Imaging biomarkers for well and moderate hepatocellular carcinoma: preoperative magnetic resonance image and histopathological correlation

Kun Huang,Zi-Ping Li,Yingmei Jia,Shi-Ting Feng,Zhenpeng Peng,Zhi Dong,Chenyu Song,Ling Xu,Mengqi Huang,Huasong Cai

doi:10.1186/s12885-019-5574-8

Abstract

BackgroundOur aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI).MethodsThis study included one hundred and fifty-six patients with solitary HCC. Preoperative gadoxetic acid-enhanced MRI findings were retrospectively analyzed. MRI qualitative features such as tumor size, margin, capsule status, signal homogeneity, intratumoral vessels, peritumoral enhancement during mid-arterial phase, peritumoral hypointensity during the hepatobiliary phase (HBP) were investigated. Apparent diffusion coefficients (ADCs), T1 reduction ratio of pre- and post-contrast enhanced images of the tumors were calculated. HCC histological grading in surgical specimens were confirmed by Edmonson’s criteria. Correlations between these MRI features and HCC histological grading were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of the model.ResultsUnivariate analysis showed that maximum tumor diameter (p = 0.004), tumor margin (p = 0.006), intratumoral vessels (p = 0.001) and peritumoral hypointensity during HBP (p = 0.000), were significantly correlated with HCC histological grading. There was no relationship between capsule, tumor signal, venous thrombosis, peritumoral enhancement during mid-arterial phase, ADC value, T1 reduction ratio, and HCC histological grading. Multivariate logistic regression analysis demonstrated that the maximum tumor diameter (p = 0.012, odds ratio = 1.002, 95% confidence interval: 1.007–1.046)) was an independent risk factor for high grade HCC.ConclusionsGreater tumor size, a more irregular margin, presence of intratumoral vessels, and peritumoral hypointensity during HBP were indicators for high grade HCC. The maximum tumor diameter was an independent risk factor for high grade HCC.

Highlights

Our aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI)
Et al [7] reported that the postoperative recurrence rate of high histological grade HCC was twice as high when compared to low grade HCC
Histological grade Based on the Edmonson grading method, the cohort of patients included 8 cases with grade I HCC, 104 cases with grade II, 44 cases with grade III, and 0 cases with grade IV

Summary

Introduction

Our aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI). Hepatocellular carcinoma (HCC) is one of the most common malignancies and is associated with poor prognosis [1]. Some studies have reported that tumor size, number of lesions, presence of vascular invasion, and degree of tumor differentiation are important factors influencing the early recurrence of tumors [3,4,5,6]. Edmondson-Steiner grade might be an independent factor affecting prognosis or recurrence of HCC. Et al [7] reported that the postoperative recurrence rate of high histological grade HCC was twice as high when compared to low grade HCC. The structure of intratumoral vessels is related to the histological grade of HCC [8, 9]

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