Abstract
BackgroundTo evaluate the utility of non-invasive parameters derived from T1 mapping and diffusion-weighted imaging (DWI) on gadoxetic acid-enhanced MRI for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).MethodsA total of 94 patients with single HCC undergoing partial hepatectomy was analyzed in this retrospective study. Preoperative T1 mapping and DWI on gadoxetic acid-enhanced MRI was performed. The parameters including precontrast, postcontrast and reduction rate of T1 relaxation time and apparent diffusion coefficient (ADC) values were measured for differentiating MVI-positive HCCs (n = 38) from MVI-negative HCCs (n = 56). The receiver operating characteristic curve (ROC) was analyzed to compare the diagnostic performance of the calculated parameters.ResultsMVI-positive HCCs demonstrated a significantly lower reduction rate of T1 relaxation time than that of MVI-negative HCCs (39.4% vs 49.9, P < 0.001). The areas under receiver operating characteristic curve (AUC) were 0.587, 0.728, 0.824, 0,690 and 0.862 for the precontrast, postcontrast, reduction rate of T1 relaxation time, ADC and the combination of reduction rate and ADC, respectively. The cut-off value of the reduction rate and ADC calculated through maximal Youden index in ROC analyses was 44.9% and 1553.5 s/mm2. To achieve a better diagnostic performance, the criteria of combining the reduction rate lower than 44.9% and the ADC value lower than 1553.5 s/mm2 was proposed with a high specificity of 91.8% and accuracy of 80.9%.ConclusionsThe proposed criteria of combining the reduction rate of T1 relaxation time lower than 44.9% and the ADC value lower than 1553.5 s/mm2 on gadoxetic acid-enhanced MRI holds promise for evaluating MVI status of HCC.
Highlights
To evaluate the utility of non-invasive parameters derived from T1 mapping and diffusion-weighted imaging (DWI) on gadoxetic acid-enhanced Gadoxetic acidenhanced magnetic resonance imaging (MRI) for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC)
Patients and treatment characteristics Among the 222 patients, 55 patients were excluded for having two or more HCCs; 8 patients were excluded for Child-Pugh C because the poor liver function could impair the quality of gadoxetic acid-enhanced MR images; 28 were excluded for other types of nodules including intrahepatic cholangiocarcinoma (n = 15), combined HCC and cholangiocarcinoma (n = 1), dysplastic nodule (n = 10) and metastases (n = 2); 16 patients were excluded for having more than 2 weeks interval time during follow-up; 21 patients were excluded for having lesions on left lobe with susceptibility or respiratory motion artifacts on DW images
To achieve better diagnostic performance, we proposed a criteria of combining the reduction rate lower than 44.9% and the apparent diffusion coefficient (ADC) value lower than 1553.5 s/ mm2 that can demonstrate a satisfactory diagnostic accuracy of 89.9% with a sensitivity of 60.6% and a high specificity of 91.8%
Summary
To evaluate the utility of non-invasive parameters derived from T1 mapping and diffusion-weighted imaging (DWI) on gadoxetic acid-enhanced MRI for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Microvascular invasion (MVI) is known as a critical predictor of early recurrence and poor prognosis after curative treatments of HCC [3,4,5]. There are some studies that demonstrate the promising results for preoperatively predicting MVI of HCC based on the evaluation of morphologic MR imaging features [6, 7] and the quantitative analysis including measuring the ADC values of diffusion weighted imaging (DWI) [8, 9], kurtosis value of diffusion kurtosis imaging [10] or D value of intravoxel incoherent motion (IVIM) [11]. The subjective nature in the evaluation of morphologic features, instable image quality of diffusion weighted/kurtosis images (i.e., T2 blackout effect, susceptibility artifacts and image distortion) or obscure algorithms in radiomics analysis are all challenges for clinical utility
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
