title: Hypervascular hepatocellular carcinoma: correlation between biologic features and signal intensity on gadoxetic acid-enhanced MR images.
abstract: OBJECTIVE
  To analyze the correlation among biologic features, tumor marker production, and signal intensity at gadoxetic acid-enhanced MR imaging in hepatocellular carcinomas (HCCs).
  
  
  METHODS
  Institutional ethics committee approval and informed consent were obtained for this retrospective study. From April 2008 to September 2011, 180 surgically resected HCCs in 180 patients (age, 65.0 years ± 10.3 [range, 34-83 years]; 138 men, 42 women) were classified as either hypointense (n = 158) or hyperintense (n = 22) compared with the signal intensity of the background liver on hepatobiliary phase gadoxetic acid-enhanced MR images. Pathologic features were analyzed and a fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) production were compared by means of serum analysis and immunohistochemical staining. Recurrence and survival rates were also evaluated. The Mann-Whitney and Pearson correlation tests were used for statistical analysis.
  
  
  RESULTS
  The grade of differentiation was higher (P = .028) and portal vein invasion was less frequent in hyperintense HCCs (13.6%) than in hypointense HCCs (36.7%) (P = .039). The serum levels of AFP, Lens culinaris agglutinin reactive fraction of AFP, and PIVKA-II were lower in hyperintense than in hypointense HCCs (P = .003, .004, and .026, respectively). Immunohistochemical AFP and PIVKA-II expression were lower in hyperintense than in hypointense HCCs (both P < .001). The recurrence rate was lower in hyperintense than in hypointense HCCs (P = .039).
  
  
  CONCLUSIONS
  The results suggest that hyperintense HCCs on gadoxetic acid-enhanced MR images are less aggressive than hypointense HCCs.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120226/-/DC1.
authors.affiliation: Departments of Radiology, Gastroenterology, and Human Pathology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan. kitaoa@staff.kanazawa-u.ac.jp
authors.forename: Azusa
authors.initials: A
authors.lastname: Kitao
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Norihide
authors.initials: N
authors.lastname: Yoneda
authors.forename: Kazuto
authors.initials: K
authors.lastname: Kozaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Wataru
authors.initials: W
authors.lastname: Koda
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kita
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D029362:Organic Anion Transporters, Sodium-Independent / Q000378:metabolism; D011498:Protein Precursors / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D012189:Retrospective Studies; D000074542:Solute Carrier Organic Anion Transporter Family Member 1B3; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D003287:Contrast Media; D029362:Organic Anion Transporters, Sodium-Independent; D011498:Protein Precursors; C421209:SLCO1B3 protein, human; D000074542:Solute Carrier Organic Anion Transporter Family Member 1B3; D000509:alpha-Fetoproteins; C073590:gadolinium ethoxybenzyl DTPA; C008208:acarboxyprothrombin; D011516:Prothrombin; D019786:Gadolinium DTPA