Gadoxetic acid-enhanced magnetic resonance imaging characteristics of hepatocellular carcinoma occurring in liver transplants

Objectives: Characteristics of hepatocellular carcinoma (HCC) on magnetic resonance (MR) images were compared in patients who did or did not undergo liver transplantation (LT), and we evaluated the relationship of these findings with overall survival (OS) and time-to-tumour recurrence (TTR) after transplantation. Methods: The enhancement pattern of gadoxetic acid-enhanced MR images of 25 patients with recurrent HCCs (LT group) and 25 surgically confirmed HCC patients in the non-transplanted (control) group were compared. Typical enhancement was defined as 1) arterial enhancement and delayed wash-out and 2) absence of typical features of cholangiocarcinoma consisting of arterial rim enhancement and target appearance on hepatobiliary phase images. OS and TTR were analyzed in the LT group according to these patterns using the log-rank test. Results: HCCs in the LT group significantly more often had an atypical enhancement pattern (16/25, 64.0%) than those in the control group (5/25, 20.0%; p = 0.004). However, OS and TTR did not differ significantly according to these enhancement patterns of recurrent HCC (p > 0.05). Conclusion: Although enhancement patterns of recurrent HCC in transplanted liver did not affect OS and TTR, these HCCs that arise after LT frequently revealed atypical enhancement on gadoxetic acid-enhanced MR imaging. Key Points: • Recurrent HCCs after LT showed atypical enhancement on gadoxetic acid-enhanced MRI. •They showed absence of delayed wash-out or cholangiocarinoma-like features. • Enhancement patterns of recurrent HCCs did not affect OS and TTR.