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Small (<20 mm) Enhancing Hepatic Nodules Seen on Arterial Phase MR Imaging of the Cirrhotic Liver: Clinical Implications

Yong Yeon Jeong1,2, Donald G. Mitchell1 and Tamotsu Kamishima1,3

1 Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th St., 1096 Main Bldg., Philadelphia, PA 19107.
2 Present address: Department of Diagnostic Radiology, Chonnam National University Medical School, 8 Hackdong, Dongku, Kwangju, South Korea.
3 Present address: Department of Radiology, Hokkaido University School of Medicine, North-15, West-7, Kita-Ku, 0608638, Sapporo, Japan.



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  		Fig. 1A. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. Axial T1-weighted gradient-echo MR image (TR/TE, 130/4.2) shows nodule as isointense.

 


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  		Fig. 1B. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. Axial fast spin-echo MR image (TR/TEeff, 3157/80) reveals isointense nodule.

 


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  		Fig. 1C. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. Axial T2-weighted gadolinium-enhanced gradient-echo dynamic MR image (TR/TE, 130/1.5) obtained during arterial phase of bolus reveals early homogenous enhancement (arrow) of 13-mm nodule.

 


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  		Fig. 1D. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. On follow-up axial T1-weighted gradient-echo image (120/4.2) obtained 3 months later at the same level as C, nodule is isointense.

 


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  		Fig. 1E. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. Axial T2-weighted fast spin-echo MR image (TR/TEeff, 7500/100) obtained at same time as D shows nodule as isointense.

 


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  		Fig. 1F. —Hepatocellular carcinoma with interval nodule growth in 41-year-old man. Nodule shows no change of signal intensity or enhancement homogeneity. Axial T1-weighted gadolinium-enhanced gradient-echo MR image (TR/TE, 120/2.1) obtained at same time as D shows considerable growth of nodule (arrow), now measuring 21 mm.

 


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  		Fig. 2A. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Axial T1-weighted gradient-echo image (TR/TE, 130/2.2) shows nodule as isointense.

 


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  		Fig. 2B. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Axial T2-weighted fast spin-echo image (TR/TEeff, 5000/100) shows nodule as isointense.

 


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  		Fig. 2C. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Axial gadolinium-enhanced gradient-echo dynamic MR image (TR/TE, 7/2) obtained during arterial phase of bolus reveals 6-mm nodule (arrow) with homogeneous enhancement.

 


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  		Fig. 2D. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Follow-up axial T1-weighted gradient-echo MR image (TR/TE, 130/2.2) obtained 15 months later at same level as C shows nodule (arrow) is hypointense and now has grown to 15 mm.

 


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  		Fig. 2E. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Axial T2-weighted fast spin-echo MR image (TR/TEeff, 4000/90) obtained at same time as D shows nodule (arrow) as more intense than liver.

 


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  		Fig. 2F. —42-year-old woman with hepatocellular carcinoma. Nodule shows interval growth and change of enhancement homogeneity. Axial T1-weighted gadolinium-enhanced gradient-echo MR image (TR/TE, 7/2) obtained at same time as D shows inhomogenous enhancement (arrow) of nodule.

 


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  		Fig. 3A. —Benign lesion in 63-year-old man that was not seen on follow-up images. On axial T1-weighted gradient-echo MR image (TR/TE, 120/4.2), nodule is not visible.

 


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  		Fig. 3B. —Benign lesion in 63-year-old man that was not seen on follow-up images. On axial T2-weighted fast spin-echo MR image (TR/TEeff, 4000/96), nodule is not visible.

 


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  		Fig. 3C. —Benign lesion in 63-year-old man that was not seen on follow-up images. Axial gadolinium-enhanced gradient-echo dynamic MR image (TR/TE, 120/2.2) obtained during arterial phase of bolus shows 8-mm nodule (arrow) with homogeneous enhancement.

 


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  		Fig. 3D. —Benign lesion in 63-year-old man that was not seen on follow-up images. On follow-up axial T1-weighted gradient-echo image (150/4.2) obtained 28 months later, nodule is not visible.

 


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  		Fig. 3E. —Benign lesion in 63-year-old man that was not seen on follow-up images. On axial T2-weighted single-shot fast spin-echo MR image (infinite/100) obtained at same time as D, nodule is not visible.

 


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  		Fig. 3F. —Benign lesion in 63-year-old man that was not seen on follow-up images. On axial gadolinium-enhanced gradient-echo dynamic MR image (7/2) of left hepatic lobe obtained at same time as D, nodule is not visible.

 


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  		Fig. 4. —Graph shows tumor-doubling time (longitudinal axis) in seven hepatocellular carcinomas with interval growth versus difference of tumor diameter in millimeters (transverse axis). Mean doubling time was 2.47 ± 1.25 months and was less than 5 months in all tumors.

 

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