Diagnosis and Management of Hypovascular Nodules in Cirrhotic Liver

Abstract

　Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (EOB-MRI) is recommended to detect hypovascular hepatocellular carcinoma (HCC), most cases of which are well differentiated HCC or early HCC. The detection sensitivity of hypovascular HCC is superior on EOB-MRI than on dynamic computed tomography (CT), superparamagnetic iron oxide (SPIO)-MRI, or contrast-enhanced ultrasonography (CE-US), although EOB-MRI shows similar diagnostic accuracy as CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). Thus, EOB-MRI is the ideal imaging modality to detect early HCC.

　Small hypovascular nodules are sometimes detected only in the hepatocyte phase on EOB-MRI. A high-intensity area on a T₂-weighted or diffusion-weighted image and the high growth rate of 1.8×10⁻³/day are the predictive factors for arterial hypervascularization of the hypovascular nodules.

　EOB-MRI has a high impact on the diagnostic algorithm of HCC.