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Prediction for Aggressiveness and Postoperative Recurrence of Hepatocellular Carcinoma Using Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

  • Author Footnotes
    1 Mengtian Lu and Qi Qu contributed equally to this work.
    Mengtian Lu
    Footnotes
    1 Mengtian Lu and Qi Qu contributed equally to this work.
    Affiliations
    Nantong University, Nantong, Jiangsu, China

    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 Mengtian Lu and Qi Qu contributed equally to this work.
    Qi Qu
    Footnotes
    1 Mengtian Lu and Qi Qu contributed equally to this work.
    Affiliations
    Nantong University, Nantong, Jiangsu, China

    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
    Search for articles by this author
  • Lei Xu
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
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  • Jiyun Zhang
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
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  • Maotong Liu
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
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  • Jifeng Jiang
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
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  • Wei Shen
    Affiliations
    Philips Healthcare Shanghai, Shanghai, China
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  • Author Footnotes
    2 Xueqin Zhang and Tao Zhang contributed equally to this work.
    Tao Zhang
    Footnotes
    2 Xueqin Zhang and Tao Zhang contributed equally to this work.
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    2 Xueqin Zhang and Tao Zhang contributed equally to this work.
    Xueqin Zhang
    Correspondence
    Address correspondence to: X.Z.
    Footnotes
    2 Xueqin Zhang and Tao Zhang contributed equally to this work.
    Affiliations
    Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, NO. 60 Youth Middle Road, Chongchuan District, Nantong, 226006, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 Mengtian Lu and Qi Qu contributed equally to this work.
    2 Xueqin Zhang and Tao Zhang contributed equally to this work.
Published:December 26, 2022DOI:https://doi.org/10.1016/j.acra.2022.12.018

      Rationale and Objectives

      To investigate the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) features on the pathologic grade, microvascular invasion (MVI), and cytokeratin-19 (CK19) expression in hepatocellular carcinomas (HCC), and to evaluate their association with postoperative recurrence of HCC.

      Materials and Methods

      This retrospective study included 147 patients with surgically confirmed HCCs who underwent gadoxetic-enhanced MRI. The lesions were evaluated quantitatively in terms of the relative enhancement ratio (RER), and qualitatively based on imaging features and clinical parameters. Logistic regression analyses were performed to investigate the value of these parameters in predicting the pathologic grade, MVI, and CK19 in HCC. Predictive factors for postoperative recurrence were determined using a Cox proportional hazards model.

      Results

      Peritumoral enhancement (odds ratio [OR], 3.396; p = 0.025) was an independent predictor of high pathologic grades. Serum protein induced by vitamin K absence or antagonist (PIVKA) level > 40 mAU/mL (OR, 3.763; p = 0.018) and peritumoral hypointensity (OR, 4.343; p = 0.003) were independent predictors of MVI. Predictors of CK19 included serum alpha-fetoprotein (AFP) level > 400 ng/mL (OR, 4.576; p = 0.005), rim enhancement (OR, 5.493; p = 0.024), and lower RER (OR, 0.013; p = 0.011). Peritumoral hypointensity (hazard ratio [HR], 1.957; p = 0.027) and poor pathologic grades (HR, 2.339; p = 0.043) were independent predictors of recurrence.

      Conclusion

      We demonstrated the value of preoperative gadoxetic-enhanced MRI in predicting aggressive pathological features of HCC. Poor pathologic grades and peritumoral hypointensity may independently predict the recurrence of HCC.

      Key Words

      Abbreviations:

      AFP (serum alpha-fetoprotein), AUC (area under the curve), AP (arterial phase), CI (confidence interval), C-index (Harrell's concordance index), CK19 (cytokeratin-19), DWI (diffusion-weighted imaging), E-S (Edmondson-Steiner), HBP (hepatobiliary phase), HCC (hepatocellular carcinomas), HR (Hazard ratio), ICC (Inter- and intraclass correlation coefficient), MRI (magnetic resonance imaging), MVI (microvascular invasion), OR (overall recurrence), PIVKA (Serum protein induced by vitamin K absence or antagonist), RER (relative enhancement ratio), ROC (receiver operating characteristic), ROI (Region of interest), SI (signal intensity), T2W (T2-weighted)
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