The Predictive Value Of Gd-EOB-DTPA-MRI In The Progression Of Hypovascular Hypointense Nodules On Hepatobiliary Phase To Hypervacular Hepatocellular Carcinoma

[Objective]Imaging follow-up was conducted to observe the natural evolution of hypovascular hypointense nodules on hepatobiliary phase in the context of liver cirrhosis,and to analyze the predictive factors of hypovascular hypointense nodules on hepatobiliary phase that progress to hypervascular hepatocellular carcinoma.[Materials and Methods]This study analyzed baseline imaging features and clinical features of 67 patients with 182 hypovascular hypointense nodules on hepatobiliary phase.Dynamic contrast MRI or CT were used to follow-up these nodules and to verify whether these nodules progressed to hypervascular hepatocellular carcinoma.The cumulative rate of progression of hypovascular hypointense nodules on hepatobiliary phase to hypervascular hepatocellular carcinoma was calculated,the predictive factors of these nodules that evolved into hypervascular hepatocellular carcinoma were analyzed and serial imaging changes of these nodules during follow-up were observed.[Result]Among the 182 hypovascular hypointense nodules on hepatobiliary phase,46(25.3%)nodules progressed to hypervascular hepatocellular carcinoma.Using Kaplan-Meier analysis,the 1-year cumulative rate of progression of hypovascular hypointense nodules to hypervascular hepatocellular carcinoma was 21.4%.The multivariate Cox analysis revealed that the hyperintensity on baseline T2-weighted image(p=0.018,HR:6.732,CI:1.390-32.602)of hypovascular hypointense nodules was identified as risk factor for progression to hypervascular hepatocellular carcinoma.The cumulative rates of progression of hypovascular hypointense nodules to hypervascular hepatocellular carcinoma with hyperintense on baseline T2-weight image was significantly higher than those with isointense or hypointense on initial T2-weight image,and the difference between the two groups was statistically significant(p<0.001).Among the 46 nodules those evolved into hypervascular hepatocellular carcinoma,a total of 34(73.9%)nodules performed hyperintense on initial T2-weighted image or a new finding of hyperintense on follow-up T2-weighted image.[Conclusion]Hyperintense on initial T2-weighted image of hypovascular hypointense nodules in patient with cirrhosis was risk factor for progression to hypervascular hepatocellular carcinoma.The serial imaging changes of hypovascular hypointense nodules during the dynamic follow-up could indicate evolution,among which hyperintense on T2-weighted image was more characteristic.