title: Hypovascular hepatic nodules showing hypointense on the hepatobiliary-phase image of Gd-EOB-DTPA-enhanced MRI to develop a hypervascular hepatocellular carcinoma: a nationwide retrospective study on their natural course and risk factors.
abstract: OBJECTIVE
  We aimed to investigate the natural outcome of nonhypervascular lesions detected in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI by performing a longitudinal study retrospectively enrolled in a nationwide manner.
  
  
  METHODS
  Between February 2008 and March 2011, 224 patients with 504 nodules that were diagnosed as nonhypervascular by imaging were recruited from institutions that participated in the present study. We examined the natural outcome of nonhypervascular lesions and evaluated the risk factors.
  
  
  RESULTS
  Of the 504 nodules, 173 (34.3%) showed hypervascular transformation. The overall cumulative incidence of hypervascular transformation was 14.9% at 12 months and 45.8% at 24 months. Multivariate analysis using the Cox regression model revealed previous treatment history for hepatocellular carcinoma (HCC; relative risk = 1.498; p = 0.036, 95% CI 1.03-2.19) and hyperintensity on T2-weighted images (relative risk = 1.724; p = 0.015, 95% CI 1.11-2.67) were identified as independent factors for hypervascular transformation.
  
  
  CONCLUSIONS
  Patients who have a previous treatment history for HCC and with hypointense nodules showing hyperintensity on T2-weighted images need careful follow-up because of the high incidence of hypervascular transformation.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University, Osakasayama, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Inoue
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hyodo
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Takayama
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.forename: Atsushi
authors.initials: A
authors.lastname: Higaki
authors.forename: Keiko
authors.initials: K
authors.lastname: Korenaga
authors.forename: Azusa
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
authors.forename: Toru
authors.initials: T
authors.lastname: Takano
authors.forename: Kennichi
authors.initials: K
authors.lastname: Miyoshi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koda
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Hironori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.forename: Hironori
authors.initials: H
authors.lastname: Ochi
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000098:blood supply* / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA