Fatima Al-Sharhan1, Anthony Dohan2, Maxime Barat3, Adlane Feddal4, Benoit Terris5, Stanislas Pol6, Vincent Mallet7, Philippe Soyer8. 1. Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: Alsharhan.Fatima@outlook.fr. 2. Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: anthony.dohan@aphp.fr. 3. Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: maxime.barat@aphp.fr. 4. Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: adlane.feddal@aphp.fr. 5. Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: benoit.terris@aphp.fr. 6. Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Hepatology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: stanislas.pol@aphp.fr. 7. Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Hepatology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: vincent.mallet@aphp.fr. 8. Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: philippe.soyer@aphp.fr.
Abstract
PURPOSE: To describe the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic steatohepatitis (NASH). METHODS: MRI examinations of 21 patients with HCC and NASH were analyzed by two observers. There were 18 men and 3 women with a mean age of 67.9 ± 10.2 (SD) years (range: 36-85 years). Images were qualitatively and quantitatively analyzed with respect to imaging presentation. RESULTS: HCC presented as a single tumor in 13/21 patients (62%), with a mean longest diameter of 26.9 ± 20.2 (SD) mm (range: 12-88 mm); 17/30 HCC (57%) had a largest diameter <20 mm. A signal drop between in- and out-of-phase T1-weighted MR images was observed in 16/30 HCC nodules (53%). All HCC nodules (30/30; 100%) showed hyperenhancement on arterial phase images and 12/30 HCC nodules (40%) did not show a wash-out on portal or delayed phase images. Encapsulation was observed in 18/30 HCC nodules (60%). MRI findings consistent with liver cirrhosis were present in 16/21 patients (76%). CONCLUSIONS: Our results show that 57% of HCC in NASH can present as a lesion smaller than 20 mm and 40% do not display wash-out. These results suggest that classical imaging criteria developed for noninvasive diagnosis of HCC should be applied with caution to HCC in patients with NASH.
PURPOSE: To describe the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic steatohepatitis (NASH). METHODS: MRI examinations of 21 patients with HCC and NASH were analyzed by two observers. There were 18 men and 3 women with a mean age of 67.9 ± 10.2 (SD) years (range: 36-85 years). Images were qualitatively and quantitatively analyzed with respect to imaging presentation. RESULTS: HCC presented as a single tumor in 13/21 patients (62%), with a mean longest diameter of 26.9 ± 20.2 (SD) mm (range: 12-88 mm); 17/30 HCC (57%) had a largest diameter <20 mm. A signal drop between in- and out-of-phase T1-weighted MR images was observed in 16/30 HCC nodules (53%). All HCC nodules (30/30; 100%) showed hyperenhancement on arterial phase images and 12/30 HCC nodules (40%) did not show a wash-out on portal or delayed phase images. Encapsulation was observed in 18/30 HCC nodules (60%). MRI findings consistent with liver cirrhosis were present in 16/21 patients (76%). CONCLUSIONS: Our results show that 57% of HCC in NASH can present as a lesion smaller than 20 mm and 40% do not display wash-out. These results suggest that classical imaging criteria developed for noninvasive diagnosis of HCC should be applied with caution to HCC in patients with NASH.