Hepatobiliary-Phase Hypointense Nodules Without Arterial-Phase Hyperenhancement: Developing a Risk Stratification for Hypervascular Transformation Based on a Real-World Observational Cohort Study

• Published in: Technology in cancer research & treatment 2024-01, Vol.23, p.15330338241299003
• Main Authors: Li, Na, Wang, Yi, Yang, Li, Yang, Chun, Zeng, Mengsu
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Cell Transformation, Neoplastic; Contrast Media; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Liver - blood supply; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neovascularization, Pathologic - diagnostic imaging; Neovascularization, Pathologic - pathology; Retrospective Studies; Risk Assessment
• ISSN: 1533-0346; 1533-0338; 1533-0338
• DOI: 10.1177/15330338241299003

Purpose To develop a risk stratification based on MRI features to predict hypervascular transformation for hepatobiliary-phase (HBP) hypointense nodules without arterial-phase hyperenhancement (APHE). Materials and methods This retrospective observational cohort study included 55 HBP hypointense nodules without APHE in 35 patients with chronic liver disease, cirrhosis, or current hepatocellular carcinoma (HCC) who underwent gadoxetic acid-enhanced MRI. The hypervascular transformation during the follow-up MRI(s) was the primary endpoint analyzed for the nodules. Univariable and multivariable Cox proportional hazard regression analyses were performed to identify risk features predicting transformation and assess their predictive value. Results Among the 55 nodules, 27 developed hypervascular transformation, while 28 did not. Diffusion-weighted imaging (DWI) hyperintensity (hazard ratio [HR], 4.98; 95% confidence interval [CI]: 1.60, 15.54; p = 0.006) and portal venous phase (PVP) hypointensity (HR, 4.08; 95% CI: 1.43, 11.64; p = 0.009) were associated with hypervascular transformation. DWI hyperintensity and PVP hypointensity had 44.4% (95% CI: 26.0%, 64.4%) and 81.9% (95% CI: 61.3%, 93.0%) sensitivity, while their specificity was 78.2% (95% CI: 64.6%, 87.8%) and 67.9 (95% CI: 47.6%, 83.4%), respectively. The specificity of the combination of two features was 100% (95% CI: 85.0%, 100%). The hypervascular transformation rates for nodules with both, either and neither of the risk MRI findings were 100% (10/10), 60.9% (14/23), and 13.6% (3/22), respectively; the median intervals for transformation were 312 (range: 73–838), 409 (range: 50–1643) and 555 (range: 423–968) days, respectively. Conclusion The combination of DWI hyperintensity and PVP hypointensity may be used as a high-risk indicator for the hypervascular transformation of HBP hypointense nodules without APHE; nodules without either feature may be treated as low-risk nodules and could adopt an extended interval follow-up schedule.