Additional nodules detected using EOB-MRI in patients with resectable single hepatocellular carcinoma: An implication for active treatment strategy

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) further enhances the identification of additional hepatic nodules compared with Computed Tomography (CT) alone; however, the optimal treatment for such additional nodules remains unclear. We investigated the long-term oncological effect of aggressive treatment strategies for additional lesions identified using EOB-MRI in patients with hepatocellular carcinoma (HCC). Data from 522 patients diagnosed with solitary HCC using computed tomography (CT) between January 2008 and December 2012 were retrospectively reviewed. Propensity score-matched (PSM) analysis was used to compare the oncologic outcomes between patients with solitary HCC and those with additional nodules on EOBMRI after aggressive treatment (resection or radiofrequency ablation (RFA)). Among the 383 patients included, 59 had additional nodules identified using EOB-MRI. Compared with patients with solitary HCC, those with additional nodules on EOB-MRI had elevated total bilirubin, aspartate transaminase, and alanine transaminase; had a lower platelet count; higher MELD score; and highly associated with liver cirrhosis (P < 0.05). Regarding long-term outcomes, 59 patients with solitary HCC and those with additional nodules after PSM were compared. Disease-free survival (DFS) and overall survival (OS) were comparable between the two groups (DFS, 60.4 vs. 44.3 months, P = 0.071; OS, 82.8 vs. 84.8 months, P = 0.986). The aggressive treatment approach, either resection or RFA, for patients with additional nodules identified on EOB-MRI was associated with long-term survival comparable with that for solitary HCC. However, further studies are required to confirm these findings.