Macrotrabecular-massive hepatocellular carcinoma: imaging identification and prediction based on gadoxetic acid–enhanced magnetic resonance imaging

Chen, Jie; Xia, Chunchao; Duan, Ting; Cao, Likun; Jiang, Hanyu; Liu, Xijiao; Zhang, Zhen; Zheng, Yi; Wu, Zhenru; Gao, Ronghui; Shi, Yujun; Song, Bin

doi:10.1007/s00330-021-07898-7

Cited by 25 publications

(27 citation statements)

References 25 publications

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“…However, after scoring, APHE hypovascular components were classified into 11 different patterns, which could be challenging in clinical practice with possible negative effects on inter-reader variability, especially with less experienced readers. 15 In accordance with prior studies, 12 , 13 we also observed significantly higher α-foetoprotein serum levels in MTM-HCCs, which was markedly increased in most patients, and a higher rate of hepatitis B infection. Based on our results and available evidence, the preoperative diagnosis of MTM-HCC in clinical practice could be suggested in patients with hepatitis B with large lesions showing TIV or non-targetoid LR-M features and high α-foetoprotein serum levels.…”

Section: Discussionsupporting

confidence: 91%

“…However, after scoring APHE hypovascular components were classified into 11 different patterns, which could be challenging in clinical practice with possible negative effects on inter-reader variability, especially with less experienced readers [15]. In accordance with prior studies [12,13],…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 61%

“…Chen et al. 13 identified high platelet count, low apparent diffusion coefficient ratio, and necrosis or severe ischaemia as independent predictors of MTM-HCC on gadoxetate disodium MRI. In that study, the sensitivity of necrosis or severe ischaemia was 86% for the diagnosis of MTM-HCC.…”

Section: Discussionmentioning

confidence: 99%

“…Mulé et al [12] reported substantial necrosis (defined as necrosis involving at least 20% of the tumor at the largest crosssectional diameter) as an independent predictive factor of MTM-HCC. Chen et al [13] identified high platelet count, low apparent diffusion coefficient ratio, and necrosis or severe ischemia as independent predictors of MTM-HCC on gadoxetate disodium MRI. In that study, the sensitivity of necrosis or severe ischemia was 86% for the diagnosis of MTM-HCC.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

“…For instance, the MTM-HCC subtype has been reported to be an independent predictor of early and overall recurrence in patients after either surgical resection or radiofrequency ablation. 6 Only a few studies have described the imaging features of HCC subtypes, in particular MTM-HCC [10] , [11] , [12] , [13] , [14] , [15] , [16] and SH-HCC. 17 These studies have focused on a combination of subjectively defined qualitative imaging features on computed tomography (CT) and magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

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Imaging features of histological subtypes of hepatocellular carcinoma: Implication for LI-RADS

et al. 2021

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Section: Discussionsupporting

confidence: 91%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Imaging features of histological subtypes of hepatocellular carcinoma: Implication for LI-RADS

et al. 2021

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Nomogram Estimating Vessels Encapsulating Tumor Clusters in Hepatocellular Carcinoma From Preoperative Gadoxetate Disodium‐Enhanced MRI

Chen

et al. 2022

Magnetic Resonance Imaging

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Background Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has potential to improve treatment decisions. Purpose To develop and validate a nomogram based on gadoxetate disodium‐enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection. Study Type Retrospective. Population A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147). Field Strength/Sequence A3.0 T/turbo spin‐echo T2‐weighted, spin‐echo echo‐planar diffusion‐weighted, and 3D T1‐weighted gradient‐echo sequences. Assessment A set of previously reported VETC‐ and/or prognosis‐correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression‐based nomogram was then constructed using the significant factors for VETC pattern. The nomogram‐estimated VETC stratification was assessed for its association with recurrence. Statistical Tests Fisher exact test, t‐test or Mann–Whitney test, logistic regression analyses, Harrell's concordance index (C‐index), nomogram, Kaplan–Meier curves and log‐rank tests. P value < 0.05 was considered statistically significant. Results Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring‐like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C‐index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram‐estimated high‐risk VETC group and low‐risk VETC group were found (2‐year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively). Data Conclusion The nomogram integrating gadoxetate disodium‐enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC. Evidence Level 4 Technical Efficacy Stage 2

