Large (≥2cm) non-hypervascular nodules depicted on MRI in the cirrhotic liver: fate and implications

Aim

To determine the fate and clinical implication of large (≥2cm), non-hypervascular nodules depicted on magnetic resonance imaging (MRI) in the cirrhotic liver.

Materials and methods

In 21 patients with cirrhosis (14 hepatitis B, two ethanol abuse, four cryptogenic, one Wilson's disease), 25 large (≥2cm in the longest dimension) non-hypervascular nodules were identified on dynamic MRI. The implications for diagnosis of the initial size, contour, and signal characteristics on MRI in addition to patients' age and cause of cirrhosis were assessed in our analysis.

Results

Twelve (75%) out of 16 lesions were malignant or potentially-malignant from 14 hepatitis B patients, while seven (78%) of the nine lesions from other patients were benign (p=0.016). The mean age of the patients who had malignant or potentially malignant lesions (57 years) was older than that for the other patients (47 years; p=0.039). The ratio of the short-to-long diameter was higher in malignant or potentially malignant lesions (mean 0.86) than in benign lesions (mean 0.69; p=0.008). There was no discriminative signal intensity characteristic (p>0.2 for all factors) that indicated the malignant potential for each non-hypervascular nodule. For all 10 lesions in the hepatitis B patients who were older than 52 years with a short-to-long diameter ratio of more than 0.75, the positive predictive value for malignant potential based on these three combined factors was 100%.

Conclusion

In older patients with cirrhosis from hepatitits B, large (≥2cm), non-hypervascular nodules with a spherical contour have a high malignant potential.