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Identification of the suitable candidates for EOB-MRI with the high risk of the presence of non-hypervascular hypointense nodules in patients with HCV infection

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Non-hypervascular hypointense nodules (NHHNs) depicted by gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid–enhanced magnetic resonance imaging (EOB-MRI) have a high likelihood of progressing to hepatocellular carcinoma (HCC). The presence of NHHNs is a strong risk factor for HCC development in patients with chronic hepatitis C virus (HCV) infection after the achievement of sustained virologic response (SVR). However, it is difficult for all patients with HCV infection to undergo EOB-MRI for NHHN detection. We therefore explored serum markers that potentially indicate the presence of NHHNs.

Methods

Three serum markers, alpha-fetoprotein (AFP), FIB-4 index, and Wisteria floribunda agglutinin–positive Mac-2 binding protein glycan isomer (M2BPGi), were measured in 481 patients with HCV infection and no history of HCC who underwent EOB-MRI. The associations between these serum marker levels and the presence of NHHNs were investigated.

Results

All three markers were associated with the presence of NHHNs. M2BPGi predicted the presence of NHHNs more accurately than AFP and FBB-4 index; M2BPGi had the highest area under the receiver operating characteristic curve. Multivariate analysis identified male gender and high M2BPGi as factors associated with the presence of NHHNs. When patients were stratified by the degree of liver fibrosis, M2BPGi increased with the progression of fibrosis. In addition, NHHNs were more prevalently detected in patients with higher M2BPGi (COI > 3.46) in patients with similar fibrosis degree.

Conclusions

M2BPGi is a serum marker that potentially identifies HCV patients with high risk of the presence of NHHNs, for whom EOB-MRI should be considered.

Key Points

• Non-hypervascular hypointense nodule on EOB-DTPA-enhanced MRI is pre-HCC nodule with high likelihood of progressing to HCC, which is a strong predictor for HCC that develops after the eradication of HCV in patients with HCV infection.

• It is difficult for all patients with HCV infection to undergo EOB-MRI for NHHN detection due to limited access, limited availability of MRI equipment, and high costs.

• Serum Wisteria floribunda agglutinin–positive Mac-2 binding protein glycan isomer (M2BPGi) levels effectively indicate the presence of NHHNs and can be used to identify patients with high risk of their presence, for whom EOB-DTPA-enhanced MRI should be considered.

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Abbreviations

AFP:

Alpha-fetoprotein

AUROC:

Area under the ROC curve

CT:

Computed tomography

DAA:

Direct-acting antiviral

EOB-MRI:

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid–enhanced magnetic resonance imaging

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

M2BPGi:

Wisteria floribunda agglutinin–positive Mac-2 binding protein glycan isomer

NHHNs:

Non-hypervascular hypointense nodules

ROC:

Receiver operating characteristic

SVR:

Sustained virologic response

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Funding

This work was supported by Health and Labor Sciences Research Grants (Research on Hepatitis) from the Ministry of Health, Labor and Welfare of Japan.

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Authors and Affiliations

  1. Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan

    Hidenori Toyoda, Satoshi Yasuda & Shohei Shiota

  2. Department of Radiology, Ogaki Municipal Hospital, Ogaki, Japan

    Yasuhiro Sone

  3. Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan

    Atsuyuki Maeda & Yuji Kaneoka

  4. Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan

    Takashi Kumada

  5. Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan

    Junko Tanaka

Authors
  1. Hidenori Toyoda
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  2. Satoshi Yasuda
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  3. Shohei Shiota
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  4. Yasuhiro Sone
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Corresponding author

Correspondence to Hidenori Toyoda.

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Guarantor

The scientific guarantor of this publication is Hidenori Toyoda.

Conflict of interest

Hidenori Toyoda reports a speaker honorarium from AbbVie, MSD, and Bayer, and Takashi Kumada reports a speaker honorarium from AbbVie, Bristol-Meyers Squibb, and Gilead Sciences. Other authors declare that they have no conflict of interest.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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• retrospective study of prospectively observed cohort

• observational study

• performed at one institution

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Toyoda, H., Yasuda, S., Shiota, S. et al. Identification of the suitable candidates for EOB-MRI with the high risk of the presence of non-hypervascular hypointense nodules in patients with HCV infection. Eur Radiol 32, 5016–5023 (2022). https://doi.org/10.1007/s00330-022-08570-4

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