Hyperintense nodules on non-enhanced T1-weighted gradient-echo magnetic resonance imaging of cirrhotic liver: Fate and clinical implications

Purpose To investigate the fate of hyperintense hepatic nodules on nonenhanced T1‐weighted (T1w) gradient‐echo (GRE) magnetic resonance (MR) images in cirrhotic patients. Materials and Methods A total of 79 cirrhotic patients with hyperintense nodules (>5 mm) on precontrast opposed‐phase (repetition time (TR)/echo time (TE) = 140/2.7 msec) GRE images from initial MRI without T2‐weighted (T2w) hyperintensity or arterial hypervascularity were subjected to analysis of subsequent MR images obtained at intervals of 12–56 months (mean = 24.5 months). Multiplicity of hyperintense nodules (group A, up to 8; group B, >8) was correlated with follow‐up changes. Results Group B patients were younger (P = 0.003) than group A patients (mean = 47.5 and 56.2 years, respectively). In 66 group A patients, 39 out of 143 lesions (27%) were enlarged, including 20 malignantly transformed or borderline lesions. Of the 104 lesions (the eight largest lesions in each patient) in 13 group B patients, only three (2.9%) were enlarged. The results of best‐ and worst‐case analyses showed that overall the lesions were benign in 91% and 82% of patients, respectively. Conclusion T1w hyperintense nodules without T2w hyperintensity or arterial hypervascularity in the cirrhotic liver are benign in most cases. In younger patients with numerous macronodules, almost all of these lesions follow a benign course. J. Magn. Reson. Imaging 2006. © 2006 Wiley‐Liss, Inc.