Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis

Eur Radiol. 2017 Feb;27(2):518-525. doi: 10.1007/s00330-016-4423-2. Epub 2016 Jun 2.


Objectives: To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images.

Methods: In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules.

Results: The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule's initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01).

Conclusions: Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination.

Key points: • Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules • The risk of hypervascularization in a nodule increased with large size • Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up.

Keywords: Gadoxetic acid-enhanced magnetic resonance imaging; Hepatocellular carcinoma; Hyperintensity; Hypervascularization; Hypovascular hepatic nodules.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnosis*
  • Contrast Media / metabolism
  • Female
  • Gadolinium DTPA / metabolism
  • Hepatocytes / pathology
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology
  • Liver Neoplasms / diagnosis*
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnosis*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA