Hepatobiliary Phase Hypointense Nodules Research Articles

Hepatobiliary-Phase Hypointense Nodules Without Arterial-Phase Hyperenhancement: Developing a Risk Stratification for Hypervascular Transformation Based on a Real-World Observational Cohort Study.

To develop a risk stratification based on MRI features to predict hypervascular transformation for hepatobiliary-phase (HBP) hypointense nodules without arterial-phase hyperenhancement (APHE). This retrospective observational cohort study included 55 HBP hypointense nodules without APHE in 35 patients with chronic liver disease, cirrhosis, or current hepatocellular carcinoma (HCC) who underwent gadoxetic acid-enhanced MRI. The hypervascular transformation during the follow-up MRI(s) was the primary endpoint analyzed for the nodules. Univariable and multivariable Cox proportional hazard regression analyses were performed to identify risk features predicting transformation and assess their predictive value. Among the 55 nodules, 27 developed hypervascular transformation, while 28 did not. Diffusion-weighted imaging (DWI) hyperintensity (hazard ratio [HR], 4.98; 95% confidence interval [CI]: 1.60, 15.54; p = 0.006) and portal venous phase (PVP) hypointensity (HR, 4.08; 95% CI: 1.43, 11.64; p = 0.009) were associated with hypervascular transformation. DWI hyperintensity and PVP hypointensity had 44.4% (95% CI: 26.0%, 64.4%) and 81.9% (95% CI: 61.3%, 93.0%) sensitivity, while their specificity was 78.2% (95% CI: 64.6%, 87.8%) and 67.9 (95% CI: 47.6%, 83.4%), respectively. The specificity of the combination of two features was 100% (95% CI: 85.0%, 100%). The hypervascular transformation rates for nodules with both, either and neither of the risk MRI findings were 100% (10/10), 60.9% (14/23), and 13.6% (3/22), respectively; the median intervals for transformation were 312 (range: 73-838), 409 (range: 50-1643) and 555 (range: 423-968) days, respectively. The combination of DWI hyperintensity and PVP hypointensity may be used as a high-risk indicator for the hypervascular transformation of HBP hypointense nodules without APHE; nodules without either feature may be treated as low-risk nodules and could adopt an extended interval follow-up schedule.

Magnetic resonance imaging-based risk factors of hepatocellular carcinoma after direct-acting antiviral therapy: A multicenter observational study.

To determine risk factors associated with hepatocellular carcinoma (HCC) development following direct-acting antiviral (DAA) therapy. We enrolled patients with chronic hepatitisC who underwent direct-acting antiviral therapy and achieved sustained virologic response at 12weeks between 2012 and 2018. Subsequently, patients were followed up. The primary endpoint was the development of HCC or the date of the last follow up when the absence of HCC was confirmed. Uni- and multivariate Cox proportional hazards models were used to identify factors contributing to HCC development, including gadoxetic acid-enhanced magnetic resonance imaging findings. The cumulative incidence rates of HCC development were calculated using the Kaplan-Meier method, and differences between groups were assessed using the log-rank test. The final study cohort comprised 482 patients (median age 70.5years; 242 men). The median follow-up period was 36.8months. Among 482 patients, 96 developed HCC (19.9%). The 1-, 3-, and 5-year cumulative rates of HCC development were 4.9%, 18.6%, and 30.5%, respectively. Multivariate analysis revealed that age, male sex, history of HCC, and hepatobiliary phase hypointense nodules without arterial phase hyperenhancement were independent risk factors significantly associated with HCC development (p<0.001-0.04). The highest risk group included patients with both a history of HCC and the presence of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement (the 1- and 3-year cumulative HCC development rates were 14.2% and 62.2%, respectively). History of HCC and presence of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement were strong risk factors for HCC development following direct-acting antiviral therapy.

Characterization of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid-enhanced MRI via contrast-enhanced ultrasound using perfluorobutane.

Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on gadoxetic acid-enhanced MRI (GA-MRI) may be nonmalignant cirrhosis-associated nodules or hepatocellular carcinomas (HCCs). We aimed to characterize HBP hypointense nodules without APHE on GA-MRI by performing contrast-enhanced ultrasound using perfluorobutane (PFB-CEUS). In this prospective, single-center study, participants at high-risk of HCC having HBP hypointense nodules without APHE at GA-MRI were enrolled. All participants underwent PFB-CEUS; if APHE and late, mild washout or washout in the Kupffer phase were present, the diagnosis of HCC was established according to the v2022 Korean guidelines. The reference standard consisted of histopathology or imaging. The sensitivity, specificity, and positive/negative predictive values of PFB-CEUS for detecting HCC were calculated. Associations between clinical/imaging features and the diagnosis of HCC were evaluated with logistic regression analyses. In total, 67 participants (age, 67.0years ± 8.4; 56 men) with 67 HBP hypointense nodules without APHE (median size, 1.5cm [range, 1.0-3.0cm]) were included. The prevalence of HCC was 11.9% (8/67). The sensitivity, specificity, and positive and negative predictive values of PFB-CEUS for detecting HCC were 12.5%(1/8), 96.6%(57/59), 33.3%(1/3) and 89.1%(57/64), respectively. Mild-moderate T2 hyperintensity on GA-MRI (odds ratio, 5.756; P = 0.042) and washout in the Kupffer phase on PFB-CEUS (odds ratio, 5.828; P = 0.048) were independently associated with HCC. Among HBP hypointense nodules without APHE, PFB-CEUS was specific for detecting HCC, which had a low prevalence. Mild-moderate T2 hyperintensity on GA-MRI and washout in the Kupffer phase on PFB-CEUS may be useful to detect HCC in those nodules.

Hypervascular transformation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid-enhanced MRI: long-term follow-up in a surveillance cohort.

With the increasing use of gadoxetic acid-enhanced MRI for HCC surveillance, hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) are frequently encountered. We investigated the rate of these nodules with hypervascular transformation, which suggests hepatocarcinogenesis, by using a prospectively collected longitudinal surveillance cohort data. This study included 382 prospectively enrolled patients at high risk for developing HCC who underwent 1-3 rounds of bi-annual surveillance gadoxetic acid-enhanced MRI. MRI was analyzed to detect HBP hypointense nodules without APHE. Follow-up dynamic CTs and MRIs were evaluated to detect hypervascular transformation of the nodules. Cox proportional hazards regression analyses were used to find predictors for hypervascular transformation. A total of 76 HBP hypointense nodules without APHE were found in 48 patients, giving a prevalence of 12.6% (48/382). The mean nodule size was 10.8 mm, with 43.4% (33/76) being ≥ 10 mm. Over a median follow-up of 78.6 months, 19 nodules (25.0%) showed hypervascular transformation, all of which demonstrated typical imaging features of HCC. On multivariable Cox-regression analysis, size (≥ 10 mm) was the only independent predictor of hypervascular transformation (hazard ratio, 3.31; 95% confidence interval, 1.21-9.05). The cumulative incidence of hypervascular transformation at 12 and 60 months of nodules ≥ 10 mm was 12.3% and 50.4%, respectively, while that of nodules < 10 mm was 2.5% and 13.9%, respectively. About half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC at 5 years of follow-up, indicating the necessity for cautious monitoring with an augmented and extended follow-up schedule for these nodules. • The prevalence of HBP hypointense nodules without APHE was 12.6% in a prospectively recruited population at high risk of developing HCC. • Nodule size ≥ 10 mm was significantly associated with hypervascular transformation, and approximately half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC during 5 years of follow-up. • Given the risk of malignant transformation, HBP hypointense nodules ≥ 10 mm without APHE should be closely monitored.

Risk Factors for Hypervascularization in Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement: A Systematic Review and Meta-analysis

To perform a systematic review and meta-analysis to determine risk factors for hypervascularization in hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) in patients with hepatocellular carcinoma (HCC). Pubmed and EMBASE databases were searched up to May 7, 2020. Studies which evaluated radiologic and clinical risk factors for hypervascularization in HBP hypointense nodules without APHE were included. Hazard ratios were meta-analytically pooled using random-effects model. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. Sixteen studies with 934 patients were included. HBP hypointense nodules without APHE with baseline size greater than 10 mm, T2 hyperintensity, and restricted diffusion showed risk for hypervascularization with pooled HRs of 2.95 (95% confidence interval [CI], 1.94-4.20), 4.21 (95% CI, 1.15-15.40), 5.83 (95% CI, 1.42-23.95), respectively. Previous HCC history contributed to hypervascularization of the nodules with hazard ratio of 2.06 (95% CI, 1.23-3.44). T1 hyperintensity, intralesional fat, Child-Pugh Class B, sex, alfa-fetoprotein, hepatitis B or C infection were not significant risk factors for hypervascularization (p ≥0.05). Study quality was generally moderate. HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI with baseline size greater than 10 mm, T2 hyperintensity, restricted diffusion and previous hepatocellular carcinoma history pose higher risk for hypervascularization. Proper patient management in patients with HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI may need to be tailored according to these risk factors.

