• Massimo Galia, Francesco Agnello, Gianvincenzo Sparacia, Domenica Matranga, Domenico Albano, Massimo Midiri, and Roberto Lagalla.
• Department of Radiology, University of Palermo, Via XII Gennaio 1/g, 90141, Palermo, Italy.
• Radiol Med. 2018 Jul 1; 123 (7): 489-497.

PurposeTo retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development.Materials And MethodsThis IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC).ResultsOn follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development.ConclusionIndeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

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