Fate of hypointense lesions on Gd-EOB-DTPA-enhanced magnetic resonance imaging

Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
European journal of radiology (Impact Factor: 2.37). 01/2012; 81(11):2973-7. DOI: 10.1016/j.ejrad.2012.01.007
Source: PubMed


To investigate the natural outcome and clinical implication of hypointense lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.
Forty patients underwent Gd-EOB-DTPA-enhanced MRI for preoperative evaluation of HCC. Hypointense lesions in the hepatobiliary phase that were hypovascular 5mm of more were extracted for follow-up. We performed a longitudinal study retrospectively for these lesions regardless of whether classical HCC developed or emerged in a different area from that of the lesions being followed.
Thirty one patients displayed 130 hypointense lesions on MRI and only nine showed no hypointense lesions. In total, 17 (13.1%) of 130 hypointense lesions on MRI developed into classical HCC. The cumulative rates for these lesions to develop into classical HCC were 3.2% at 1 year, 11.1% at 2 years and 15.9% at 3 years. The total occurrence rates of classical HCC (25.8% at 1 year, 52.6% at 2 years and 76.4% at 3 years) were higher compared to those regarding only occurrence of classical HCC from hypointense lesions on MRI (10.0% at 1 year, 35.6% at 2 years and 44.6% at 3 years), although no significant difference was observed (p=0.073).
Hypointense lesions that are detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI have some malignant potential, although treating these lesions aggressively in patients who already have HCC may be too severe.

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    • "Particularly, some early hypovascular HCC are only observed as hypointense nodules during the hepatobiliary phase at gadoxetate-enhanced MR imaging without being readily seen during dynamic imaging. The subgroup of lesions showing both absence of enhancement during the arterial phase and hypointensity during the hepatobiliary phase is challenging because not all of these lesions correspond to HCC or will evolve into HCC [106] [107]. In this setting, hyperintensity on DW MR images increases the likelihood of early HCC or progression to hypervascular HCC [107] [108]. "
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    • "However, atypical HCCs carry the risk to be overlooked in dynamic phase images and Gd-EOB-DTPA-enhanced hepatobiliary phase images have been shown to improve both detection and characterization of those lesions [15]. Only recently the malignant potential of hypointense lesions detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI has been shown emphasizing its clinical benefit [25]. "
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