The emergence of non‐hypervascular hypointense nodules on Gd‐EOB‐DTPA‐enhanced MRI in patients with chronic hepatitis C

Abstract

Summary Background Intrahepatic non‐hypervascular hypointense nodules (NHHNs) detected during the hepatobiliary phase of gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid‐enhanced magnetic resonance imaging (EOB‐MRI) have the potential to transition into typical hypervascular hepatocellular carcinoma (HCC). However, the incidence and risk factors for the emergence of these nodules in patients with chronic hepatitis C virus (HCV) infection are unknown. Aim To investigate the incidence and risk factors for NHHNs in patients with chronic HCV infection in a longitudinal follow‐up study Methods EOB‐MRI was performed in 608 patients with chronic HCV infection and no history of HCC. The characteristics of patients with and without NHHNs were compared. In patients without NHHNs at baseline, the incidence of NHHN emergence and associated risk factors were analysed. Results NHHNs were detected at baseline in 93 of 608 patients (15.3%). Among 515 patients without NHHNs at baseline, the 1‐year, 3‐year and 5‐year incidence of NHHN emergence was 1.8%, 9.8% and 16.4%, respectively. Only FIB‐4 index was independently associated with the emergence of NHHNs in multivariate analyses. Whereas NHHNs emerged in 24.1% of patients with FIB‐4 index ≥ 3.25 at 5 years, none emerged in patients with FIB‐4 index < 1.45. Conclusion In patients with chronic HCV infection, advanced liver fibrosis is an important risk factor for the presence or emergence of NHHNs.

Editorial: the emergence of non‐hypervascular hypointense nodules in Gd‐EOB‐DTPA‐enhanced MRI in patients with chronic hepatitis C. Authors' reply

“…We appreciate the comments by Dr Crane et al on our study . We agree that the majority of the patients in our study were at high risk for hepatocellular carcinoma (HCC) . However, one important finding of this study was that no non‐hypervascular hypointense nodules (NHHNs) emerged in patients with low FIB‐4 index (<1.45).…”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article …”

Editorial: the emergence of non‐hypervascular hypointense nodules on Gd‐EOB‐DTPA‐enhanced MRI in patients with chronic hepatitis C

“…The most recent study by Toyoda et al reports on the emergence of NHHN in 515 patients with HCV infection and without baseline NHHNs. NHHNs emerged over 5 years in 24% of patients with advanced fibrosis/cirrhosis (Fib‐4 ≥ 3.25), and in 7.2% of those with some fibrosis (Fib‐4 1.45‐3.23), but did not occur in those without fibrosis (Fib‐4 ≤ 1.45) . No other baseline factor was independently associated with the emergence of NHHNs.…”

Editorial: impact of the introduction of direct‐acting anti‐viral drugs on hepatocarcinogenesis—a prospective serial follow‐up MRI study

“…This result indicates that NHHNs may be precancerous lesions. Furthermore, the authors’ group recently showed that a high FIB‐4 index was the only independent risk factor associated with the occurrence of NHHNs in HCV patients 7 . Therefore, SVR by DAAs may be related to improved prognosis in patients with NHHNs since it reduces the incidence of hypervascularity, especially in those with advanced liver fibrosis.…”