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Eur Radiol. 2018 Feb;28(2):506-513. doi: 10.1007/s00330-017-5033-3. Epub 2017 Sep 11.

Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis.

Author information

1
Department of Diagnostic Medicine and Prevention, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
2
Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy.
3
Department of Digestive Diseases, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
4
Division of Internal Medicine, Ospedale di Faenza, Faenza, Italy.
5
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
6
Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy. stefano.brillanti@unibo.it.
7
U.O. di Gastroenterologia, Via Massarenti 9, 40138, Bologna, Italy. stefano.brillanti@unibo.it.

Abstract

OBJECTIVES:

To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis.

METHODS:

Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48-74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA.

RESULTS:

After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0-318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10-20 mm in 27, 20-50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54-84), even in 17/29 nodules with 10-20 mm diameter (58.6%, CI: 39-76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22-47) (p= 0.0007). MVI did not correlate with history of previous HCC.

CONCLUSIONS:

HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients.

KEY POINTS:

• In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy. • HCC presents imaging features of microvascular invasion, predictive of more aggressive progression. • Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.

KEYWORDS:

Computed tomography; Drug side effects; Hepatitis C; Liver neoplasms; Magnetic resonance imaging

PMID:
28894901
DOI:
10.1007/s00330-017-5033-3
[Indexed for MEDLINE]

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