagnostic capabilities . Recently, the presence of hypovascular hepatic nodules in very early‐ and early‐stage HCC patients has been reported to be a significant risk factor for recurrence and a poor prognosis after curative treatment, such as radiofrequency ablation or hepatectomy . These results suggest that the presence of hypovascular hepatic nodules might indicate a high potential for hepatocarcinogenesis in the background liver.…”

Risk stratification of hepatocellular carcinoma in patients with chronic liver disease by combining gadolinium‐ethoxybenzyl diethylenetriamine‐pentaacetic acid–enhanced magnetic resonance imaging and magnetic resonance elastography

“…[6][7][8] According to several previous studies, patients with hepatic nonhypervascular hypointense nodules (NHHNs) that are visible during the hepatobiliary phase of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) are at higher risk of developing HCC than patients without such nodules. [9][10][11][12][13][14][15][16] Liver stiffness (LS), as assessed by MRE, and NHHNs are both magnetic resonance-based biomarkers. This study was performed to evaluate the utility of using these biomarkers to stratify the risk of chronic liver disease patients developing HCC compared with that of other biomarkers.…”