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Management of subcentimetre arterially enhancing and hepatobiliary hypointense lesions on gadoxetic acid-enhanced MRI in patients at risk for HCC

 Chae Jung Park  ;  Chansik An  ;  Sumi Park  ;  Jin-Young Choi  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.28(4) : 1476-1484, 2018 
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Diagnosis ; Gadoxetic acid ; Hepatocellular carcinoma ; Magnetic resonance imaging ; Sensitivity and specificity
OBJECTIVES: To investigate the significance of subcentimetre (</=1 cm) arterially enhancing and hepatobiliary hypointense lesions (SAELs) observed on gadoxetic acid-enhanced magnetic resonance imaging (MRI) of patients at risk of hepatocellular carcinoma (HCC). METHODS: A SAEL was defined as a subcentimetre hypervascular nodule exhibiting a hepatobiliary phase defect on gadoxetic acid-enhanced MRI. We included 52 SAELs from 46 patients in a HCC surveillance population. The HCC reference standard was pathologic confirmation or a nodule >1 cm with typical imaging features of HCC at follow-up imaging. The malignancy rate and HCC-favourable imaging findings of SAELs were evaluated. RESULTS: The malignancy rate among SAELs was 57.7% (30/52). At diagnosis, all SAELs that progressed to overt HCC were treatable with curative intention. Venous or late dynamic phase washout was more frequently observed with malignant SAELs than with benign SAELs (57.7% vs. 30.6%; P = 0.01). If SAELs exhibiting washout were considered as HCC, sensitivity, specificity, and positive predictive value was 83.3%, 50%, and 69.4%, respectively. CONCLUSION: Among patients at risk of HCC, SAELs on gadoxetic acid-enhanced MRI exhibited high malignant potential. However, close observation may be an appropriate strategy for isolated SAELs. A washout appearance may be helpful for predicting malignancy. KEY POINTS: * Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images. * Screening frequently detects subcentimetre arterially enhancing and hepatobiliary hypointense lesions (SAELs). * A majority of SAELs progressed to overt HCC within 2 years. * A venous-phase washout appearance correlated significantly with malignancy in SAELs.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Park, Chae Jung(박채정) ORCID logo https://orcid.org/0000-0002-5567-8658
An, Chansik(안찬식) ORCID logo https://orcid.org/0000-0002-0484-6658
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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