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Natural history of postvascular‐phase iso‐enhanced lesions on the sonogram in chronic liver diseases
Author(s) -
Kondo Takayuki,
Maruyama Hitoshi,
Sekimoto Tadashi,
Shimada Taro,
Takahashi Masanori,
Chiba Tetsuhiro,
Kanai Fumihiko,
Yokosuka Osamu,
Yamaguchi Tadashi
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12449
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , confidence interval , natural history , proportional hazards model , magnetic resonance imaging , gastroenterology , prospective cohort study , nuclear medicine , hccs , ultrasound , radiology
Background and Aim This study examined the natural history of postvascular‐phase iso‐enhanced lesions ( PIELs ) on contrast‐enhanced sonograms to determine the potential risk and predictive factors for developing hepatocellular carcinoma ( HCC ) in chronic liver diseases. Methods This prospective study included 87 PIELs on contrast‐enhanced sonograms (postvascular‐phase: 10 min post‐injection of perflubutane microbubbles) in 72 patients with chronic liver diseases (45 males and 27 females; age 65.0 ± 10.8y; PIEL diameter 12.5 ± 4.2 mm). The PIELs were followed up by ultrasound/contrast‐enhanced ultrasound, computed tomography, or magnetic resonance imaging at 3 to 6 months intervals. Results Twenty patients developed HCCs during the study period (median, 22.0 months). The cumulative risk of HCC occurrence was 7.9% at 1 year and 36.0% at 3 years. The presence of coexistent HCC (hazard ratio [ HR ], 4.975; 95% confidence interval [ CI ], 1.729–14.316; P = 0.003) and alpha‐fetoprotein > 20 ng/mL ( HR , 4.104; 95% CI , 1.621–10.392; P = 0.003) were significant factors for the risk of HCC occurrence. Fourteen of these lesions were diagnosed as HCCs that developed from iso‐enhanced lesions. Cumulative HCC occurrence rates from PIEL > 14 mm was 23.5% at 1 year and 46.3% at 3 years. Cox regression analysis showed that PIEL > 14 mm ( HR , 6.780; 95% CI , 2.060–22.32; P = 0.002) and alpha‐fetoprotein > 20 ng/ mL ( HR , 4.892; 95% CI , 1.559–15.350; P = 0.007) were statistically significant factors for HCC occurrence. Conclusions Patients with coexistent HCC , alpha‐fetoprotein > 20 ng/ mL , or PIEL > 14 mm should be carefully monitored because of the high potential for HCC occurrence.