Effect of hepatic fat fraction on major hepatocellular carcinoma features at magnetic resonance imaging

Background: Hepatocellular carcinoma (HCC) is the fifth most frequent cancer on the world. Fat accumulation within hepatocytes is known as hepatic steatosis. In recent years, research has found that people with non-alcoholic fatty liver disease have a higher chance of developing HCC. The LI-RADS((R)) (Liver Imaging Reporting and Data System) was created to facilitate consistent reporting of imaging findings in patients at risk of HCC. The aim of this study was to see how hepatic fat fraction affects the LI-RADS major HCC features on magnetic resonance imaging (MRI). Results: All HCCs (92/92; 100%) showed arterial phase hyperenhancement (APHE); however, a significant association between hepatic steatosis and late APHE was found. Encapsulation was observed in 51 HCC (55.4%); in hepatic steatosis patients 17 HCC (37.8%) displayed enhancing capsule in delayed phase of the study, compared to 34 HCC (72.3%) in non-steatotic patients. The HCC size ranged from 11 to 200 mm (Mean 42.2 +/- 51.8 mm) in the hepatic steatosis group; however, in patients with negative hepatic steatosis the size ranged from 13 to 205 (Mean 62.9 +/- 54.5 mm). Conclusions: Hepatic steatosis had a significant association with absent enhancing capsule, late arterial enhancement, as well as a lesion size less than 50 mm. "Fat sparing in solid mass" and "non-enhancing capsule" ancillary features had a significant association with hepatic steatosis, while "mild-moderate T2 hyperintensity" and "fat in mass, more than adjacent liver" ancillary features had a significant association with absent hepatic steatosis.