Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis

To evaluate the prognosis of "strict" high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis. The study included thirty-three patients with 60 "strict" high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization). Ten (16.7 %) of 60 "strict" high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 +/- 4.5 mm/year) were significantly higher than those in group B (3.4 +/- 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 +/- 189.5 day) was significantly shorter than in group B (419 +/- 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization. Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization. aEuro cent "Strict" high-risk nodules are defined as hepatocellular nodules detected only in the hepatobiliary-phase. aEuro cent Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods. aEuro cent Increased growth rate is an important predictive factor for hypervascular transformation. aEuro cent Management of patients with "strict" high-risk nodules becomes more appropriate.