Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2013; 19(42): 7433-7439
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7433
Differentiation between dysplastic nodule and early-stage hepatocellular carcinoma: The utility of conventional MR imaging
Chen-Te Chou, Jung-Mao Chou, Ting-An Chang, Shiu-Feng Huang, Chia-Bang Chen, Yao-Li Chen, Ran-Chou Chen
Chen-Te Chou, Ran-Chou Chen, Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei 112, Taiwan
Chen-Te Chou, Chia-Bang Chen, Department of Radiology, Chang-Hua Christian Hospital, Chang-Hua 500, Taiwan
Jung-Mao Chou, Ting-An Chang, Shiu-Feng Huang, Department of Pathology, Taipei City Hospital, Taipei 106, Taiwan
Yao-Li Chen, Transplant Medicine and Surgery Research Centre, Chang-Hua Christian Hospital, Chang-Hua 500, Taiwan
Ran-Chou Chen, Department of Radiology, Taipei City Hospital, Taipei 106, Taiwan
Author contributions: Chou CT and Chen RC designed the research; Chou CT, Chen CB, Chou JM, Chang TA, and Huang SF performed the research; Chen RC and Chen YL analyzed the data; and Chou CT, Chou JM and Chen RC wrote the manuscript.
Correspondence to: Ran-Chou Chen, MD, Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Beitou District, Taipei 112, Taiwan. chenranchou@yahoo.com.tw
Telephone: +886-2-27093600-5103 Fax: +886-2-27040013
Received: June 22, 2013
Revised: August 16, 2013
Accepted: September 16, 2013
Published online: November 14, 2013
Abstract

AIM: To elucidate the variety of ways early-stage hepatocellular carcinoma (HCC) can appear on magnetic resonance (MR) imaging by analyzing T1-weighted, T2-weighted, and gadolinium-enhanced dynamic studies.

METHODS: Seventy-three patients with well-differentiated HCC (wHCC) or dysplastic nodules were retrospectively identified from medical records, and new histological sections were prepared and reviewed. The tumor nodules were categorized into three groups: dysplastic nodule (DN), wHCC compatible with Edmondson-Steiner grade I HCC (w1-HCC), and wHCC compatible with Edmondson-Steiner grade II HCC (w2-HCC). The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.

RESULTS: Among the 73 patients, 14 were diagnosed as having DN, 40 were diagnosed as having w1-HCC, and 19 were diagnosed as having w2-HCC. Hyperintensity measurements on T2-weighted axial images (T2WI) were statistically significant between DNs and wHCC (P = 0.006) and between DN and w1-HCC (P = 0.02). The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC. Hyperintensity on both T1W out-phase imaging (P = 0.007) and arterial enhancement on dynamic study (P = 0.005) showed statistically significant differences between w1-HCC and w2-HCC. The other imaging features revealed no significant differences between w1-HCC and w2-HCC.

CONCLUSION: In the follow-up for a cirrhotic nodule, increased signal intensity on T2WI may be a sign of malignant transformation. Furthermore, a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.

Keywords: Dysplastic nodule, Hepatocellular carcinoma, Histological grading, Magnetic resonance imaging, Well-differentiated hepatocellular carcinoma

Core tip: The aim of this article was to differentiate between early-stage hepatocellular carcinoma (HCC) and dysplastic nodules using conventional magnetic resonance (MR) imaging. We found that conventional MR imaging could provide additional information to differentiate between early-stage HCC and dysplastic nodules in equivocal lesions. During follow-up for a cirrhotic nodules, increased signal intensity on T2-weighted axial images may be a sign of malignant transformation. Loss of hyperintensity on T1WI and the detection of arterial enhancement may indicate further progression of the histological grade.