Prognostic value of incidental hypervascular micronodules detected on cone-beam computed tomography angiography of patients with liver metastasis

Bruno C. Odisio, Veronica L. Cox, Silvana C. Faria, Suguru Yamashita, Xiao Shi, Joe Edward Ensor, Jr., Aaron K. Jones, Armeen Mahvash, Sanjay Gupta, Alda L. Tam, Jean Nicolas Vauthey, Ravi Murthy

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: To determine the clinical relevance of incidentally-found hypervascular micronodules (IHM) on cone-beam computed tomography angiography (CBCTA) in patients with liver metastasis undergoing transarterial (chemo)embolization (TACE/TAE). Material and methods: This was a HIPAA-compliant institutional review board-approved single-institution retrospective review of 95 non-cirrhotic patients (52 men; mean age, 60 years) who underwent CBCTA prior to (chemo)embolic delivery. IHM were defined by the presence of innumerable subcentimetre hepatic parenchymal hypevascular foci not detected on pre-TACE/TAE contrast-enhanced cross-sectional imaging. Multivariate analysis was performed to compare time to tumour progression (TTP) between patients with and without IHM. Results: IHM were present in 21 (22%) patients. Patients with IHM had a significantly shorter intrahepatic TTP determined by a higher frequency of developing new liver metastasis (hazard ratio [HR]: 1.99; 95% confidence interval [CI] 1.08–3.67, P= 0.02). Patients with IHM trended towards a shorter TTP of the tumour(s) treated with TACE/TAE (HR: 1.72; 95% CI: 0.98–3.01, P= 0.056). Extrahepatic TTP was not significantly different between the two cohorts (P= 0.27). Conclusion: Patients with IHM on CBCTA have worse prognosis due to a significantly higher risk of developing new hepatic tumours. Further work is needed to elucidate its underlying mechanisms of pathogenesis. Key Points: • 21% of liver metastasis patients undergoing TACE/TAE have IHM on CBTA. • IHM are associated with a high risk of developing new hepatic tumours. • IHA are also associated with a trend toward poorer response to TACE/TAE.

Original languageEnglish (US)
Pages (from-to)4837-4845
Number of pages9
JournalEuropean Radiology
Issue number11
StatePublished - Nov 1 2017


  • Cone-beam computed tomography
  • Disease progression
  • Embolization
  • Incidental findings
  • Liver metastasis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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