Abstract
BackgroundSpecific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent.Methods86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity.ResultsHistopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31).ConclusionsSWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.
Highlights
Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis
Patient were included in the study if (a) features suspicious for HCC were detected on magnetic resonance imaging (MRI), in combination with clinical history and elevated serum AFP level (. 400 ng/ml) and (b) diagnosis of HCC confirmed by means of histology
With respect to tumor size, 17 lesions were smaller than 3 cm, 38 lesions were 3.1–10 cm, and 4 lesions were greater than 10 cm. 3/59 (5%) lesions were hypointense, 9/59 (15%) were isointense and 47/59 (80%) were hyperintense visually compared with the surrounding liver on T2WI, T2*WI, and susceptibility-weighted imaging (SWI) images
Summary
Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. Contrast-enhanced MRI, the most widely used clinical method to detect HCC, relies on differences in perfusion dynamics between normal hepatic parenchyma and that of altered tumor vascularity, which consists of unpaired arteries and sinusoidal capillarization. Characteristic morphologic features of HCC, detectable by both histopathology and MRI, are a fibrous capsule and a mosaic pattern of contrast enhancement on MRI (corresponding to fibrous septa and macroscopic heterogeneity, respectively, on histopathology) [3,4]. The presence of a fibrous capsule is considered a favorable prognostic factor, allowing surgical cure of HCC [6] by providing a simpler resection with a greater preservation of surrounding non-malignant liver parenchyma, which is important for patients with decreased liver function [7]. It has been found that the presence of vascular invasion ( microvascular invasion) is an important prognostic factors in HCC [10]
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