Ultraschall Med 2008; 29 - OP_3_1
DOI: 10.1055/s-2008-1079827

Small hypoechoic nodules in cirrhotic patients with previously treated HCC: analysis of non-enhancing nodules at contrast-enhanced-US

L Tarantino 1, I Sordelli 2, G Francica 3
  • 1Hepatology And Interventional Ultrasound, S. Giovanni Di Dio Hospital, Italy
  • 2V Division of Surgery – Second University of Naples, Italy
  • 3S. Maria della della Pietà Hospital – ASLNA3– Casoria (NA), Italy

Objective: To analyze new small hypoechoic nodules (SHN) showing absence of enhancement at Contrast-enhanced sonography (CEUS), in cirrhotic patients previously treated for Hepatocellular Carcinoma (HCC).

Subjects and methods: 215 cirrhotic patients with HCC previously treated with surgery (19) and/or Percutaneous ablation (192) and/or Chemoembolization (44) were prospectively studied with US every two months (follow-up range: 10–32 months; median: 20 months) in order to early detect new hepatic nodules. All detected SHN were studied with CEUS. Nodules showing early arterial enhancement at CEUS were considered recurrent HCCs and treated with thermal ablation. Non-enhancing nodules in arterial phase underwent fine needle biopsy, and the cases with positive hystology for HCC underwent thermal ablation. HCC-hystologically negative nodules were followed-up with US every two months. Increasing in size at follow-up was considered specific for recurrent HCC. Follow-up results were compared to FNB results.

Results: 78 SHNs (size range: 7–20mm; mean: 16mm) were detected at US in 65 patients within 4–24 months (mean: 12 months) after previous HCC treatment. CEUS showed early arterial enhancement in 52/78 (67%) nodules (diameter range 9–20mm; mean 16mm). 26 non-enhancing nodules (diameter range:7–13mm) underwent FNB. 11/26 (42%) cases showing HCC at hystology underwent thermal ablation. 15/26 cases (58%) of „cirrhosis“ at hystology were followed-up (4–24 months; mean: 12 months). 4/15 (27%) nodules increased in size within 4–8 months and underwent thermal ablation. 5/15 (33%) did not change at follow-up controls and are still on follow-up. 3/15 (20%) nodules fainted or completely disappeared at US examination.

All non-enhancing nodules were <13mm in size.

Conclusions: Over 2/3 of small hypoechoic relapsing nodules in the clinical setting of cirrhotic patient with previously treated HCC show early arterial enhancement at CEUS. 66% of non-enhancing nodules in arterial phase could not be malignant, and even disappear at follow-up control.