Abstract
The objectives of the study were to assess the imaging features of hypovascular borderline lesions containing hypervascular foci on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and to evaluate the ability of Gd-EOB-DTPA-enhanced MRI to diagnose high-risk borderline lesions possibly consistent with early hepatocellular carcinoma (HCC). Institutional review board approval was obtained for this retrospective analysis of imaging findings, and informed consent was obtained from 217 consecutive patients undergoing Gd-EOB-DTPA-enhanced MRI and angiography-assisted computed tomography (CT) for examination of hepatocellular nodular lesions in cirrhotic livers. There were 73 nodules showing hypervascular foci in borderline lesions identified by angiography-assisted CT. Signal intensity patterns of the nodules were evaluated on hepatobiliary-phase Gd-EOB-DTPA-enhanced T1-weighted MRI obtained 20 minutes after intravenous injection of contrast media. Among 73 high-risk borderline lesions, 59 were hypointense (81%), and 14 were isointense (19%), compared with background liver parenchyma. There were 27 untreated lesions followed by CT and/or MRI. Almost half of these nodules transformed into hypervascular HCC, regardless of signal intensities seen on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI. Although many high-risk borderline HCC lesions are hypointense on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI, some high-risk borderline lesions are isointense and transform at the same rate into hypervascular HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common tumor in the world, and is the third most common cause of cancer-related death, after lung and stomach cancer[1].Based on clinical and histopathological analyses, most HCC develops from chronic liver disease in a multistep process[2,3]
Conclusions: many high-risk borderline HCC lesions are hypointense on hepatobiliary phase Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI), some high-risk borderline lesions are isointense and transform at the same rate into hypervascular HCC
During the period from April 2008 to June 2009, within from 217 consecutive patients undergoing Gd-EOB-DTPA-enhanced MRI and angiography-assisted computed tomography (CT) for examination of hepatocellular nodular lesions in chronic liver disease, a total of 73 nodules demonstrating a hypervascular focus in a borderline lesion were identified by CT during hepatic arteriography (CTHA) and CTAP in 42 patients
Summary
Hepatocellular carcinoma (HCC) is the fifth most common tumor in the world, and is the third most common cause of cancer-related death, after lung and stomach cancer[1].Based on clinical and histopathological analyses, most HCC develops from chronic liver disease in a multistep process[2,3]. The spectrum of hepatocellular nodules ranges from benign regenerative lesions to classic HCC demonstrating vascular invasion and distant metastasis, with intermediate steps including low- and high-grade dysplastic nodules (DNs) and early HCC4. Among these nodules, high-grade DN and early HCC are considered to be the precursors of classic HCC, and show a multistep progression from high-grade DN to early HCC to classic HCC. High-grade DN and early HCC are considered to be the precursors of classic HCC, and show a multistep progression from high-grade DN to early HCC to classic HCC These high-grade DNs and early HCCs are called “borderline lesions” in clinical practice because they are difficult to differentiate by imaging and biopsy, and because of their biologically benign nature. The detection and characterization of early HCC is important because of its much higher potential for progression to classic invasive HCC5
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