Introduction : It is known that Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid enhanced magnetic resonance imaging (EOB-MRI) improved the detection of hepatocellular carcinoma (HCC). In preoperative MRI, additional non-hypervascular hypointense nodule (ANHHN) is found sometimes, however there are only few studies about prognosis of curative treatments of ANHHN and primary HCC lesion together.

Methods : We retrospectively reviewed medical records and preoperative images of 441 HCC patients who underwent surgical curative treatment at Yonsei Cancer Center from January 2008 to December 2012.

Results : Among 441 patients, 279 were diagnosed HCC with Computed Tomography (CT) and MRI both, 79 patients were diagnosed with additional EOB-MRI because of uncertain diagnosis in CT , and 83 patients were founded additional lesion in EOB-MRI. Overall survival analysis showed no statistically difference between the single and addtional lesion groups, and there was a significant difference between the single and multiple HCC groups. However, in disease-free survival analysis, there was no difference between multiple HCC and addtional lesion groups, but only single HCC group showed statistically favorable results. Single HCC group (median 80 months, 95% CI [64.002-89.986]) vs multiple HCC group (median 24 months, 95% CI [17.483-30.517]) vs ANHHN group (median 32 months, 95% CI [21.135-42.865]).

Conclusions : Patients with ANHHN showed similar disease-free survival compared to multiple HCC, but overall survival was similar to that of single HCC. Therefore, a single overt HCC with ANHHN should be considered a surgical candidate and combined active treatment is recommended if their liver function is allowed.