Abstract

Background: Preoperative grading of hepatocellular carcinoma (HCC) is an important factor associated with prognosis after liver resection. The promising prediction of the differentiation of HCC remains a challenge. The purpose of our study was to investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of HCC, compared with the intravoxel incoherent motion (IVIM) imaging.Methods: From September 2018 to February 2020, 88 patients with HCC were enrolled and divided into four groups (G1, G2, G3, and G4) based on the histologic grades. Preoperative APT signal intensity (SI), apparent diffusion coefficient (ADC), true molecular diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f ) of HCC were independently measured by two radiologists. The averaged values of those parameters were compared using an analysis of variance. The Spearman rank analysis was used to compare the correlation between those imaging parameters and the histological grades. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance.Results: There were significant differences in APT SI, ADC, D, and f among the four grades of HCC (all P < 0.001). A moderate to good relationship was found between APT SI and the histologic grade of HCC (r = 0.679, P < 0.001). APT SI had an area under the ROC curve (AUC) of 0.890 (95% CI: 0.805–0.947) for differentiating low- from high-grade HCC, and the corresponding sensitivity and specificity were 85.71% and 82.05%, respectively. Comparison of ROC curves demonstrated that the AUC of APT SI was significantly higher than those of IVIM-derived parameter (Z = 2.603, P = 0.0092; Z = 2.099, P = 0.0358; Z = 4.023, P = 0.0001; Z = 2.435, P = 0.0149, compared with ADC, D, D*, and f , respectively). Moreover, the combination of both techniques further improved the diagnostic performance, with an AUC of 0.929 (95% CI: 0.854–0.973).Conclusion: APT imaging may be a potential noninvasive biomarker for the prediction of histologic grading of HCC and complements IVIM imaging for the more accurate and comprehensive characterization of HCC.

Highlights

  • Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and its incidence has been increasing worldwide in recent decades [1]

  • The Shapiro–Wilk test revealed that all the quantitative imaging parameters measured by the two observers were normally distributed

  • The intraclass correlation coefficient (ICC) between the two observers were 0.998 [95% confidence interval (CI): 0.996–0.998], 0.989, 0.995, 0.994, and 0.996 for amide proton transfer (APT) SI, apparent diffusion coefficient (ADC), D, D∗, and f, respectively, suggesting an excellent reliability

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Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and its incidence has been increasing worldwide in recent decades [1]. It has been reported that histological grading of HCC is one of the most important predictive factors for early tumor recurrence and prognosis after curative liver resection [4]. Conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) diffusion-weighted MR imaging [5,6,7] have shown their potential values in providing useful biomarkers for the prediction of HCC grading. The IVIM approach has been one of the most widely used MR imaging techniques to evaluate the histologic grade of HCC [6, 8]. Preoperative grading of hepatocellular carcinoma (HCC) is an important factor associated with prognosis after liver resection. The purpose of our study was to investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of HCC, compared with the intravoxel incoherent motion (IVIM) imaging

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