title: Hypovascular hypointense nodules on hepatobiliary phase without T2 hyperintensity on gadoxetic acid-enhanced MR images in patients with chronic liver disease: long-term outcomes and risk factors for hypervascular transformation.
abstract: OBJECTIVE
  To evaluate the long-term outcomes and imaging features associated with hypervascularization of hypovascular nodules that show T2 iso-/hypointensity and hypointensity on hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) images in patients with chronic liver disease.
  
  
  METHODS
  Sixty patients and 114 nodules, which were hypovascular and iso-/hypointense on T2-weighted images and hypointense on HBP of gadoxetic acid-enhanced MRI, were included. We evaluated the effect of baseline clinical features, baseline MR features and growth rate on subsequent hypervascularization.
  
  
  RESULTS
  Twenty-seven nodules in 21 patients transformed to hypervascular hepatocellular carcinoma (HCC). Using multivariate Cox analysis, T1 hyperintensity (hazard ratio [HR] = 2.69, P = 0.021), previous history of HCC (HR = 2.64, P = 0.021), and initial nodule size (HR = 1.09, P = 0.046) were identified to be associated with hypervascularization. The growth rate of nodules was a more powerful determinant of subsequent hypervascularization than baseline clinical and MR features. At long-term follow-up after >3 years, only one nodule with T1 isointensity showed hypervascularization.
  
  
  CONCLUSIONS
  Careful follow-up or diagnostic procedures, such as biopsy, should be considered for up to 3 years after detection of hypointense nodules on HBP with T1 hyperintensity or a higher growth rate.
  
  
  CONCLUSIONS
  • T1 hyperintensity is a baseline MR predictive factor for subsequent hypervascularization. • A higher growth rate is a more powerful determinant of subsequent hypervascularization. • Management of patients with these predictive factors requires more attention.
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Chonbuk, 561-712, Korea.
authors.forename: Yong Seek
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Chonbuk, 561-712, Korea. pichgo@gmail.com.|Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea. pichgo@gmail.com.
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Song
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Chonbuk, 561-712, Korea.|Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Lee
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Chonbuk, 561-712, Korea.|Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D011230:Precancerous Conditions / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Gadoxetic acid; Hepatocarcinogenesis; Hepatocellular carcinoma; Hypervascular transformation; Magnetic resonance imaging