Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

2017 ◽  
Vol 26 (4) ◽  
pp. 387-393 ◽  
Author(s):  
Andreea E. Scheau ◽  
Cristian Scheau ◽  
Ioana G. Lupescu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
Magnetic Resonance ◽  
Transarterial Chemoembolization ◽  
Hepatitis Virus ◽  
Statistical Significance ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Nodule Morphology

Background & Aims: Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient’s prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence.Method: Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study.Results: All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a “classical” enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria.Conclusions: Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.Abbreviations. ADC: Apparent diffusion coefficient; CT: Computed tomography; DEB-TACE: drug-eluting beads transarterial chemoembolization; DWI: Diffusion-weighted imaging; Gd-EOB-DTPA: acidum gadoxeticum; HCC: hepatocellular carcinoma; HBV: hepatitis virus B; HCV: hepatitis virus C; HDV: hepatitis virus D; IN-OPP: in-phase and out-of-phase; mRECIST: modified Response Evaluation Criteria in Solid Tumors; MRI: Magnetic resonance imaging; ROI: region of interest; TACE: Transarterial chemoembolization; WI: weighted imaging.

scholarly journals Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment – Part 2

2017 ◽  
Vol 50 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Miguel Ramalho ◽  
António P. Matos ◽  
Mamdoh AlObaidy ◽  
Fernanda Velloni ◽  
Ersan Altun ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
Magnetic Resonance ◽  
Diagnostic Algorithm ◽  
Response To Treatment ◽  
Locoregional Therapy ◽  
Liver Imaging ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Abstract In the second part of this review, we will describe the ancillary imaging features of hepatocellular carcinoma (HCC) that can be seen on standard magnetic resonance imaging (MRI) protocol, and on novel and emerging protocols such as diffusion weighted imaging and utilization of hepatocyte-specific/hepatobiliary contrast agent. We will also describe the morphologic sub-types of HCC, and give a simplified non-invasive diagnostic algorithm for HCC, followed by a brief description of the liver imaging reporting and data system (LI-RADS), and MRI assessment of tumor response following locoregional therapy.

scholarly journals An overview of hepatocellular carcinoma with atypical enhancement pattern: spectrum of magnetic resonance imaging findings with pathologic correlation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jelena Djokic Kovac ◽  
Aleksandar Ivanovic ◽  
Tamara Milovanovic ◽  
Marjan Micev ◽  
Francesco Alessandrino ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
Magnetic Resonance ◽  
Cirrhotic Liver ◽  
Hepatobiliary Phase ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Enhancement Pattern ◽  
Diffusion Restriction ◽  
Mri Features

Abstract Background In the setting of cirrhotic liver, the diagnosis of hepatocellular carcinoma (HCC) is straightforward when typical imaging findings consisting of arterial hypervascularity followed by portal-venous washout are present in nodules larger than 1 cm. However, due to the complexity of hepatocarcinogenesis, not all HCCs present with typical vascular behaviour. Atypical forms such as hypervascular HCC without washout, isovascular or even hypovascular HCC can pose diagnostic dilemmas. In such cases, it is important to consider also the appearance of the nodules on diffusion-weighted imaging and hepatobiliary phase. In this regard, diffusion restriction and hypointensity on hepatobiliary phase are suggestive of malignancy. If both findings are present in hypervascular lesion without washout, or even in iso- or hypovascular lesion in cirrhotic liver, HCC should be considered. Moreover, other ancillary imaging findings such as the presence of the capsule, fat content, signal intensity on T2-weighted image favour the diagnosis of HCC. Another form of atypical HCCs are lesions which show hyperintensity on hepatobiliary phase. Therefore, the aim of the present study was to provide an overview of HCCs with atypical enhancement pattern, and focus on their magnetic resonance imaging (MRI) features. Conclusions In order to correctly characterize atypical HCC lesions in cirrhotic liver it is important to consider not only vascular behaviour of the nodule, but also ancillary MRI features, such as diffusion restriction, hepatobiliary phase hypointensity, and T2-weighted hyperintensity. Fat content, corona enhancement, mosaic architecture are other MRI feautures which favour the diagnosis of HCC even in the absence of typical vascular profile.

scholarly journals Comparison of LI-RADS 2018 and KLCA-NCC 2018 for noninvasive diagnosis of hepatocellular carcinoma using magnetic resonance imaging

2020 ◽  
Vol 26 (3) ◽  
pp. 340-351 ◽  
Author(s):  
Sunyoung Lee ◽  
Seung-seob Kim ◽  
Dong ryul Chang ◽  
Hyerim Kim ◽  
Myeong-Jin Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hepatocellular Carcinoma ◽  
High Risk ◽  
Magnetic Resonance ◽  
Statistical Significance ◽  
Liver Imaging ◽  
Noninvasive Diagnosis ◽  
Resonance Imaging ◽  
Extracellular Contrast Agent ◽  
Significant Difference

Background/Aims: This study aimed to compare the diagnostic performances of Liver Imaging Reporting and Data System (LI-RADS) 2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.Methods: This retrospective study included 273 treatment-naïve patients (71 patients with extracellular contrast agent [ECA]-MRI and 202 patients with hepatobiliary agent [HBA]-MRI; 352 lesions including 263 HCCs) with high risk of HCC who underwent contrast-enhanced MRI between 2016 and 2017. Two readers evaluated all lesions according to the criteria of LI-RADS 2018 and KLCA-NCC 2018. The per-lesion diagnostic performances were compared using the generalized estimating equation method.Results: On ECA-MRI, the sensitivity and specificity of LI-RADS 2018 and KLCA-NCC 2018 were not significantly different (LR-5 vs. definite HCC: 75.8% vs. 69.4%, <i>P</i>=0.095 and 95.8% vs. 95.8%, <i>P</i>>0.999; LR-5/4 vs. definite/probable HCC: 87.1% vs.83.9%, P=0.313 and 87.5% vs. 91.7%, <i>P</i>=0.307). On HBA-MRI, definite HCC of KLCA-NCC 2018 showed significantly higher sensitivity (79.1% vs. 68.2%, <i>P</i><0.001) than LR-5 of LI-RADS 2018 without a significant difference in specificity (93.9% vs. 95.4%, <i>P</i>=0.314). Definite/probable HCC of KLCA-NCC 2018 had higher specificity (92.3% vs. 80.0%, <i>P</i>=0.003) than LR-5/4 of LI-RADS 2018. The sensitivity was lower for definite/probable HCC than for LR-5/4 without statistical significance (85.6% vs. 88.1%, <i>P</i>=0.057).Conclusions: On ECA-MRI, LI-RADS 2018 and KLCA-NCC 2018 showed comparable diagnostic performances. On HBA-MRI, definite HCC of KLCA-NCC 2018 provided better sensitivity than LR-5 category of LI-RADS 2018 without compromising the specificity, while definite/probable HCC of KLCA-NCC 2018 revealed higher specificity than LR-5/4 of LI-RADS 2018 for diagnosing HCC.

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