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Meta-Analysis
. 2022 Feb;29(2):198-210.
doi: 10.1016/j.acra.2020.08.031. Epub 2020 Sep 20.

Risk Factors for Hypervascularization in Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement: A Systematic Review and Meta-analysis

Tae-Hyung Kim  1 , Sungmin Woo  2 , Sangwon Han  3 , Chong Hyun Suh  4 , Richard Kinh Gian Do  5 , Jeong Min Lee  6
Affiliations
Meta-Analysis

Risk Factors for Hypervascularization in Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement: A Systematic Review and Meta-analysis

Tae-Hyung Kim et al. Acad Radiol. 2022 Feb.

Abstract

Rationale and objectives: To perform a systematic review and meta-analysis to determine risk factors for hypervascularization in hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) in patients with hepatocellular carcinoma (HCC).

Materials and methods: Pubmed and EMBASE databases were searched up to May 7, 2020. Studies which evaluated radiologic and clinical risk factors for hypervascularization in HBP hypointense nodules without APHE were included. Hazard ratios were meta-analytically pooled using random-effects model. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool.

Results: Sixteen studies with 934 patients were included. HBP hypointense nodules without APHE with baseline size greater than 10 mm, T2 hyperintensity, and restricted diffusion showed risk for hypervascularization with pooled HRs of 2.95 (95% confidence interval [CI], 1.94-4.20), 4.21 (95% CI, 1.15-15.40), 5.83 (95% CI, 1.42-23.95), respectively. Previous HCC history contributed to hypervascularization of the nodules with hazard ratio of 2.06 (95% CI, 1.23-3.44). T1 hyperintensity, intralesional fat, Child-Pugh Class B, sex, alfa-fetoprotein, hepatitis B or C infection were not significant risk factors for hypervascularization (p ≥0.05). Study quality was generally moderate.

Conclusion: HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI with baseline size greater than 10 mm, T2 hyperintensity, restricted diffusion and previous hepatocellular carcinoma history pose higher risk for hypervascularization. Proper patient management in patients with HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI may need to be tailored according to these risk factors.

Keywords: Arterial phase hyperenhancement; Gd-EOB-DTPA; Hepatocellular carcinoma; Hypervascularization; Meta-analysis; Systematic review.

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Conflict of interest statement

DISCLOSURES

There are no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection process for meta-analysis.
Figure 2.
Figure 2.
Assessment of risk of bias by the QUIPS tool. (Color version of figure available online.)
Figure 3.
Figure 3.
Forest plots of studies on the association between radiological risk factors for hypervascularization in HBP hypointense nodules without APHE. * used cutoff of 9mm.
Figure 4.
Figure 4.
Forest plots of studies on the association between clinical risk factors for hypervascularization in HBP hypointense nodules without APHE.
See this image and copyright information in PMC

Comment in

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