Large (>or=2 cm) non-hypervascular nodules depicted on MRI in the cirrhotic liver: fate and implications.
OBJECTIVE
To determine the fate and clinical implication of large (>or=2 cm), non-hypervascular nodules depicted on magnetic resonance imaging (MRI) in the cirrhotic liver.


METHODS
In 21 patients with cirrhosis (14 hepatitis B, two ethanol abuse, four cryptogenic, one Wilson's disease), 25 large (>or=2 cm in the longest dimension) non-hypervascular nodules were identified on dynamic MRI. The implications for diagnosis of the initial size, contour, and signal characteristics on MRI in addition to patients' age and cause of cirrhosis were assessed in our analysis.


RESULTS
Twelve (75%) out of 16 lesions were malignant or potentially-malignant from 14 hepatitis B patients, while seven (78%) of the nine lesions from other patients were benign (p=0.016). The mean age of the patients who had malignant or potentially malignant lesions (57 years) was older than that for the other patients (47 years; p=0.039). The ratio of the short-to-long diameter was higher in malignant or potentially malignant lesions (mean 0.86) than in benign lesions (mean 0.69; p=0.008). There was no discriminative signal intensity characteristic (p>0.2 for all factors) that indicated the malignant potential for each non-hypervascular nodule. For all 10 lesions in the hepatitis B patients who were older than 52 years with a short-to-long diameter ratio of more than 0.75, the positive predictive value for malignant potential based on these three combined factors was 100%.


CONCLUSIONS
In older patients with cirrhosis from hepatitis B, large (>or=2 cm), non-hypervascular nodules with a spherical contour have a high malignant potential.
Yu
J S
JS
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, Seoul, Republic of Korea. yjsrad97@yuhs.ac
Chung
J J
JJ
Kim
J H
JH
Kim
K W
KW
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies