Preoperative gadoxetic acid-enhanced MRI predicts aggressive pathological features in LI-RADS category 5 hepatocellular carcinoma

Abstract

To investigate whether Liver Imaging Reporting and Data System (LI-RADS) imaging features and non-LI-RADS imaging features can predict aggressive pathological features in adult patients with hepatocellular carcinoma (HCC). From February 2018 to September 2021, 236 adult patients with cirrhosis or hepatitis B virus infection in which liver cancer was suspected underwent MRI within 1 month before surgery. Significant MRI findings and alpha-fetoprotein (AFP) level predicted high-grade HCC and microvascular invasion (MVI) by univariate and multivariate logistic regression models. The study included 112 patients with histopathologically confirmed liver cancer (≤5 cm), 35 of whom (31.3%) high-grade HCC and 42 of 112 (37.5%) patients had MVI. Mosaic architecture (odds ratio [OR]=6.031; 95% confidence interval [CI]: 1.366, 26.626; p=0.018), coronal enhancement (OR=5.878; 95% CI: 1.471, 23.489; p=0.012), and intratumoural vessels (OR=5.278; 95% CI: 1.325, 21.020; p=0.018) were significant independent predictors of high-grade HCC. A non-smooth tumour margin (OR=10.237; 95% CI: 1.547, 67.760; p=0.016), coronal enhancement (OR=3.800; 95% CI: 1.152, 12.531; p=0.028), and peritumoural hypointensity on the hepatobiliary phase (HBP; OR=10.322; 95% CI: 2.733, 38.986; p=0.001) were significant independent predictors of MVI. In high-risk adult patients with single LR-5 HCC (≤5 cm), mosaic architecture, coronal enhancement, and intratumoural vessels are independent predictors of high-grade HCC. Non-smooth tumour margin, coronal enhancement, and peritumoural hypointensity on HBP independently predicted MVI.