To evaluate the outcomes of small (5-10 mm), arterially enhancing nodules (SAENs) shown exclusively at the hepatic arterial phase of CT in a hepatocellular carcinoma (HCC) surveillance population and to determine risk factors for developing HCC.
The study population included 112 patients (male:female = 100:12; aged 36-92 years) with 175 SAENs who were at risk of HCC. We evaluated serial changes during follow-up (1.4-41.8 months, mean 35.7 months) and analysed the initial CT findings of SAENs and the accompanying lesions to elucidate the risk factors for HCC development.
Of 175 SAENs, 101(57.7%) disappeared and 34(19.4%) persisted. Forty SAENs (22.9%) became HCC in 33 patients (29.5%). Presence of HCC treatment history (p = 0.005, risk ratio = 7.429), a larger size of SAEN (p = 0.003, risk ratio = 1.630), presence of coexistent HCC (p = 0.021, risk ratio = 3.777) and absence of coexistent typical arterioportal shunts (p = 0.003, risk ratio = 4.459) turned out to be independently significant risk factors for future development of HCC.
SAENs were frequently seen in an HCC surveillance population and have a 22.9% probability of becoming HCC on a per-lesion basis. Risk increased particularly when the lesion was associated with a previous or concurrent HCC, a large size or found without a coexistent typical arterioportal shunt.
[Show abstract][Hide abstract] ABSTRACT: Recently, Gadoxetic acid (Gd-EOB-DTPA; Primovist®; Bayer Schering Pharma), a tissue-specific contrast material, has been used for clinical MR imaging. This agent is a biphasic hepatobiliary contrast agent because it behaves as both an extracellular and a hepatocyte-specifi c agent as it undergoes both renal and biliary excretion. Up to 50% of the injected dose is taken up into normal hepatocytes due to the presence of the lipophilic ethoxybenzyl group in its chemical structure. As such, dynamic imaging can be performed using this agent for the evaluation of hemodynamic perfusion or status and for hepatobiliary phase imaging (10 to 20 minutes after injection) for the evaluation of functional status. Compared to extracellular contrast materials, Gadoxetic acid-enhanced magnetic resonance imaging (MRI) provides comparable arterial enhancement and prominent venous washout of hepatocellular carcinoma (HCC) during dynamic imaging. Additional hepatobiliary phase images are useful for the detection of small lesions that are not readily visible during dynamic imaging. Current evidence and experience suggest that Gadoxetic acid-enhanced MRI will improve the accuracy of HCC imaging diagnosis by allowing better characterization of hypovascular lesions and better differentiation of small arterial enhancing lesions as well as by providing improved preoperative staging accuracy. Therefore, with the aid of Gadoxetic acid-enhanced MRI, very early HCC will be more commonly diagnosed, with patient treatment occurring in earlier stages of the disease.
Gut and liver 03/2011; 5(1):15-21. DOI:10.5009/gnl.2011.5.1.15 · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abnormalities of the portal venous system are a heterogeneous group of conditions that can cause substantial morbidity and mortality and may lead to complications during surgery or percutaneous interventions involving the portal venous system. High-resolution computed tomography, ultrasonography, and magnetic resonance imaging permit a comprehensive, noninvasive evaluation of the portal venous system, enabling the detection of both structural and functional abnormalities. However, an understanding of the embryologic development of the normal portal venous anatomy and anatomic variants is essential to accurately interpret the imaging findings. Knowledge of the characteristic appearances of abnormalities of the portal venous system allows a more confident diagnosis, permitting timely treatment and more informed guidance of surgical procedures and percutaneous interventions, which may lead to an improved outcome.
[Show abstract][Hide abstract] ABSTRACT: To measure diagnostic performance in the detection of hepatocellular carcinoma (HCC) by using the most recent technology and multiphase gadolinium-enhanced magnetic resonance (MR) imaging and to compare with earlier results at the same institution.
This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was obtained. Between January 2008 and April 2010, 101 patients underwent liver transplantation and pretransplantation abdominal MR imaging within 90 days. Prospective image interpretations from the clinical record were reviewed for documentation of HCC, including size, number, and location. Liver explant histologic examination provided the reference standard for lesion analysis and was performed in axial gross slices in conjunction with the MR imaging report for direct comparison. Tumors were categorized according to size (≥ 2 cm or <2 cm), and MR imaging detection sensitivity, specificity, predictive values, and accuracy were calculated according to category. The Fisher exact test was used to compare results from this study against prior reported results.
Thirty-five (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specificity of 97.1% (34 of 35) and 100% (66 of 66), respectively. For lesions 2 cm or larger, MR imaging had a sensitivity and specificity of 100% (23 of 23) and 100% (78 of 78), respectively. For lesions smaller than 2 cm, MR imaging had a sensitivity and specificity of 82.6% (19 of 23) and 100% (78 of 78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53 of 58) in the current study, compared with 77.8% in 2007 (P = .07). For lesions smaller than 2 cm, the sensitivity was 87.5% (28 of 32) in the current study, compared with 55.6% previously (P = .02).
MR imaging remains a highly accurate diagnostic method for the preoperative evaluation of HCC, and detection of small (<2 cm) tumors has been significantly improved compared with that of earlier studies.
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