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Does hypointense HCC in the Hepatobiliary Phase at Gadoxetate-Enhanced MRI Predict Recurrence After Surgery? A Systematic Review and Meta-analysis

Published:October 15, 2022DOI:https://doi.org/10.1016/j.acra.2022.09.015

      Rationale and Objectives

      The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid-enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within 3 years after surgery conducted for a curative purpose (resection or liver transplantation).

      Materials and Methods

      Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles.

      Results

      Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within 3 years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27-7.68; p = 0.01). Heterogeneity was classified as intermediate (I2 = 52%). Articles included in the review overall presented a low risk of bias.

      Conclusion

      Hypointense HCC in the HBP on gadoxetic acid-enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.

      Key Words

      Abbreviations:

      AASLD (American Association for the Study of Liver Diseases), ADC (Apparent Diffusion Coefficient), HCC (Hepatocellular Carcinoma), HBP (Hepatobiliary Phase), CI (Confidence Interval), SI (Signal Intensity), OATP8 (Organic Anion Transporting Polypeptide 8), OR (Odds Ratio), PICOS (Patient, Index test, Comparator, Outcome and Study design), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), QUIPS (Quality in Prognostic Studies), MRI (Magnetic Resonance Imaging)
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