title: Intrahepatic distant recurrence after radiofrequency ablation for hepatocellular carcinoma: precursor nodules on pre-procedural gadoxetic acid-enhanced liver magnetic resonance imaging.
abstract: Background Intrahepatic distant recurrence (IDR) after radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) is associated with poor overall survival outcome. Purpose To evaluate the incidence and findings on pre-procedural gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) of precursor nodules for IDR after RF ablation for HCC. Material and Methods This study was approved by our institutional review board. Among 343 patients treated with RF ablation for HCC between 2009 and 2011, 141 patients who underwent pre-procedural gadoxetic acid-enhanced liver MRI and experienced IDR were enrolled. The presence of precursor nodules for IDR on pre-procedural imaging was assessed. Nodules were categorized based on hypervascularity in the arterial phase and signal intensity on hepatobiliary phase images. Time to recurrence was compared between patients with and without precursor nodules. Results In 46 (32.7%) of 141 patients (50 HCCs), there were precursor nodules on pre-procedural MRIs (median follow-up period, 4.39 years; range, 0.08-6.08). In three patients, HCCs were missed on imaging. In the remaining 43 patients, the 47 precursor nodules identified were non-hypervascular hypointense (n = 26), non-hypervascular isointense (n = 6), non-hypervascular hyperintense (n = 2), hypervascular hypointense (n = 10), and hypervascular isointense (n = 3). The mean time-to-recurrence was significantly shorter for patients with precursor nodules than for those without (16.6 versus 24.0 months, P = 0.011). Conclusion About one-third of patients with IDR after RF ablation for HCC had precursor nodules on pre-procedural gadoxetic acid-enhanced MRI, most commonly non-hypervascular hypointense nodules in the hepatobiliary phase.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoung Doo
authors.initials: KD
authors.lastname: Song
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Lee
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young-Sun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kang
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Radiofrequency ablation; gadoxetic acid; hepatocellular carcinoma; intrahepatic distant recurrence; non-hypervascular hypointense