Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Radiology. 2012 Oct;265(1):104-14. doi: 10.1148/radiol.12112649. Epub 2012 Aug 13.
To investigate the imaging features of hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced magnetic resonance (MR) images in patients with cirrhosis that may be associated with progression to hypervascular hepatocellular carcinoma (HCC).
The institutional review board approved this retrospective study and waived informed patient consent. This study included 135 patients with a diagnosis of hepatitis B-induced liver cirrhosis and 214 hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images. MR images were analyzed with respect to nodule size, degree of hypointensity at hepatobiliary phase (four grades), presence of fat, and signal intensity on T1- and T2-weighted and diffusion-weighted (DW) images. Univariate and multivariate Cox regression analyses were used to identify variables that are associated with developing hypervascular HCC.
On follow-up MR images, 139 nodules (65.0%) had no evidence of HCC (mean follow-up, 522 days) (group 1), but 75 (35.0%) became hypervascular HCC (mean follow-up, 388 days) (group 2). Univariable Cox analysis revealed that the degree of hypointensity on hepatobiliary phase images (P=.044 and .001) and hyperintensity on T2-weighted and DW images (P=.001 and .0001) was significantly related to the development of hypervascular HCC. According to the multivariable Cox analysis, no other variable significantly adjusted the model once hyperintensity at initial DW imaging was already included as an associated variable, (hazard ratio, 7.44; 95% confidence interval: 4.28, 12.94; P=.0001).
Hyperintensity on DW images in hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis is strongly associated with progression to hypervascular HCC.
研究肝硬化患者肝胆期钆塞酸增强磁共振（MR）图像中低血供低信号结节的影像学特征，这些特征可能与进展为高血供肝细胞癌（HCC）有关。
本回顾性研究经机构审查委员会批准，并豁免了患者知情同意。本研究纳入了 135 例诊断为乙型肝炎相关性肝硬化患者和 214 个肝胆期钆塞酸增强 MR 图像上的低血供低信号结节。分析了结节大小、肝胆期低信号程度（四级）、有无脂肪和 T1 加权、T2 加权及弥散加权（DW）图像上的信号强度。采用单变量和多变量 Cox 回归分析来确定与发生高血供 HCC 相关的变量。
在随访的 MR 图像上，139 个结节（65.0%）无 HCC 证据（平均随访时间 522 天）（1 组），但 75 个结节（35.0%）发展为高血供 HCC（平均随访时间 388 天）（2 组）。单变量 Cox 分析显示，肝胆期图像的低信号程度（P=.044 和.001）和 T2 加权及 DW 图像上的高信号（P=.001 和.0001）与发生高血供 HCC 显著相关。多变量 Cox 分析显示，一旦 DW 成像初始时的高信号被纳入相关变量，其他变量均不能显著调整模型，（风险比，7.44；95%置信区间：4.28，12.94；P=.0001）。
肝硬化患者肝胆期钆塞酸增强 MR 图像上低血供低信号结节的 DW 图像上的高信号与进展为高血供 HCC 密切相关。
