1
|
Xing F, Ma Q, Lu J, Zhu W, Du S, Jiang J, Zhang T, Xing W. Nodule-in-nodule architecture of hepatocellular carcinomas: enhancement patterns in the hepatobiliary phase and pathological features. Abdom Radiol (NY) 2024:10.1007/s00261-024-04259-y. [PMID: 38913136 DOI: 10.1007/s00261-024-04259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to evaluate the enhancement patterns in the hepatobiliary phase (HBP) and pathological features of nodule-in-nodule-type hepatocellular carcinoma (NIN-HCC) patients. METHODS In this single-institution retrospective study, 27 consecutive cirrhosis patients with 29 histologically confirmed NIN-HCCs who underwent preoperative examination via Gd-EOB-DTPA-enhanced MRI were enrolled from January 2016 to September 2023. Two blinded radiologists assessed the imaging features of both the inner and outer nodules in NIN-HCCs to reach a consensus on the Liver Imaging Reporting & Data System (LI-RADS) categories of the lesions. Based on the different enhancement patterns of the inner and outer nodules in the HBP, NIN-HCCs were classified into different groups and further divided into different types. Imaging features and LI-RADS categories were subsequently compared among the groups. Pathological findings for NIN-HCCs were also evaluated. RESULTS Among 29 NIN-HCCs, all inner nodules showed hypervascularity, with a maximum diameter of 13.2 ± 5.5 mm; 51.7% (15/29) showed "wash-in with washout" enhancement; and 48.3% (14/29) showed "wash-in without washout" enhancement. All outer nodules showed hypovascularity, with a maximum diameter of 25.6 ± 7.3 mm, and 51.9% (14/29) showed a washout appearance on PVP. Among all the lesions, the maximum diameter was 27.5 ± 6.8 mm; 12 (41.4%) lesions were LR-4, and 17 (58.6%) lesions were LR-5. NIN-HCCs were classified into hypointense (62.1%, 18/29) and isointense (37.9%, 11/29) groups based on the signal intensity of the outer nodules in the HBP. In the hypointense group, 2 (6.9%) of the inner nodules were hypointense (type A), 11 (37.9%) were isointense (type B), and 5 (17.2%) were hyperintense (type C) compared to the background hypointense outer nodules. In the isointense group, 9 (31.0%) of the inner nodules were hypointense (type D), 2 (6.9%) were isointense (type E), and no (0%) was hyperintense (type F) compared to the background isointense outer nodules. There were no significant differences in the diameter, dynamic enhancement patterns of the inner or outer nodules, or LI-RADS scores of the lesions between the hypointense group and the isointense group (all P > 0.05). Histologically, the inner nodules of NIN-HCCs were mainly composed of moderately differentiated HCC (75.9% 22/29), whereas the outer nodules consisted of either well-differentiated HCC or high-grade dysplastic nodules (HGDNs). CONCLUSIONS NIN-HCCs exhibit specific MRI findings closely associated with their pathological features. The spectrum of HBP enhancement patterns provides valuable insights into the underlying cell biological mechanisms of these lesions. NIN-HCC subtypes may be used as a morphologic marker in the early stage of multistep hepatocarcinogenesis.
Collapse
Affiliation(s)
- Fei Xing
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Qinrong Ma
- Department of Pathology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Jiang Lu
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Wenjing Zhu
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Sheng Du
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Jifeng Jiang
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China
| | - Tao Zhang
- Department of Radiology, Third Affiliated Hospital of Nantong University and Nantong Third People's Hospital, #99 Youth Middle Road, Chongchuan District, Nantong, 226000, Jiangsu, China.
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Tianning District, Changzhou, 213000, Jiangsu, China.
