Jeong Woo Kim MD, Presenter: Nothing to Disclose

Chang Hee Lee MD, Abstract Co-Author: Nothing to Disclose

Yang Shin Park MD, Abstract Co-Author: Nothing to Disclose

Jong Mee Lee, Abstract Co-Author: Nothing to Disclose

Jae Woong Choi MD, Abstract Co-Author: Nothing to Disclose

Kyeong Ah Kim MD, Abstract Co-Author: Nothing to Disclose

Cheol Min Park MD, Abstract Co-Author: Nothing to Disclose

 To identify imaging features that can reliably differentiate hepatocellular carcinoma(HCC) with paradoxical uptake on hepabiliary phase(HBP) from focal nodular hyperplasia(FNH) or FNH-like nodule in Gd-EOB-DTPA-enhanced MR imaging

 This study was approved by our institutional review board and the requirement for informed consent was waived. 19 pathologically confirmed HCC with paradoxical uptake on HBP, 28 FNHs, and 21 FNH-like nodules from 61 patients who had undergone Gd-EOB-DTPA-enhanced liver MRI were included. Two radiologists reviewed independently and in consensus all MR images and evaluated following the image features: signal intensities on T1WI, T2WI, and DWI, appearances on T2WI(T2 scar) and HBP(EOB scar), arterial enhancement pattern, washout pattern(venous hypoenhancement) on venous phase(2 minutes), uptake pattern on HBP, and chemical shifting on in- and out-of-phases. ADC values were also measured. Image features that were statistically significant by univariate analysis were entered into multivariate logistic regression analysis.  

 Interobserver agreement was excellent(κ>0.85). Among imaging features analyzed, signal intensities on T1WI and DWI, appearances on T2WI and HBP, arterial enhancement pattern, washout pattern on venous phase, uptake pattern on HBP were significantly different among the three groups. (p= <0.001, 0.010, 0.008, <0.001, <0.001, <0.001, and <0.001 respectively) In multivariate analysis, heterogeneous washout pattern on venous phase, heterogeneous uptake pattern on HBP, and heterogeneous arterial enhancement pattern were independent significant variables in the differentiation of HCC with paradoxical uptake from FNH or FNH-like nodule. (p = <0.001, <0.001, and <0.001, respectively)

 HCC showing paradoxical uptake on HBP in Gd-EOB-DTPA-enhanced liver MRI may be difficult to differentiate from FNH or FNH-like nodule. HCC with paradoxical uptake can be differentiated from FNH or FNH-like nodule on the basis of heterogeneous washout pattern on venous phase, heterogeneous uptake pattern on HBP, and heterogeneous arterial enhancement pattern in Gd-EOB-DTPA-enhanced MRI.

 Heterogeneous washout pattern on venous phase, heterogeneous uptake pattern on HBP, and heterogeneous arterial enhancement pattern in Gd-EOB-DTPA-enhanced liver MR imaging can be helpful in differentiating HCC with paradoxical uptake on HBP from FNH or FNH-like nodule.

Kim, J, Lee, C, Park, Y, Lee, J, Choi, J, Kim, K, Park, C, Can We Differentiate Hepatocellular Carcinoma (HCC) with Paradoxical Uptake on Hepatobiliary Phase(HBP) from Focal Nodular Hyperplasia (FNH) or FNH-like Nodule in Gd-EOB-DTPA-enhanced MR Imaging?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009287.html