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Evaluation and Prognostication of Gd‐EOB‐DTPA MRI and CT in Patients With Macrotrabecular‐Massive Hepatocellular Carcinoma

Cheng,

Li,

Wang

et al. 2023

Magnetic Resonance Imaging

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BackgroundMacrotrabecular‐massive hepatocellular carcinoma (MTM‐HCC) is highly aggressive. Comparing the diagnosis ability of CT and gadoxetate disodium (Gd‐EOB‐DTPA) MRI for MTM‐HCC are lacking.PurposeTo compare the performance of Gd‐EOB‐DTPA MRI and CT for differentiating MTM‐HCC from non‐MTM‐HCC, and determine the prognostic indicator.Study TypeRetrospective.SubjectsPost‐surgery HCC patients, divided into the training (N = 272) and external validation (N = 44) cohorts.Field Strength/Sequence3.0 T, T1‐weighted imaging, in‐opp phase, and T1‐weighted volumetric interpolated breath‐hold examination/liver acquisition with volume acceleration; enhanced CT.AssessmentThree radiologists evaluated clinical characteristics (sex, age, liver disease, liver function, blood routine, alpha‐fetoprotein [AFP] and prothrombin time international normalization ratio [PT‐INR]) and imaging features (tumor length, intratumor fat, hemorrhage, arterial phase peritumoral enhancement, intratumor necrosis or ischemia, capsule, and peritumoral hepatobiliary phase [HBP] hypointensity). Compared the performance of CT and MRI for diagnosing MTM‐HCC. Follow‐up occurred every 3–6 months, and nomogram demonstrated the probability of MTM‐HCC.Statistical TestsFisher test, t‐test or Wilcoxon rank‐sum test, area under the curve (AUC), 95% confidence interval (CI), multivariable logistic regression, Kaplan–Meier curve, and Cox proportional hazards. Significance level: P < 0.05.ResultsGd‐EOB‐DTPA MRI (AUC: 0.793; 95% CI, 0.740–0.839) outperformed CT (AUC: 0.747; 95% CI, 0.691–0.797) in the training cohort. The nomogram, incorporating AFP, PT‐INR, and MRI features (non‐intratumor fat, incomplete capsule, intratumor necrosis or ischemia, and peritumoral HBP hypointensity) demonstrated powerful performance for diagnosing MTM‐HCC with an AUC of 0.826 (95% CI, 0.631–1.000) in the external validation cohort. Median follow‐up was 347 days (interquartile range [IQR], 606 days) for the training cohort and 222 days (IQR, 441 days) for external validation cohort. Intratumor necrosis or ischemia was an independent indicator for poor prognosis.Data ConclusionGd‐EOB‐DTPA MRI might assist in preoperative diagnosis of MTM‐HCC, and intratumor necrosis or ischemia was associated with poor prognosis.Evidence Level4Technical EfficacyStage 2

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Macrotrabecular-massive hepatocellular carcinoma: imaging identification and prediction based on gadoxetic acid–enhanced magnetic resonance imaging

Cited by 25 publications

References 25 publications

Imaging features of histological subtypes of hepatocellular carcinoma: Implication for LI-RADS

Imaging features of histological subtypes of hepatocellular carcinoma: Implication for LI-RADS

Nomogram Estimating Vessels Encapsulating Tumor Clusters in Hepatocellular Carcinoma From Preoperative Gadoxetate Disodium‐Enhanced MRI

Evaluation and Prognostication of Gd‐EOB‐DTPA MRI and CT in Patients With Macrotrabecular‐Massive Hepatocellular Carcinoma

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