Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features
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To determine the imaging and clinicopathological features of MRI doughnut-like nodules (HBP-doughnut nodules), hyperintense at the hepatobiliary phase (HBP) after injection of gadoxetic acid (EOB) and without arterial-phase hyperenhancement (APHE) in cirrhotic liver.
The Institutional Review Board approved this retrospective study and informed consent was waived. We enrolled 309 consecutive patients with liver cirrhosis who were examined by EOB-MRI, dynamic CT, and angiography-assisted CT between 2008 and 2012 and searched for HBP-doughnut nodules. We evaluated imaging characteristics including haemodynamics and signal intensity of MRI, pathological findings, and frequency of malignant transformation.
One hundred and one HBP-doughnut nodules without APHE were identified in 18 patients (6%), including seven of 59 (12%) patients with hepatitis-B-virus-related, nine of 230 (3.9%) with hepatitis-C-virus-related, and two of 33 (6.1%) with alcoholic cirrhosis. All nodules showed enhancement peaks in the portal phase, the same or increased intranodular portal supply on CT during arterial portography, and the same or decreased intranodular arterial supply on CT during hepatic arteriography. On T2-weighted and diffusion-weighted images, 37 (36%) and 24 (24%) nodules, respectively, showed hyperintensity predominantly in the central area. Three nodules were diagnosed by fine needle biopsy as non-neoplastic hepatic nodules. Ninety-three of 101 (92%) nodules in 16 patients were followed up during an observation period of 1163 ± 902 days (range 57–2920 days), and none showed malignant transformation.
HBP-doughnut nodules without APHE in cirrhotic liver were not infrequent. None became malignant. We propose calling them ‘multiacinar cirrhotic nodules’ based on the classification by an International Working Party.
• HBP-doughnut nodules without APHE were seen in 6% of patients with liver cirrhosis.
• The enhancement peak of HBP-doughnut nodules without APHE was in the portal phase, which reflected the fact that they were supplied predominantly by the portal vein, based on angiography-assisted CT findings.
• None of the HBP-doughnut nodules without APHE in cirrhotic liver became malignant, and in conjunction with limited pathological features, they may be corresponding to multiacinar cirrhotic nodules in the International Working Party classification.
KeywordsDiagnosis Magnetic resonance imaging Gadolinium Multidetector computed tomography
CT during arterial portography
CT during hepatic arteriography
Focal nodular hyperplasia
Hepatitis B virus
Hepatitis C virus
Idiopathic portal hypertension
Large regenerative nodule
Nodular regenerative hyperplasia
Organic anion transporter polypeptide
We thank Cathel Kerr, Ph.D., and Libby Cone, M.D., M.A., from Edanz Group (www.edanzediting.com/ac) for editing drafts of this manuscript.
This study has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Toshifumi Gabata, M.D., Ph.D.
Conflict of interest
The authors declare that they have no competing interests.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Approval was obtained from the Institutional Review Board of Kanazawa University Graduate School of Medical Sciences, Japan.
• performed at one institution
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