title: Outcomes of patients with elevated α-fetoprotein level and initial negative findings at MR imaging.
abstract: OBJECTIVE
  To evaluate interval cancer diagnosis in patients with elevated α-fetoprotein (AFP) level and initial negative findings at magnetic resonance (MR) imaging.
  
  
  METHODS
  The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Seventeen patients with elevated AFP levels (>300 ng/mL [>300 μg/L]) and initial negative findings at hepatic MR imaging from 2002 to 2011 were identified. MR reports, pathology reports, and medical records were reviewed to determine outcome, including identification of hepatocellular carcinoma (HCC), and track changes in serum AFP level. Initial and follow-up MR images were reviewed to evaluate presence and size of hepatic nodules. Significance of AFP values was tested with repeated-measures analysis of variance.
  
  
  RESULTS
  Ten (59%) of 17 patients developed HCCs (13 tumors) after a mean of 138 days (range, 41-247 days). Nine (90%) of 10 patients with HCCs underwent follow-up MR imaging, and one patient (10%) underwent liver transplantation without MR follow-up. Of 12 HCCs in nine patients who underwent follow-up MR imaging, 10 (83%) were noted at follow-up MR imaging and two were found only at surgery. Mean diameter of visualized HCCs was 3.4 cm. Of 10 HCCs detected at follow-up MR imaging, five were identifiable in retrospect at initial MR studies (mean diameter, 1.4 cm). Serum AFP levels in patients with HCCs were significantly higher than those in patients without HCCs and progressively increased over time (P = .012).
  
  
  CONCLUSIONS
  Subsequent HCCs in patients with elevated AFP levels and initial negative findings at MR imaging are relatively common and demonstrable during short follow-up. Close follow-up (serial 3-month studies) is recommended in the setting of a steady increase in AFP level.
authors: Department of Radiology, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, Chapel Hill, NC 27599-7510, USA.
authors: Bong Soo
authors: BS
authors: Kim
authors: Paul Hideyo
authors: PH
authors: Hayashi
authors: Seung Hyoung
authors: SH
authors: Kim
authors: Wirana
authors: W
authors: Angthong
authors: Saowanee
authors: S
authors: Srirattanapong
authors: John T
authors: JT
authors: Woosley
authors: Richard C
authors: RC
authors: Semelka
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D009942:Organometallic Compounds; D000509:alpha-Fetoproteins; C064572:gadobenic acid; D008536:Meglumine; C064925:gadodiamide; D019786:Gadolinium DTPA