Radiologic-Pathologic Correlation of Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement at Gadoxetic Acid-enhanced MRI: A Multicenter Study.

Background Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) at gadoxetic acid-enhanced MRI may indicate hepatocellular carcinoma (HCC) or nonmalignant cirrhosis-associated nodules. Purpose To assess the distribution of pathologic diagnoses of HBP hypointense nodules without APHE at gadoxetic acid-enhanced MRI and to evaluate clinical and imaging features in differentiating their histologic grades. Materials and Methods This retrospective multicenter study included pathologic analysis-confirmed HBP hypointense nodules without APHE (≤30 mm) in patients with chronic liver disease or cirrhosis screened between January 2008 and June 2016. Central pathologic review by 10 pathologists determined final histologic grades as progressed HCC, early HCC, high-grade dysplastic nodule (DN), and low-grade DN or regenerative nodule. Gadoxetic acid-enhanced MRI features were analyzed by three radiologists. Multivariable logistic regression analyses with elastic net regularization were performed to identify clinical and imaging features for differentiating histologic grades. Results There were 298 patients (mean age, 59 years ± 10; 226 men) with 334 nodules evaluated, and progressed HCCs were diagnosed in 44.0% (147 of 334), early HCCs in 20.4% (68 of 334), high-grade DNs in 27.5% (92 of 334), and low-grade DNs or regenerative nodules in 8.1% (27 of 334). Serum α-fetoprotein level 100 ng/mL or greater (odds ratio, 2.7; P = .01) and MRI features including well-defined margin (odds ratio, 5.5; P = .003), hypointensity at precontrast T1-weighted imaging (odds ratio, 3.2; P < .001), intermediate hyperintensity at T2-weighted imaging (odds ratio, 3.4; P < .001), and restricted diffusion (odds ratio, 1.9; P = .04) were independent predictors for progressed HCC at multivariable analysis. Conclusion In patients at high risk for hepatocellular carcinoma (HCC), hepatobiliary phase hypointense nodules without arterial phase hyperenhancement at gadoxetic acid-enhanced MRI corresponded mainly to progressed HCCs, early HCCs, and high-grade dysplastic nodules. High α-fetoprotein level and some imaging features at MRI helped to differentiate progressed HCC from lower grade nodules. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Motosugi in this issue.

Direct-Acting Antiviral Agents Reduce the Risk of Malignant Transformation of Hepatobiliary Phase-Hypointense Nodule without Arterial Phase Hyperenhancement to Hepatocellular Carcinoma on Gd-EOB-DPTA-Enhanced Imaging in the Hepatitis C Virus-Infected Liver

Background and Aims: Hepatobiliary phase-hypointense nodules without arterial phase hyperenhancement (HHNs without APHE) on gadolinium-ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) are considered to be dysplastic nodules or early hepatocellular carcinoma (HCC) and have high risk of undergoing malignant transformation and progression to hypervascular HCC. The aim of this study was to evaluate the clinical outcome of HHNs without APHE diagnosed by Gd-EOB-DTPA-enhanced MRI before the eradication of HCV by direct-acting antiviral agents (DAAs). Methods: We retrospectively investigated 221 consecutive patients with HCV infection who were treated with DAAs. Thirty patients with 65 HHNs without APHE were enrolled in a sustained virologic response (SVR) cohort and 22 with 43 HHNs without APHE who did not receive DAAs or had failed HCV eradication therapy were enrolled in a non-SVR cohort. Fifty-seven percent of patients in the SVR group and 64% of those in the non-SVR group had a history of HCC. The primary endpoint of this study was the development of hypervascular HCC from HHNs without APHE detected on imaging. The cumulative incidence and relative risk of progression to hypervascular HCC in relation to clinical characteristics were compared between the two cohorts. Results: The 2-year cumulative incidence of progression to hypervascular HCC was 8.5 and 21.9% in the SVR and non-SVR cohorts, respectively. There was a significant reduction in progression of HHNs without APHE to HCC after the eradication of HCV (p = 0.022, log-rank test). Multivariate Cox regression analysis identified hyperintensity on T2-weighted images (relative risk 14.699, p < 0.001) and achieving SVR (relative risk 0.290, p = 0.043) as independent factors associated with the risk of HCC. During follow-up, 6 (9.2%) of the HHNs without APHE in the SVR cohort became undetectable on hepatocyte-phase images. Conclusions: Eradication of HCV by DAAs could reduce the hypervascularization rate of HHNs without APHE, and some of these nodules disappeared.

Hepatobiliary phase hypointense nodule without arterial phase hyperenhancement: are they at risk of HCC recurrence after ablation or surgery? A systematic review and meta-analysis.

To perform a systematic review and meta-analysis to determine intrahepatic distant recurrence (IDR) risk of hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on pretreatment gadoxetic acid-enhanced MRI in patients with hepatocellular carcinoma (HCC) treated with either hepatectomy or radiofrequency ablation (RFA). PubMed and EMBASE databases were searched up to April 6, 2019. We included studies that evaluated HBP hypointense nodules without APHE as risk factors for IDR in HCC patients treated with either hepatectomy or RFA. Hazard ratios (HR) were meta-analytically pooled using random effects model. Subgroup analyses stratified to clinicopathologic variables were performed to explore heterogeneity. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. Eight studies with 842 patients were analyzed. The overall pooled HR for IDR was 2.44 (95% CI, 1.99-2.98) and were 2.14 (95% CI, 1.66-2.76) and 3.07 (95% CI, 2.19-4.31) for patients that underwent hepatectomy and RFA, respectively. No significant heterogeneity was present (I2 = 0%). The presence of these nodules was consistently shown to be significant factors for IDR in other subgroups (HR = 1.74-3.07). Study quality was generally moderate. HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. Stratification of patient management with regard to performing additional tests or treatment for these nodules and modification of proper follow-up strategies may be required in patients with HCC who have these nodules on pretreatment gadoxetic acid-enhanced MRI. • HBP hypointense nodules without APHE constitute an entity that is unique in gadoxetic acid-enhanced MRI. • HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. • Stratification of management and modification of proper follow-up strategies may be required in HCC patients who have these nodules on pretreatment gadoxetic acid-enhanced MRI.

Hepatobiliary versus Extracellular MRI Contrast Agents in Hepatocellular Carcinoma Detection: Hepatobiliary Phase Features in Relation to Disease-free Survival

Background MRI with hepatobiliary contrast material is more sensitive than MRI with extracellular contrast material in the detection of hepatocellular carcinoma (HCC). Purpose To determine whether postsurgical outcomes differ between patients who undergo MRI with hepatobiliary contrast material and those who undergo MRI with extracellular contrast material by analyzing disease-free survival (DFS) rates after curative resection of HCC. Materials and Methods From January 2014 to December 2015, 170 treatment-naïve patients who underwent contrast-enhanced preoperative liver MRI and curative hepatic resection for HCC were retrospectively included and observed until September 2018. DFS rates were compared between the two groups, which were classified based on the type of MRI contrast agent used. The MRI with hepatobiliary contrast material group was further divided into a hypointense nodule-positive group and a hypointense nodule-negative group according to the presence of residual hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) after surgery. DFS rates were calculated by using the Kaplan-Meier method and were compared among the three groups by using a log-rank test. Results Patients were included in either the MRI with extracellular contrast material group (n = 53; mean age, 60 years ± 9 [standard deviation]) or the hepatobiliary contrast material group (n = 117; mean age, 60 years ± 8; 26 patients were in the hypointense nodule-positive group). Over a median follow-up period of 34.1 months, median DFS rates did not differ between the extracellular contrast material group (35.8 months) and the hepatobiliary contrast material group (43.5 months) (P = .46). However, median DFS in the extracellular contrast material group was longer than that in the hypointense nodule-positive group (35.8 months vs 25.8 months, P < .001) and shorter than that in the hypointense nodule-negative group (35.8 months vs 48.6 months, P = .02). Conclusion Patients who undergo preoperative MRI with hepatobiliary contrast material and resection of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement may show better disease-free survival. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Motosugi in this issue.

