title: Incidence for progression of hypervascular HCC in hypovascular hepatic nodules showing hyperintensity on gadoxetic acid-enhanced hepatobiliary phase in patients with chronic liver diseases.
abstract: OBJECTIVE
  The purpose of this study was to elucidate the incidence and risk factors for the progression of hyperintense nodules, observed in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), to hypervascular hepatocellular carcinoma (HCC).
  
  
  METHODS
  Hypovascular nodules (n = 157) showing hyperintensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 41 patients. All patients underwent computed tomography (CT) during hepatic arteriography and CT during arterial portography within one month of Gd-EOB-DTPA-enhanced MRI. The incidence of progression to hypervascular or classical HCC was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Tumor size was determined by univariate and multivariate analysis to be an important risk factor of hypervascularization (p = 0.041, odds ratio 1.135). The cumulative incidences of hypervascularization in hypovascular nodules showing hyperintensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were 2.4, 4.5, and 6.2 % at 12, 24, and 36 months, respectively. The incidence of hypervascularization was significantly increased in nodules >10 mm in diameter (p = 0.00035).
  
  
  CONCLUSIONS
  In patients with chronic liver disease, hypovascular nodules presenting as hyperintense in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI and >10 mm in diameter have malignant potential for progression to hypervascular HCC and require careful management.
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan, megumi@m.ehime-u.ac.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Matsuda
authors.forename: Takaharu
authors.initials: T
authors.lastname: Tsuda
authors.forename: Shinji
authors.initials: S
authors.lastname: Yoshioka
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Murata
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Teruhito
authors.initials: T
authors.lastname: Mochizuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000175:diagnosis / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA