Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates

Reena C. Jha, Paulo A. Zanello, Xai Mai Nguyen, Marieta Pehlivanova, Lynt B. Johnson, Thomas Fishbein, Kirti Shetty

Research output: Contribution to journalArticle

Abstract

Rationale and Objectives: Current clinical practice favors imaging rather than biopsy to diagnose hepatocellular carcinoma (HCC). There is a need to better understand tumor biology and aggressiveness of HCC. Our goal is to investigate magnetic resonance imaging (MRI) features of HCC that are associated with faster growth rates (GRs). Materials and Methods: After approval from institutional review board, a retrospective evaluation was performed of pre-liver transplant patients. Fifty-two patients who developed a >2 cm HCC on serial imaging were included in the study group, with a total of 60 HCCs seen. Precursor foci were identified on serial MRIs before the specific diagnostic features of >2cm HCC could be made, and GRs and MRI features, including signal on T1- and T2-weighted images (WI), the presence of intralesional steatosis on chemical shift imaging, and enhancement pattern were analyzed. GRs were correlated with imaging features. Results: The average GR of precursor lesions to >2cm HCC was determined to be 0.23cm/mo (standard deviation [SD], 0.32), with a doubling time of 5.26months (SD, 5.44). The presence of increased signal intensity (SI) on T2-WI was associated with significantly higher growth (P=0002), whereas increased intensity on T1-WI at the initial study was associated with a significantly lower GR (P=0162). Furthermore, lesions with hypervascular enhancement with washout pattern had significantly higher GR (P=0164). There is no evidence of differences in GRs seen in lesions with steatosis. Conclusions: Small precursor lesions with increased SI on T2-WI and a washout pattern of enhancement are associated with faster GRs, which may suggest more aggressive tumor biology. These features may be helpful in patient management and surveillance for HCC.

Original languageEnglish (US)
Pages (from-to)1455-1464
Number of pages10
JournalAcademic Radiology
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Hepatocellular Carcinoma
Magnetic Resonance Imaging
Growth
Neoplasms
Research Ethics Committees
Transplants
Biopsy
Liver

Keywords

  • Diagnosis
  • Hepatocellular carcinoma
  • Liver cancer
  • Liver neoplasms
  • MR
  • Prognosis prediction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Jha, R. C., Zanello, P. A., Nguyen, X. M., Pehlivanova, M., Johnson, L. B., Fishbein, T., & Shetty, K. (2014). Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates. Academic Radiology, 21(11), 1455-1464. https://doi.org/10.1016/j.acra.2014.06.011

Small hepatocellular carcinoma : MRI findings for predicting tumor growth rates. / Jha, Reena C.; Zanello, Paulo A.; Nguyen, Xai Mai; Pehlivanova, Marieta; Johnson, Lynt B.; Fishbein, Thomas; Shetty, Kirti.

In: Academic Radiology, Vol. 21, No. 11, 01.11.2014, p. 1455-1464.

Research output: Contribution to journalArticle

Jha, RC, Zanello, PA, Nguyen, XM, Pehlivanova, M, Johnson, LB, Fishbein, T & Shetty, K 2014, 'Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates', Academic Radiology, vol. 21, no. 11, pp. 1455-1464. https://doi.org/10.1016/j.acra.2014.06.011
Jha RC, Zanello PA, Nguyen XM, Pehlivanova M, Johnson LB, Fishbein T et al. Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates. Academic Radiology. 2014 Nov 1;21(11):1455-1464. https://doi.org/10.1016/j.acra.2014.06.011
Jha, Reena C. ; Zanello, Paulo A. ; Nguyen, Xai Mai ; Pehlivanova, Marieta ; Johnson, Lynt B. ; Fishbein, Thomas ; Shetty, Kirti. / Small hepatocellular carcinoma : MRI findings for predicting tumor growth rates. In: Academic Radiology. 2014 ; Vol. 21, No. 11. pp. 1455-1464.
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abstract = "Rationale and Objectives: Current clinical practice favors imaging rather than biopsy to diagnose hepatocellular carcinoma (HCC). There is a need to better understand tumor biology and aggressiveness of HCC. Our goal is to investigate magnetic resonance imaging (MRI) features of HCC that are associated with faster growth rates (GRs). Materials and Methods: After approval from institutional review board, a retrospective evaluation was performed of pre-liver transplant patients. Fifty-two patients who developed a >2 cm HCC on serial imaging were included in the study group, with a total of 60 HCCs seen. Precursor foci were identified on serial MRIs before the specific diagnostic features of >2cm HCC could be made, and GRs and MRI features, including signal on T1- and T2-weighted images (WI), the presence of intralesional steatosis on chemical shift imaging, and enhancement pattern were analyzed. GRs were correlated with imaging features. Results: The average GR of precursor lesions to >2cm HCC was determined to be 0.23cm/mo (standard deviation [SD], 0.32), with a doubling time of 5.26months (SD, 5.44). The presence of increased signal intensity (SI) on T2-WI was associated with significantly higher growth (P=0002), whereas increased intensity on T1-WI at the initial study was associated with a significantly lower GR (P=0162). Furthermore, lesions with hypervascular enhancement with washout pattern had significantly higher GR (P=0164). There is no evidence of differences in GRs seen in lesions with steatosis. Conclusions: Small precursor lesions with increased SI on T2-WI and a washout pattern of enhancement are associated with faster GRs, which may suggest more aggressive tumor biology. These features may be helpful in patient management and surveillance for HCC.",
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AU - Zanello, Paulo A.

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AU - Shetty, Kirti

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