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Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC

  • Dong Ho Lee
  • Jeong Min LeeEmail author
  • Mi Hye Yu
  • Bo Yun Hur
  • Nam-Joon Yi
  • Kwang-Woong Lee
  • Kyung-Suk Suh
  • Jung-Hwan Yoon
  • Yoon Jun Kim
  • Jeong-Hoon Lee
  • Su Jong Yu
  • Joon Koo Han
Hepatobiliary-Pancreas
  • 21 Downloads

Abstract

Objective

This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3 cm.

Methods

This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3 cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method.

Results

Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38–5.51]) and RFA (p = 0.004, HR = 1.78 [1.20–2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001).

Conclusions

While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA.

Key Points

The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA).

Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules.

In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.

Keywords

Hepatocellular carcinoma Ablation technique Hepatectomy Magnetic resonance imaging 

Abbreviations

AFP

Alpha-fetoprotein

CI

Confidence interval

EM

Extrahepatic metastasis

HBP

Hepatobiliary phase

HCC

Hepatocellular carcinoma

HR

Hazard ratio

IDR

Intrahepatic distant recurrence

LTP

Local tumor progression

MR

Magnetic resonance

RFA

Radiofrequency ablation

RFS

Recurrence-free survival

SD

Standard deviation

Notes

Funding

The authors state that there are no grants or funds supporting this study.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jeong Min Lee.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

Supplementary material

330_2018_5941_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 30 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Dong Ho Lee
    • 1
  • Jeong Min Lee
    • 1
    • 2
    Email author
  • Mi Hye Yu
    • 3
  • Bo Yun Hur
    • 4
  • Nam-Joon Yi
    • 5
  • Kwang-Woong Lee
    • 5
  • Kyung-Suk Suh
    • 5
  • Jung-Hwan Yoon
    • 6
  • Yoon Jun Kim
    • 6
  • Jeong-Hoon Lee
    • 6
  • Su Jong Yu
    • 6
  • Joon Koo Han
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University HospitalSeoulSouth Korea
  2. 2.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyKonkuk University School of MedicineSeoulSouth Korea
  4. 4.Department of Radiology, Healthcare System Gangnam CenterSeoul National University HospitalSeoulSouth Korea
  5. 5.Department of SurgerySeoul National University HospitalSeoulSouth Korea
  6. 6.Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea

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