Clin Mol Hepatol.  2019 Dec;25(4):390-399. 10.3350/cmh.2018.0103.

Risk assessment of hepatocellular carcinoma development for indeterminate hepatic nodules in patients with chronic hepatitis B

Affiliations
  • 1Department of Internal Medicine and Yonsei University College of Medicine, Seoul, Korea. ksukorea@yuhs.ac
  • 2Department of Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
  • 3Yonsei Liver Center, Severance Hospital, Seoul, Korea.
  • 4Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. gafield2@yuhs.ac

Abstract

BACKGROUND/AIMS
A risk prediction model for the development of hepatocellular carcinoma (HCC) from indeterminate nodules detected on computed tomography (CT) (Rad(CT) score) in patients with chronic hepatitis B (CHB)-related cirrhosis was proposed. We validated this model for indeterminate nodules on magnetic resonance imaging (MRI).
METHODS
Between 2013 and 2016, Liver Imaging Reporting and Data System (LI-RADS) 2/3 nodules on MRI were detected in 99 patients with CHB. The Rad(CT) score was calculated.
RESULTS
The median age of the 72 male and 27 female subjects was 58 years. HCC history and liver cirrhosis were found in 47 (47.5%) and 44 (44.4%) patients, respectively. The median Rad(CT) score was 112. The patients with HCC (n=41, 41.4%) showed significantly higher Rad(CT) scores than those without (median, 119 vs. 107; P=0.013); the Chinese university-HCC and risk estimation for HCC in CHB (REACH-B) scores were similar (both P>0.05). Arterial enhancement, T2 hyperintensity, and diffusion restriction on MRI were not significantly different in the univariate analysis (all P>0.05); only the Rad(CT) score significantly predicted HCC (hazard ratio [HR]=1.018; P=0.007). Multivariate analysis showed HCC history was the only independent HCC predictor (HR=2.374; P=0.012). When the subjects were stratified into three risk groups based on the Rad(CT) score (<60, 60-105, and >105), the cumulative HCC incidence was not significantly different among them (all P>0.05, log-rank test).
CONCLUSIONS
HCC history, but not Rad(CT) score, predicted CHB-related HCC development from LI-RADS 2/3 nodules. New risk models optimized for MRI-defined indeterminate nodules are required.

Keyword

Radiographic image interpretation, Computer-assisted; Liver neoplasms; Hepatitis B; Risk assessment; Hepatocellular carcinoma

MeSH Terms

Asian Continental Ancestry Group
Carcinoma, Hepatocellular*
Diffusion
Female
Fibrosis
Hepatitis B
Hepatitis B, Chronic*
Hepatitis, Chronic*
Humans
Incidence
Information Systems
Liver
Liver Cirrhosis
Liver Neoplasms
Magnetic Resonance Imaging
Male
Multivariate Analysis
Radiographic Image Interpretation, Computer-Assisted
Risk Assessment*
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