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Hepatocellular Carcinoma Presenting at Contrast-Enhanced Multi–Detector-Row Computed Tomography or Gadolinium-Enhanced Magnetic Resonance Imaging as a Small (≤2 cm), Indeterminate Nodule: Growth Rate and Optimal Interval Time for Imaging Follow-Up

Furlan, Alessandro MD*; Marin, Daniele MD†‡; Agnello, Francesco MD§; Di Martino, Michele MD; Di Marco, Vito MD; Lagalla, Roberto MD§; Catalano, Carlo MD; Brancatelli, Giuseppe MD

Journal of Computer Assisted Tomography: January/February 2012 - Volume 36 - Issue 1 - p 20–25
doi: 10.1097/RCT.0b013e31823ed462
Abdominal Imaging

Objective The objective of the study was to measure growth rate and to determine the optimal interval time for imaging follow-up of hepatocellular carcinomas (HCCs) presenting at multi–detector-row computed tomography (MDCT) or magnetic resonance imaging (MRI) as small, indeterminate lesions.

Methods We included patients with cirrhosis with HCC initially presenting as indeterminate lesion of 2 cm or less at MDCT or MRI August 2005 to August 2009 and with available imaging follow-up. Measures of tumor growth included tumor volume doubling time (TVDT), tumor percentual diameter increase, and tumor percentual volume increase.

Results We examined 48 patients (mean age, 64 years) with 69 HCCs. At index examination, mean (SD) maximum transverse diameter and volume of lesions were 1.2 (SD, 0.3) cm and 0.6 (SD, 0.7) cm3, respectively. Median TVDT was 210 days. Tumors with follow-up longer than 365 days had significant increase in tumor percentual diameter increase and tumor percentual volume increase.

Conclusions Median TVDT of 210 days suggests extended follow-up of 6 months for small, indeterminate liver nodules detected at MDCT or MRI.

From the *Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA; †Department of Radiology, Duke University Medical Center, Durham, NC; ‡Department of Radiological Sciences, University of Rome-La Sapienza, Rome; and §Department of Radiology, and ∥Sezione di Scienze Radiologiche, Di.Bi.Me.F., University of Palermo, Palermo, Italy.

Received for publication August 22, 2011; accepted October 25, 2011.

Reprints: Alessandro Furlan, MD, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 15213 Pittsburgh, PA (e-mail:

The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.