Matteo Renzulli1, Federica Buonfiglioli2, Fabio Conti2, Stefano Brocchi1, Ilaria Serio3, Francesco Giuseppe Foschi4, Paolo Caraceni5, Giuseppe Mazzella5, Gabriella Verucchi2, Rita Golfieri1, Pietro Andreone2, Stefano Brillanti6,7. 1. Department of Diagnostic Medicine and Prevention, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 2. Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy. 3. Department of Digestive Diseases, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 4. Division of Internal Medicine, Ospedale di Faenza, Faenza, Italy. 5. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy. 6. Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy. stefano.brillanti@unibo.it. 7. U.O. di Gastroenterologia, Via Massarenti 9, 40138, Bologna, Italy. stefano.brillanti@unibo.it.
Abstract
OBJECTIVES: To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis. METHODS: Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48-74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA. RESULTS: After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0-318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10-20 mm in 27, 20-50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54-84), even in 17/29 nodules with 10-20 mm diameter (58.6%, CI: 39-76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22-47) (p= 0.0007). MVI did not correlate with history of previous HCC. CONCLUSIONS: HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients. KEY POINTS: • In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy. • HCC presents imaging features of microvascular invasion, predictive of more aggressive progression. • Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.
OBJECTIVES: To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis. METHODS: Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48-74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA. RESULTS: After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0-318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10-20 mm in 27, 20-50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54-84), even in 17/29 nodules with 10-20 mm diameter (58.6%, CI: 39-76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22-47) (p= 0.0007). MVI did not correlate with history of previous HCC. CONCLUSIONS: HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhoticpatients. KEY POINTS: • In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy. • HCC presents imaging features of microvascular invasion, predictive of more aggressive progression. • Cirrhoticpatients need aggressive and close monitoring after direct-acting antiviral therapy.
Entities:
Keywords:
Computed tomography; Drug side effects; Hepatitis C; Liver neoplasms; Magnetic resonance imaging
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