PURPOSE: To evaluate the natural history of incidental enhancing nodules (IEN) on contrast enhanced cone beam computed tomography (CE-CBCT) during transarterial treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A single-center retrospective analysis of 100 patients with HCC who underwent CE-CBCT prior to transarterial treatment from August 2015 to June 2019 was performed. Inclusion criteria were patients with segmental distribution sub-lobar HCC, CE-CBCT of the target lesion and non-target liver parenchyma, and follow-up cross sectional imaging. Patients with IEN ≥3 mm that did not meet imaging criteria for HCC were analyzed. Exclusion criteria included biphenotypic tumors and IEN present inside the treated area of the liver. RESULTS: Fifty-six percent of patients demonstrated a total of 154 IEN on CE-CBCT of which 13 IEN (8.5%) progressed to HCC. The mean primary tumor size was 29 mm (range: 10.2-189.0mm). 10 patients had ≥ 4 IEN and 46 patients had 1-3 IEN. Mean IEN size was 6.75 mm (range: 3.0-16.3mm). The median follow-up interval after CE-CBCT was 282 days (IQR: 143 - 522). Increased pretreatment AFP (≥15.5 ng/mL, p value: 0.035), having ≥4 IEN (p value: 0.020), and HCV (p value: 0.015) were significantly correlated with IEN progression to HCC. No statistically significant differences were identified in baseline neutrophil to lymphocyte ratio, targeted HCC characteristics (size, macrovascular invasion, infiltrative pattern, enhancement pattern, and satellite lesions), and IEN size between those with IEN progression to HCC and those without. CONCLUSION: Most IEN ≥ 3mm on CE-CBCT in patients with segmental distribution sub-lobar HCC do not progress to HCC. Patients with segmental distribution sub-lobar HCC with ≥4 IEN, AFP elevation (≥15.5 ng/mL), or HCV have an increased risk of IEN progression to HCC.
PURPOSE: To evaluate the natural history of incidental enhancing nodules (IEN) on contrast enhanced cone beam computed tomography (CE-CBCT) during transarterial treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A single-center retrospective analysis of 100 patients with HCC who underwent CE-CBCT prior to transarterial treatment from August 2015 to June 2019 was performed. Inclusion criteria were patients with segmental distribution sub-lobar HCC, CE-CBCT of the target lesion and non-target liver parenchyma, and follow-up cross sectional imaging. Patients with IEN ≥3 mm that did not meet imaging criteria for HCC were analyzed. Exclusion criteria included biphenotypic tumors and IEN present inside the treated area of the liver. RESULTS: Fifty-six percent of patients demonstrated a total of 154 IEN on CE-CBCT of which 13 IEN (8.5%) progressed to HCC. The mean primary tumor size was 29 mm (range: 10.2-189.0mm). 10 patients had ≥ 4 IEN and 46 patients had 1-3 IEN. Mean IEN size was 6.75 mm (range: 3.0-16.3mm). The median follow-up interval after CE-CBCT was 282 days (IQR: 143 - 522). Increased pretreatment AFP (≥15.5 ng/mL, p value: 0.035), having ≥4 IEN (p value: 0.020), and HCV (p value: 0.015) were significantly correlated with IEN progression to HCC. No statistically significant differences were identified in baseline neutrophil to lymphocyte ratio, targeted HCC characteristics (size, macrovascular invasion, infiltrative pattern, enhancement pattern, and satellite lesions), and IEN size between those with IEN progression to HCC and those without. CONCLUSION: Most IEN ≥ 3mm on CE-CBCT in patients with segmental distribution sub-lobar HCC do not progress to HCC. Patients with segmental distribution sub-lobar HCC with ≥4 IEN, AFP elevation (≥15.5 ng/mL), or HCV have an increased risk of IEN progression to HCC.