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Non-Invasive PET/MR Imaging in an Orthotopic Mouse Model of Hepatocellular Carcinoma
Published on: August 31, 2022
Outcomes of patients with elevated α-fetoprotein level and initial negative findings at MR imaging
Bong Soo Kim1, Paul Hideyo Hayashi, Seung Hyoung Kim
1Department of Radiology, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Bldg, Chapel Hill, NC 27599-7510, USA.
Purpose:
To evaluate interval cancer diagnosis in patients with elevated α-fetoprotein (AFP) level and initial negative findings at magnetic resonance (MR) imaging.
Materials And Methods:
The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Seventeen patients with elevated AFP levels (>300 ng/mL [>300 μg/L]) and initial negative findings at hepatic MR imaging from 2002 to 2011 were identified. MR reports, pathology reports, and medical records were reviewed to determine outcome, including identification of hepatocellular carcinoma (HCC), and track changes in serum AFP level. Initial and follow-up MR images were reviewed to evaluate presence and size of hepatic nodules. Significance of AFP values was tested with repeated-measures analysis of variance.
Results:
Ten (59%) of 17 patients developed HCCs (13 tumors) after a mean of 138 days (range, 41-247 days). Nine (90%) of 10 patients with HCCs underwent follow-up MR imaging, and one patient (10%) underwent liver transplantation without MR follow-up. Of 12 HCCs in nine patients who underwent follow-up MR imaging, 10 (83%) were noted at follow-up MR imaging and two were found only at surgery. Mean diameter of visualized HCCs was 3.4 cm. Of 10 HCCs detected at follow-up MR imaging, five were identifiable in retrospect at initial MR studies (mean diameter, 1.4 cm). Serum AFP levels in patients with HCCs were significantly higher than those in patients without HCCs and progressively increased over time (P = .012).
Conclusion:
Subsequent HCCs in patients with elevated AFP levels and initial negative findings at MR imaging are relatively common and demonstrable during short follow-up. Close follow-up (serial 3-month studies) is recommended in the setting of a steady increase in AFP level.
Insights
Patients with high alpha-fetoprotein (AFP) levels and negative initial MRIs can develop hepatocellular carcinoma (HCC). Close follow-up with serial imaging is recommended due to the common occurrence of interval HCC.
Area of Science:
- Hepatology
- Diagnostic Imaging
- Oncology
Background:
- Elevated alpha-fetoprotein (AFP) levels can indicate liver disease.
- Magnetic resonance (MR) imaging is a key tool for liver lesion detection.
- Interval cancers pose a diagnostic challenge.
Purpose of the Study:
- To assess the diagnosis of interval cancers in patients with elevated AFP and initially negative MR imaging.
- To evaluate the development of hepatocellular carcinoma (HCC) in this patient group.
Main Methods:
- Retrospective review of 17 patients with AFP >300 ng/mL and negative initial hepatic MR imaging.
- Analysis of MR reports, pathology, medical records, and serum AFP levels.
- Review of initial and follow-up MR images for hepatic nodule detection.
Main Results:
- 59% of patients developed HCC within a mean of 138 days.
- Follow-up MR imaging detected 83% of HCCs, with some visible in retrospect on initial scans.
- Significantly higher and increasing AFP levels were observed in patients with HCC.
Conclusions:
- Subsequent HCC is common in patients with elevated AFP and negative initial MR imaging.
- Close follow-up, including serial 3-month MR studies, is recommended.
- Monitoring AFP level trends is crucial for early detection.
