Tae-Hyung Kim1,2, Sungmin Woo3, Sangwon Han4, Chong Hyun Suh5, Dong Ho Lee1,6, Jeong Min Lee1,6,7. 1. Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea. 2. Department of Radiology, Naval Pohang Hospital, Pohang, Republic of Korea. 3. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. woos@mskcc.org. 4. Department of Nuclear Medicine, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea. 5. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea. 6. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. 7. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Abstract
OBJECTIVE: To perform a systematic review and meta-analysis to determine intrahepatic distant recurrence (IDR) risk of hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on pretreatment gadoxetic acid-enhanced MRI in patients with hepatocellular carcinoma (HCC) treated with either hepatectomy or radiofrequency ablation (RFA). METHODS: PubMed and EMBASE databases were searched up to April 6, 2019. We included studies that evaluated HBP hypointense nodules without APHE as risk factors for IDR in HCC patients treated with either hepatectomy or RFA. Hazard ratios (HR) were meta-analytically pooled using random effects model. Subgroup analyses stratified to clinicopathologic variables were performed to explore heterogeneity. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. RESULTS: Eight studies with 842 patients were analyzed. The overall pooled HR for IDR was 2.44 (95% CI, 1.99-2.98) and were 2.14 (95% CI, 1.66-2.76) and 3.07 (95% CI, 2.19-4.31) for patients that underwent hepatectomy and RFA, respectively. No significant heterogeneity was present (I2 = 0%). The presence of these nodules was consistently shown to be significant factors for IDR in other subgroups (HR = 1.74-3.07). Study quality was generally moderate. CONCLUSIONS: HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. Stratification of patient management with regard to performing additional tests or treatment for these nodules and modification of proper follow-up strategies may be required in patients with HCC who have these nodules on pretreatment gadoxetic acid-enhanced MRI. KEY POINTS: • HBP hypointense nodules without APHE constitute an entity that is unique in gadoxetic acid-enhanced MRI. • HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. • Stratification of management and modification of proper follow-up strategies may be required in HCC patients who have these nodules on pretreatment gadoxetic acid-enhanced MRI.
OBJECTIVE: To perform a systematic review and meta-analysis to determine intrahepatic distant recurrence (IDR) risk of hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on pretreatment gadoxetic acid-enhanced MRI in patients with hepatocellular carcinoma (HCC) treated with either hepatectomy or radiofrequency ablation (RFA). METHODS: PubMed and EMBASE databases were searched up to April 6, 2019. We included studies that evaluated HBP hypointense nodules without APHE as risk factors for IDR in HCCpatients treated with either hepatectomy or RFA. Hazard ratios (HR) were meta-analytically pooled using random effects model. Subgroup analyses stratified to clinicopathologic variables were performed to explore heterogeneity. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. RESULTS: Eight studies with 842 patients were analyzed. The overall pooled HR for IDR was 2.44 (95% CI, 1.99-2.98) and were 2.14 (95% CI, 1.66-2.76) and 3.07 (95% CI, 2.19-4.31) for patients that underwent hepatectomy and RFA, respectively. No significant heterogeneity was present (I2 = 0%). The presence of these nodules was consistently shown to be significant factors for IDR in other subgroups (HR = 1.74-3.07). Study quality was generally moderate. CONCLUSIONS: HBP hypointense nodules without APHE are risk factors for IDR in HCCpatients treated with either RFA or hepatectomy. Stratification of patient management with regard to performing additional tests or treatment for these nodules and modification of proper follow-up strategies may be required in patients with HCC who have these nodules on pretreatment gadoxetic acid-enhanced MRI. KEY POINTS: • HBP hypointense nodules without APHE constitute an entity that is unique in gadoxetic acid-enhanced MRI. • HBP hypointense nodules without APHE are risk factors for IDR in HCCpatients treated with either RFA or hepatectomy. • Stratification of management and modification of proper follow-up strategies may be required in HCCpatients who have these nodules on pretreatment gadoxetic acid-enhanced MRI.
Authors: Tae-Hyung Kim; Sungmin Woo; Sangwon Han; Chong Hyun Suh; Richard Kinh Gian Do; Jeong Min Lee Journal: Acad Radiol Date: 2020-09-20 Impact factor: 5.482