Prediction of microvascular invasion of hepatocellular carcinoma in liver transplantation using quantitative parameters in dynamic computed tomography

Abstract

Background: Microvascular invasion (MVI) is well known to negatively influence outcomes following surgical tratment of hepatocellular carcinoma (HCC). The aim of this study was to investigate whether quantitative measurements of dynamic computed tomography (CT) could be useful in predicting MVI in HCC. Methods: A retrospective review was conducted in patients submitted to liver transplantation (LT) with HCC from March 2010 to August 2017. 115 HCCs from 70 patients were analyzed. Regions of interest (ROIs) were obtained on pre-contrast, arterial, portal, and equilibrium phase images. Enhancement profiles were assessed, analyzed and were compared with histopathological references of MVI. Generalized Estimating Equations – GEE and logistic regression analysis were used for univariate parameters. To identify the independent predictiors of MVI among the CT parameters, receiver operating characteristic (ROC) curve was performed. Results: Of the 115 HCCs, 34 (27%) had evidence of MVI in explant. None of the CT quantitative parameters was predictive of MVI. There was no statistically significant difference in percentage attenuatino ratio – PAR between HCCs with MVI and those without MVI in portal (median attenuation ratio, 117.1 for MVI and 114.5 for no-MVI) or equilibrium (median attenuation ratio, 130.5 for MVI and 126.1 for no-MVI) phases. There was also no statistically significant difference in relative washout ratio – RWR on portal and equilibrium phases between HCCs with MVI and those without MVI (realtive washout, 6.7 for MVI and 1.8 for no-MVI on portal phase, and 24.9 for MVI and 20.3 for no-MVI on equilibrium phase). Conclusion: There was no relation of preoperatively dynamic CT quantitative parameters with prediction of MVI for HCCs. All tumor characteristics failed to predict MVI.