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Non-alcoholic fatty liver disease-associated hepatocellular carcinoma: effect of hepatic steatosis on major hepatocellular carcinoma features at MRI.
Thompson, Scott M; Garg, Ishan; Ehman, Eric C; Sheedy, Shannon P; Bookwalter, Candice A; Carter, Rickey E; Roberts, Lewis R; Venkatesh, Sudhakar K.
Afiliación
  • Thompson SM; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Garg I; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Ehman EC; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Sheedy SP; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Bookwalter CA; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Carter RE; 2 Division of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine, Mayo Clinic , Jacksonville, FL , USA.
  • Roberts LR; 3 Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
  • Venkatesh SK; 1 Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic , Rochester, MN , USA.
Br J Radiol ; 91(1092): 20180345, 2018 Dec.
Article en En | MEDLINE | ID: mdl-30074820
ABSTRACT

OBJECTIVE:

To evaluate the effect of hepatic steatosis on LI-RADS® major features at MRI in patients with non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC).

METHODS:

HCC and liver parenchyma features at MRI from 48 consecutive patients with NAFLD and histology proven HCC (mean ± SD; 4.5 ± 3.4 cm) were independently reviewed by three radiologists. Inter-rater agreement was determined by prevalence/bias-adjusted kappa. Hepatic fat signal fraction (FS%) was independently calculated. HCC features were compared by FS% at MRI using logistic regression analysis and histologic steatosis grade using Cochran-Armitage test for trend, stratified by cirrhotic liver morphology or histologic fibrosis stage. Receiver operating characteristic curves were generated to determine the sensitivity and specificity for major HCC features by FS%.

RESULTS:

Major HCC features included arterial phase hyperenhancement (APHE) in 45 (93%), portal venous phase washout (PVWO) in 30 (63%), delayed phase washout (DPWO) in 38 (79%) and enhancing "capsule" in 34 (71%). Cirrhotic morphology was present in 22 (46%). Inter-rater agreement was 0.75 for APHE, 0.42-0.58 for PVWO, 0.58-0.71 for DPWO and 0.38-0.67 for enhancing "capsule". There was an 18%, 14% and 22% increase in the odds of absent PVWO, DPWO and capsule appearance for every 1% increase in hepatic FS% in patients with non-cirrhotic liver morphology (p = 0.011, 0.040 and 0.029, respectively). Hepatic FS% ≥ 14.8% had a sensitivity and specificity of 64 and 100% for absent PVWO and 71 and 90% for absent DPWO in patients with non-cirrhotic liver morphology.

CONCLUSION:

Absent washout and capsule appearance are associated with increasing hepatic steatosis in patients with non-cirrhotic, NAFLD-associated HCC. ADVANCES IN KNOWLEDGE In patients with non-cirrhotic, non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC), absent HCC washout and capsule appearance are associated with increasing hepatic steatosis, thereby potentially impacting the noninvasive imaging diagnosis of HCC in these patients. Lack of washout or capsule appearance in steatotic livers at MRI may require alternative criteria for the diagnosis of HCC in patients with non-cirrhotic NAFLD.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Imagen por Resonancia Magnética / Carcinoma Hepatocelular / Enfermedad del Hígado Graso no Alcohólico / Hígado / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Radiol Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Imagen por Resonancia Magnética / Carcinoma Hepatocelular / Enfermedad del Hígado Graso no Alcohólico / Hígado / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Radiol Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos