Non-invasive diagnosis of small hepatocellular carcinoma

February's issue of the Alimentary Pharmacology & Therapeutics examines the Impact of gadoxetic acid-enhanced magnetic resonance on the non-invasive diagnosis of small hepatocellular carcinoma.

Gadoxetic acid is a ‘hepatocyte-specific’ contrast agent for magnetic resonance in both the vascular and the hepatobiliary phases.

Dr Granito and colleagues from Italy evaluated the contribution of the hepatobiliary phase of gadoxetic acid in the diagnosis of small hepatocellular carcinoma in cirrhotic patients under surveillance.

Between 2008 and 2011, the team detected 48 consecutive small liver nodules were detected in 33 patients.

The patients prospectively underwent contrast-enhanced ultrasound, gadoxetic acid-enhanced (Gd-EOB-DTPA) magnetic resonance (MR), and helical-computed tomography in a blind study.

The diagnosis of hepatocellular carcinoma was established according to AASLD 2005 criteria.

Of the 48 nodules, the researchers diagnosed 38 as hepatocellular carcinoma.

The team reported that of the 38 diagnosed, 24 were based on AASLD non-invasive criteria, 11 were diagnosed at histology, and 3 during follow-up.

8 of the 38 nodules showed hypointensity in the hepatobiliary phase at MRI

Alimentary Pharmacology & Therapeutics

The typical vascular pattern was detected in 30 hepatocellular carcinoma nodules by magnetic resonance, in 22 by helical-computed tomography and in 17 by contrast-enhanced ultrasound.

The team of doctors observed hypointensity during the magnetic resonance hepatobiliary phase in all hepatocellular carcinoma nodules, and in 3 nonmalignant nodules.

The team noted that 8 of the 38 hepatocellular carcinoma nodules, 7 of which lacked the typical vascular features at any of the imaging modalities, showed washout in the portal/venous phase and hypointensity in the hepatobiliary phase at MRI, while this pattern was not detected in any nonmalignant lesion.

Dr Granito and team comment, "Gadoxetic acid magnetic resonance may enhance the sensitivity of the non-invasive diagnosis of small hepatocellular carcinoma nodules in cirrhotic patients under surveillance."

"Double hypointensity in the portal/venous and hepatobiliary phases could be considered a new magnetic resonance pattern, highly suggestive of hypovascular hepatocellular carcinoma."