title: Bone Metastases of Hepatocellular Carcinoma: Appearance on MRI Using a Standard Abdominal Protocol.
abstract: OBJECTIVE
  The purpose of this study is to describe the MRI features of hepatocellular carcinoma (HCC) bone metastases.
  
  
  METHODS
  Thirty-three consecutive patients were included. Two radiologists performed qualitative and quantitative analysis. The coordinator searched for clinical and epidemiologic features related to patients and their primary liver tumors. Earlier MRI studies were also reviewed to determine whether bone metastases were already present and prospectively identified. Descriptive statistics and the Lin concordance correlation coefficient were used.
  
  
  RESULTS
  Chronic hepatitis C virus infection was the most common cause of liver disease (20/32; 62.5%), and diffuse and multifocal HCC were the most frequent types of liver HCCs (28/33; 84.8%). Most lesions were located at the spine (109/155; 70.3%), with high signal intensity on fat-suppressed T1-weighted (54/62; 87.1%) and T2-weighted (53/62; 85.5%) images. Bone metastases were predominantly nodular (48/62; 77.4%), confined to the vertebral body (40/60; 66.7%), and best visualized at the arterial phase (40/62; 64.5%). The ring pattern of enhancement was present in 23 of 62 lesions, and the remaining lesions showed diffuse enhancement. Thirty-five of 62 (56.4%) bone metastases showed arterial peak of enhancement. In 13 of 33 (39.9%) patients, bone metastases were not prospectively reported.
  
  
  CONCLUSIONS
  Most patients with bone metastases had chronic hepatitis C virus infection and diffuse or multifocal HCC. Metastases are most commonly appreciated as hypervascular focal moderately intensely enhancing nodular masses on the hepatic arterial dominant phase images, with concomitant moderately high signal intensity on fat-suppressed T1- and T2-weighted images.
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Velloni
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.|2 Department of Radiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ramalho
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.|3 Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Mamdoh
authors.initials: M
authors.lastname: AlObaidy
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.|2 Department of Radiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: António P
authors.initials: AP
authors.lastname: Matos
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.
authors.forename: Ersan
authors.initials: E
authors.lastname: Altun
authors.affiliation: 1 Department of Radiology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, 101 Manning Dr, Chapel Hill, NC 27599-7510.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D002985:Clinical Protocols; D003287:Contrast Media; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: MRI; bone metastases; diffuse hepatocellular carcinoma; hepatocellular carcinoma; spine