Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors: A Two-Center Retrospective Study

OBJECTIVES

Current literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast-enhanced ultrasound (CEUS) features in HIPT and compare them with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI).

METHODS

A total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B-mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi-square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.

RESULTS

On the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper- or iso-enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash-out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash-out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).

CONCLUSIONS

The CEUS features of HIPT lesions typically include mildly hyper-enhanced or iso-enhanced in AP, rapid wash-out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash-out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

Diagnostic model using LI-RADS v2018 for predicting early recurrence of microvascular invasion-negative solitary hepatocellular carcinoma

OBJECTIVES

To develop a diagnostic model for predicting the early recurrence of microvascular invasion (MVI)-negative hepatocellular carcinoma (HCC) after surgical resection, using the Liver Imaging Reporting and Data System (LI-RADS) version 2018.

METHODS

This retrospective study included 73 patients with MVI-negative HCC who underwent Gadoxetic acid-enhanced MRI (EOB-MRI) scanning before surgical resection. The clinical factors and LI-RADS v2018 MRI features associated with early recurrence were determined using univariable and multivariable analyses. A diagnostic model predicting early recurrence after surgical resection was developed, and its predictive ability was evaluated via a receiver operating characteristic curve. Then, the recurrence-free survival (RFS) rates were analyzed by Kaplan-Meier method.

RESULTS

In total, 26 (35.6%) patients were diagnosed with early recurrence according to the follow-up results. Infiltrative appearance and targetoid hepatobiliary phase (HBP) appearance were independent predictors associated with early recurrence (p < 0.05). For the established diagnostic model that incorporated these two significant predictors, the AUC value was 0.76 (95% CI: 0.64-0.85) for predicting early recurrence after resection, which was higher than the infiltrative appearance (AUC: 0.67, 95% CI: 0.55-0.78, p = 0.019) and targetoid HBP appearance (AUC: 0.68, 95% CI:0.57-0.79, p = 0.028). In the RFS analysis, patients with infiltrative appearance and targetoid HBP appearance showed significantly lower RFS rates than those without infiltrative appearance (2-year RFS rate, 48.0% vs. 72.0%; p = 0.009) and targetoid HBP appearance (2-year RFS rate, 60.0% vs. 35.0%; p = 0.003).

CONCLUSION

An EOB-MRI model based on infiltrative appearance and targetoid HBP appearance showed good performance in predicting early recurrence of HCC after surgery, which may provide personalized guidance for clinical treatment decisions in patients with MVI-negative HCC.

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI improves diagnosis and efficacy evaluation of early-stage hepatocellular carcinoma

OBJECTIVE

To investigate the use of hepatocyte-specific contrast agent Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and efficacy evaluation of patients with early-stage hepatocellular carcinoma.

METHODS

A retrospective clinical study was conducted on 157 patients diagnosed with stage Ia-Ib liver cancer. Of these, 100 patients underwent preoperative EOB-MRI, while 57 patients underwent contrast-enhanced computerized tomography (CECT). The study compared the accuracy, sensitivity, and specificity of these two imaging modalities in diagnosing early-stage hepatocellular carcinoma. In the EOB-MRI group, 100 patients underwent radiofrequency ablation or interventional procedures, and imaging data were collected post-scan. The following arterial and hepatobiliary phase enhancement features were analyzed: length-diameter difference (LDD), signal intensity ratio of metastases to liver parenchyma (RatioM/L), relative signal intensity difference (RSID), normalized relative enhancement (NRE), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values. Based on treatment outcomes, patients were categorized into high and low response rate groups, and the imaging parameters between these two groups were compared. Univariate and multivariate analyses were performed to evaluate the significance of these parameters in predicting patient outcomes.

RESULTS

The accuracy of lesion detection by EOB-MRI was 97.4%, significantly higher than that of CECT (80.0%) (P < 0.05). The area under the curve (AUC) for the EOB-MRI group was 0.923 (95% CI: 0.784-1.000), with a sensitivity of 97.4% and a specificity of 83.3%. In comparison, the AUC for the CECT group was 0.712 (95% CI: 0.582-0.843), with a sensitivity of 77.2% and a specificity of 65.2%. The median response rate of patients with early-stage hepatocellular carcinoma to systemic therapy was 60% (range: 36%-81%). Using 60% as the cut-off value, patients were divided into a high response rate group (n = 53) and a low response rate group (n = 47). Univariate and multivariate logistic regression analyses of the EOB-MRI parameters in both groups identified ADC and NRE as independent predictors for assessing the treatment efficacy of early-stage hepatocellular carcinoma.

CONCLUSION

EOB-MRI is effective for both the diagnosis and evaluation of treatment efficacy in early-stage hepatocellular carcinoma.