| |
Collapse
|
2
|
van Rosmalen BV, Visentin M, Furumaya A, van Delden OM, Kazemier G, van Gulik TM, Verheij J, Stieger B. Association Between Gadoxetic Acid-Enhanced Magnetic Resonance Imaging, Organic Anion Transporters, and Farnesoid X Receptor in Benign Focal Liver Lesions. Drug Metab Dispos 2024; 52:118-125. [PMID: 38050024 DOI: 10.1124/dmd.123.001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
The organic anion uptake and efflux transporters [organic anion-transporting polypeptide (OATP)1B1, OATP1B3 and multidrug resistance-associated protein (MRP)2 and MRP3] that mediate the transport of the hepatobiliary-specific contrast agent gadoxetate (Gd-EOB-DTPA) are direct or indirect targets of the farnesoid X receptor (FXR), a key regulator of bile acid and lipid homeostasis. In benign liver tumors, FXR expression and activation is not yet characterized. We investigated the expression and activation of FXR and its targets in hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) and their correlation with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Gd-EOB-DTPA MRI patterns were assessed by an expert radiologist. The intensity of the lesions on the hepatobiliary phase was correlated to mRNA expression levels of OATP1B1, OATP1B3, MRP2, MRP3, FXR, and small heterodimer partner (SHP) in fresh surgical specimens of patients with FNH or HCA subtypes. Normal and tumor sample pairs of 43 HCA and 14 FNH were included. All FNH (14/14) were hyperintense. Of the 34 HCA with available Gd-EOB-DTPA-enhanced MRI, 6 were hyperintense and 28 HCA were hypointense. OATP1B3 was downregulated in the hypointense tumors compared with normal surrounding liver tissue (2.77±3.59 vs. 12.9±15.6, P < 0.001). A significant positive correlation between FXR expression and activation and OATP1B3 expression level was found in the HCA cohort. SHP showed a trend toward downregulation in hypointense HCA. In conclusion, this study suggests that the MRI relative signal in HCA may reflect expression level and/or activity of SHP and FXR. Moreover, our data confirms the pivotal role of OATP1B3 in Gd-EOB-DTPA uptake in HCA. SIGNIFICANCE STATEMENT: FXR represents a valuable target for the treatment of liver disease and metabolic syndrome. Currently, two molecules, ursodeoxycholate and obeticholate, are approved for the treatment of primary biliary cirrhosis and cholestasis, with several compounds in clinical trials for the treatment of metabolic dysfunction-associated fatty liver disease. Because FXR expression and activation is associated with gadoxetate accumulation in HCA, an atypical gadoxetate-enhanced MRI pattern might arise in patients under FXR-targeted therapy, thereby complicating the differential diagnosis.
Collapse
Affiliation(s)
- Belle V van Rosmalen
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Michele Visentin
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Alicia Furumaya
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Otto M van Delden
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Geert Kazemier
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Thomas M van Gulik
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Joanne Verheij
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| | - Bruno Stieger
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands (B.V.vR., A.F., T.M.vG.); Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands (B.V.vR., A.F., O.M.vD., T.M.vG., J.V.); Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland (M.V., B.S.); Amsterdam UMC Location University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands (O.M.vD.); Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands (G.K.); Cancer Center Amsterdam, Amsterdam, The Netherlands (G.K.); and Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, The Netherlands (J.V.)
| |
Collapse
|
5
|
Qu Q, Lu M, Xu L, Zhang J, Liu M, Jiang J, Zhao X, Zhang X, Zhang T. A model incorporating histopathology and preoperative gadoxetic acid-enhanced MRI to predict early recurrence of hepatocellular carcinoma without microvascular invasion after curative hepatectomy. Br J Radiol 2023; 96:20220739. [PMID: 36877238 PMCID: PMC10078874 DOI: 10.1259/bjr.20220739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES To assess the predictive value of preoperative gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI) features and postoperative histopathological grading for early recurrence of hepatocellular carcinoma (HCC) without microvascular invasion (MVI) after curative hepatectomy. METHODS A total of 85 MVI-negative HCC cases were retrospectively analyzed. Cox analyses were used to identify the independent predictors of early recurrence (within a 24 months span). The clinical prediction Model-1 or Model-2 was established without or with postoperative pathological factor, respectively. Nomogram models were constructed and receiver operating characteristic (ROC) curve analysis was used to assess the models' predictive ability. Internal validation of the prediction models for early HCC recurrence was performed using a bootstrap re-sampling approach. RESULTS In the multivariate cox regression analysis, Edmondson-Steiner grade, peritumoral hypointensity on hepatobiliary phase (HBP), and relative intensity ratio (RIR) in HBP were identified as independent variables associated with early recurrence. The C-index of the nomogram models and internal validation were both between 0.7 and 0.8, showing good model fitting and calibration effects. The area under the ROC curve (AUC) was 0.781 for Model-1 based on the two preoperative MRI factors. When a third factor, the Edmondson-Steiner grade, was included (Model-2), the AUC increased to 0.834, and the sensitivity increased from 71.4 to 96.4%. CONCLUSIONS Edmondson-Steiner grade, peritumoral hypointensity on HBP, and RIR on HBP can help predict early recurrence of MVI-negative HCC. In comparison with Model-1 (only imaging features), Model-2 (imaging features + histopathological grades) increases the sensitivity in predicting early recurrence of HCC without MVI. ADVANCES IN KNOWLEDGE Preoperative GA-enhanced MRI signs are of great value in predicting early postoperative recurrence of HCC without MVI, and a combined pathological model was established to evaluate the feasibility and effectiveness of this technique.
Collapse
Affiliation(s)
- Qi Qu
- Nantong University, Nantong, 226000, Jiangsu, China
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Mengtian Lu
- Nantong University, Nantong, 226000, Jiangsu, China
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Lei Xu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Jiyun Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Maotong Liu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Jifeng Jiang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | | | - Xueqin Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| | - Tao Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People’s Hospital, Nantong, 226000, Jiangsu, China
| |
Collapse
|