MRI presentation of hepatocellular carcinoma in non-alcoholic steatohepatitis (NASH)

Fatima Al-Sharhan; Anthony Dohan; Maxime Barat; Adlane Feddal; Benoit Terris; Stanislas Pol; Vincent Mallet; Philippe Soyer

doi:10.1016/j.ejrad.2019.108648

MRI presentation of hepatocellular carcinoma in non-alcoholic steatohepatitis (NASH)

Eur J Radiol. 2019 Oct:119:108648. doi: 10.1016/j.ejrad.2019.108648. Epub 2019 Sep 7.

Authors

Fatima Al-Sharhan¹, Anthony Dohan², Maxime Barat³, Adlane Feddal⁴, Benoit Terris⁵, Stanislas Pol⁶, Vincent Mallet⁷, Philippe Soyer⁸

Affiliations

¹ Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: Alsharhan.Fatima@outlook.fr.
² Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: anthony.dohan@aphp.fr.
³ Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: maxime.barat@aphp.fr.
⁴ Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: adlane.feddal@aphp.fr.
⁵ Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: benoit.terris@aphp.fr.
⁶ Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Hepatology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: stanislas.pol@aphp.fr.
⁷ Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France; Department of Hepatology, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Electronic address: vincent.mallet@aphp.fr.
⁸ Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France. Electronic address: philippe.soyer@aphp.fr.

PMID: 31521875
DOI: 10.1016/j.ejrad.2019.108648

Abstract

Purpose: To describe the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic steatohepatitis (NASH).

Methods: MRI examinations of 21 patients with HCC and NASH were analyzed by two observers. There were 18 men and 3 women with a mean age of 67.9 ± 10.2 (SD) years (range: 36-85 years). Images were qualitatively and quantitatively analyzed with respect to imaging presentation.

Results: HCC presented as a single tumor in 13/21 patients (62%), with a mean longest diameter of 26.9 ± 20.2 (SD) mm (range: 12-88 mm); 17/30 HCC (57%) had a largest diameter <20 mm. A signal drop between in- and out-of-phase T1-weighted MR images was observed in 16/30 HCC nodules (53%). All HCC nodules (30/30; 100%) showed hyperenhancement on arterial phase images and 12/30 HCC nodules (40%) did not show a wash-out on portal or delayed phase images. Encapsulation was observed in 18/30 HCC nodules (60%). MRI findings consistent with liver cirrhosis were present in 16/21 patients (76%).

Conclusions: Our results show that 57% of HCC in NASH can present as a lesion smaller than 20 mm and 40% do not display wash-out. These results suggest that classical imaging criteria developed for noninvasive diagnosis of HCC should be applied with caution to HCC in patients with NASH.

Keywords: Chronic liver disease; Hepatocellular carcinoma (HCC); Magnetic resonance imaging (MRI); Malignant tumor; Tissue characterization.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular / pathology*
Contrast Media
Female
Humans
Liver Cirrhosis / pathology
Liver Neoplasms / pathology*
Magnetic Resonance Imaging / methods
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / pathology*
Observer Variation
Retrospective Studies

Substances

Contrast Media