Hepatobiliary phase hypointense nodule without arterial phase hyperenhancement as a risk factor for late recurrence (>1 year) of hepatocellular carcinoma after surgery

To evaluate the value of magnetic resonance imaging (MRI) features, including liver stiffness measured by magnetic resonance elastography (MRE) and the presence of hepatobiliary phase (HBP) hypointense nodule without arterial phase hyperenhancement (APHE), for predicting late recurrence (>1 year) after surgery for hepatocellular carcinoma (HCC). This retrospective study included 124 consecutive patients who had undergone surgery for HCC and preoperative MRI. After excluding patients with early recurrence within 1 year after surgery, 89 patients were analysed. Preoperative MRI images were reviewed by a radiologist to record imaging findings, including (1) liver stiffness by MRE, (2) size of the HCCs, (3) number of HCCs, and (4) presence of HBP hypointense nodule without APHE. Pathological findings included tumour grade, vascular/biliary/capsule invasion, and fibrosis stage of the liver. Considering imaging/pathological findings and patients' characteristics as dependent variables, Cox proportional hazards model analysis was performed to identify independent factors associated with late recurrence after surgery. The median follow-up period was 37.3 months. During follow-up, 29 patients (32.5%) developed late recurrence after surgery. In multivariate analysis, underlying liver disease (viral hepatitis) and presence of HBP hypointense nodules without APHE (p=0.010 and 0.033, respectively) were independently associated with disease-free survival (DFS). Kaplan-Meier analysis revealed that patients with HBP hypointense nodules without APHE had a significantly lower DFS rate than those without the nodule (39.2% versus 74.1% at 3 years after surgery, p=0.008). The presence of HBP hypointense nodules without APHE was an indicator of late recurrence after surgery for HCC.

Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC.

This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3cm. This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method. Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38-5.51]) and RFA (p = 0.004, HR = 1.78 [1.20-2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001). While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA. • The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA). • Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules. • In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.

Hypovascular hypointense nodules in hepatobiliary phase without T2 hyperintensity: long-term outcomes and added value of DWI in predicting hypervascular transformation

PurposeTo evaluate outcomes and risk factors associated with hypervascularization in hypovascular, hepatobiliary phase (HBP) hypointense nodules (HHNs) without T2 hyperintensity on gadoxetic acid-enhanced magnetic resonance (MR) images in chronic liver disease patients. Materials and methods222 HHNs were analyzed. Multivariate analysis with a Cox proportional hazard regression model was used. Results41 nodules became hypervascular hepatocellular carcinoma (HCC). History of HCC, hyperintensity on T1WI or DWI, and higher growth rate were risk factors for hypervascularization (P < .05). ConclusionHistory of HCC, hyperintensity on T1WI or DWI, and higher growth rate were associated with nodular progression to hypervascular HCC.

Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MRI: Risk of HCC recurrence after radiofrequency ablation

Hepatobiliary phase images (HBPI) of gadoxetic acid-enhanced MRI can depict borderline hepatocellular nodules that have the potential to progress into hypervascular hepatocellular carcinomas (HCCs), as non-hypervascular hypointense nodules. We retrospectively evaluated the impact of the presence of non-hypervascular hypointense nodules at HBPI of gadoxetic acid-enhanced MRI on the patient's prognosis after radiofrequency ablation (RFA) for early stage HCCs. A total of 139 patients who underwent pre-procedural gadoxetic acid-enhanced MRI followed by RFA were included. After a mean follow-up of 44.6±13.2 months, we compared the results of tumor recurrence as well as overall and recurrence-free survival (RFS) with the presence of non-hypervascular hypointense nodules on HBPI. The presence of non-hypervascular hypointense nodules on HBPI did not affect overall survival (p=0.136). However, the estimated 5-year RFS rate was 71.3% in 29 patients without non-hypervascular hypointense nodules on HBPI compared to 27.9% in 110 patients with non-hypervascular hypointense nodules on HBPI, indicating a significant difference (hazard ratio=2.84 [1.39-5.98], p=0.006). When we classified recurrence into local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extra-hepatic metastasis [EM], five-year cumulative incidences (CI) of IDR in patients with non-hypervascular hypointense nodules on HBPI were significantly higher than those in patients without non-hypervascular hypointense nodules on HBPI (17.9% vs. 67.5%, p<0.001). Five-year CIs of LTP and EM showed no significant difference (p>0.05). The presence of non-hypervascular hypointense hepatocellular nodules on HBPI of gadoxetic acid-enhanced MRI taken prior to RFA is a significant predictive factor of recurrence after RFA of early stage HCCs, particularly IDR.