Multi-phasic magnetic resonance imaging of hemodynamic interchanges in hepatocarcinogenesis

Abstract

Background Liver cirrhosis and hepatocellular cancer deem a substantial global health burden and are the end result of a variety of chronic liver diseases. Guidelines have been introduced to secure standardized approaches in the diagnosis and management of hepatocellular carcinoma (HCC). Established guidelines agree upon the distinctive dynamic enhancement findings of HCC, characterized by arterial phase wash-in and venous or delayed phase washout. The indeterminate focal hepatic lesions constitute a diagnostic dilemma. The aim of the study was quantification of hepatic vascular parameters using dynamic contrast-enhanced (DCE)-MRI to study liver hemodynamic disturbances that can differentiate between focal hepatic lesions during hepatocellular carcinogenesis. Results The study was conducted on 95 patients with comparing perfusion abnormalities across different liver cirrhosis pathologies, and the comparison revealed the correlation of hemodynamics with hepatocarcinogenesis and grades of cirrhosis. Relative enhancement curves were graphed to illustrate the different enhancement patterns across the spectrum of hepatonodular lesions of cirrhosis and among types of de novo and recurrent HCC. Statistical significance was highest between dysplastic nodules (DNs) and HCCs (maximal relative enhancement (MRE) 0.88, wash-in ratio (WIR) 0.84, washout ratio (WOR) 0.78, time to peak (TTP) 0.74, area under curve (AUC 0.73, T0 0.70), compared to those between cirrhotic liver and DNs (MRE 0.74, To 0.62). Least significances were between de novo and recurrent HCCs (TTP 0.66, r AUC 0.66, MRE 0.63). Performances between non-cirrhotic and cirrhotic liver [WOR 0.81, time to peak (TTP) 0.80, r AUC 0.63] surpassed those among different grades of cirrhosis (the highest was between non-tumoral and tumoral cirrhosis: TTP 0.74, MRE 0.68, WIR 0.65, WOR 0.65). Conclusions Dynamic contrast-enhanced magnetic resonance imaging hemodynamic metrics promise potential usefulness as non-invasive biomarkers in assessment of liver cirrhosis, characterization of cirrhotic nodules, and evaluation of multistep hepatocarcinogenesis.