Kyoung Doo Song MD, Abstract Co-Author: Nothing to Disclose

Seong Hyun Kim, Abstract Co-Author: Nothing to Disclose

Hyo Keun Lim MD, Abstract Co-Author: Nothing to Disclose

Jisun Lee, Presenter: Nothing to Disclose

Seong-Yoon Ryu MD, Abstract Co-Author: Nothing to Disclose

To evaluate the natural course of subcentimeter hypervascular nodule at high-risk for developing to hepatocellular carcinoma (HCC) (SHNHR) by using a serial follow-up with gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in patients with chronic liver disease.

Institutional review board approval was obtained, and informed consent was waived. A SHNHR was defined as a subcentimeter hypervascular nodule having typical imaging findings of HCC on gadoxetic acid-enhanced MRI and DWI. We included 43 patients who had newly detected 50 SHNHRs. The progression rate to overt HCC was calculated by the Kaplan-Meier method. Cox proportional hazard model was used to evaluate the independent prognostic significance of baseline covariates for progression to overt HCC.

The median follow-up period was 139 days (range, 58 – 394 days). The cumulative progression rate to overt HCC at 3, 6, 9, and 12 months were 16.8%, 62.8%, 82.1%, and 88.1%. The initial size of SHNHR at baseline MRI was the significant predictor of increased risk of progression to overt HCC in univariate (hazard ratio [HR] = 1.399; 95% confidence interval [CI]: 1.132, 1.728; p = 0.002) and multivariate analysis (HR = 1.647; 95% CI: 1.229, 2.206; p = 0.001), and its optimal cut-off value was 5 mm based on the time-dependent receiver operating characteristic curve at 12 months.

The progression rate of SHNHR to overt HCC within 12 months was very high (88.1%). The initial size of SHNHR at baseline MRI was a significant risk factor for progression to overt HCC.

1. Prompt treatment of SHNHRs may be justified, given the very high (88.1%) progression rate of SHNHR to overt HCC within 12 months. 2. If SHNHRs are followed up without any treatment, MRI follow-up at 3-month intervals seems to be reasonable. 3. If management strategy is determined by the risk for progression to overt HCC, 5 mm or less SHNHRs can be followed up without any treatment and prompt treatment may be considered for SHNHRs greater than 5 mm in the greatest dimension.  

Song, K, Kim, S, Lim, H, Lee, J, Ryu, S, Subcentimeter Hypervascular Nodule at High-risk for Hepatocellular Carcinoma in Patients with Chronic Liver Disease: Natural Course on Serial Gadoxetic Acid-enhanced MRI and Diffusion-weighted Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015436.html