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Peng Huang,1,2,&ast; Xiaoyan Ni,1,2,&ast; Changwu Zhou,1– 3 Zhang Shi,1,2 Fei Wu,1,2 Yuyao Xiao,1,2 Chun Yang,1,2 Mengsu Zeng1– 3 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mengsu Zeng, Shanghai Institute of Medical Imaging, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 13501922963, Email zeng.mengsu@zs-hospital.sh.cn Chun Yang, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 18702135336, Email dryangchun@hotmail.comObjective: To compare the pathologic diagnosis and survival of patients with subcentimeter and 1– 2 cm nodules that present with diagnostic hallmarks of hepatocellular carcinoma (HCC).Methods: Diagnostic hallmarks of HCC were defined as hyperintensity on T2 weighted imaging, restricted diffusion, arterial phase hyperenhancement, washout on portal venous phase, and hypointensity on hepatobiliary phase. We retrospectively included 139 patients undergoing curative resection with single nodules ≤ 2 cm that present imaging features described above on gadoxetic acid-enhanced MRI. The final diagnosis was confirmed by histopathological assessment. Recurrence-free survival (RFS) was compared using Kaplan–Meier analysis with the Log-rank test. Factors associated with overall and early recurrence were identified using Cox regression analysis.Results: Among 139 nodules (49 nodules < 1 cm), there was no significant difference in the percentage of HCC between subcentimeter and 1– 2 cm nodules (94.0% vs 94.4%, P > 0.999). Microvascular invasion (MVI) was less common in subcentimeter HCC (4.3% vs 17.6%, P = 0.032). There were 27 recurrences during a median follow-up time of 46.7 months. Patients with subcentimeter HCC achieved less recurrence, with a 5-year RFS rate of 87.3%. The MVI-positive patients had more early and overall recurrence. A tumor size < 1 cm was associated with lower overall recurrence (HR, 0.336; P = 0.047). No factors were independently associated with early recurrence.Conclusion: Subcentimeter nodules with diagnostic hallmarks of HCC are highly associated with HCC diagnosis and achieve less tumor recurrence after resection. Early diagnosis and treatment of subcentimeter HCC may be more appropriate.Keywords: carcinoma, hepatocellular, magnetic resonance imaging, gadolinium ethoxybenzyl DTPA

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