Diffusion-weighted imaging for identifying patients at high risk of tumor recurrence following liver transplantation

Chuang, Yi‐Hsuan; Ou, Hsin‐You; Yu, Chun‐Yen; Chen, Chao‐Long; Weng, Ching‐Chun; Tsang, Leo Leung-Chit; Hsu, Hsien‐Wen; Lim, Wei-Xiong; Huang, Tung‐Liang; Cheng, Yu‐Fan

doi:10.1186/s40644-019-0264-y

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…Similar controversial results regarding ADC mean in the prediction of HCC with MVI were reported by two studies stating that ADC mean is significantly lower in HCCs with MVI than in HCCs without MVI [37,38]. However, another three studies reported no significant differences between HCCs with MVI and HCCs without MVI [39][40][41]. To date, no standardized ADC measuring method has been available for liver DWI study.…”

Section: Discussionsupporting

confidence: 53%

“…To date, no standardized ADC measuring method has been available for liver DWI study. Some researchers tend to draw an ROI avoiding the cystic necrotic part, and the hemorrhage of the measured lesion [28,29,35,38,40,42,43], while some draw the ROI on the entire liver tumor [27,34,36,37,39,41]. This may explain the diversity of ADC mean measurements and the correlation between MVI and the histo-pathologic grade of HCC.…”

Section: Discussionmentioning

confidence: 99%

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A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI

Liao

Cheng

et al. 2022

JCM

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Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is a histopathological marker and risk factor for HCC recurrence. We integrated diffusion-weighted imaging (DWI) and magnetic resonance (MR) image findings of tumors into a scoring system for predicting MVI. In total, 228 HCC patients with pathologically confirmed MVI who underwent surgical resection or liver transplant between November 2012 and March 2021 were enrolled retrospectively. Patients were divided into a right liver lobe group (n = 173, 75.9%) as the model dataset and a left liver lobe group (n = 55, 24.1%) as the model validation dataset. Multivariate logistic regression identified two-segment involved tumor (Score: 1; OR: 3.14; 95% CI: 1.22 to 8.06; p = 0.017); ADCmin ≤ 0.95 × 10−3 mm2/s (Score: 2; OR: 10.88; 95% CI: 4.61 to 25.68; p = 0.000); and largest single tumor diameter ≥ 3 cm (Score: 1; OR: 5.05; 95% CI: 2.25 to 11.30; p = 0.000), as predictive factors for the scoring model. Among all patients, sensitivity was 89.66%, specificity 58.04%, positive predictive value 68.87%, and negative predictive value 84.41%. For validation of left lobe group, sensitivity was 80.64%, specificity 70.83%, positive predictive value 78.12%, and negative predictive value 73.91%. The scoring model using ADCmin, largest tumor diameter, and two-segment involved tumor provides high sensitivity and negative predictive value in MVI prediction for use in routine functional MR.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI

Liao

Cheng

et al. 2022

JCM

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“…This situation might be the reason for the missing correlation. Nevertheless, despite some studies reporting a correlation between lower ADC values with early recurrence after liver transplantation [10] or SIRT [29], and lower OS after TACE or SIRT [30], all of these studies are retrospective single-centre studies; and other studies have reported no such correlation [15]. HCC has mostly a heterogeneous intratumoral architecture, especially in large lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with the same BCLC class or Child-Pugh grade do not benefit from the treatments equally, and there is a need for additional features to cover all the variations in clinical outcomes within the same category. Multiple studies have investigated a correlation between radiological appearances and recurrence, survival or histopathological grade of the lesions [10,11], but most of these studies investigated patients who underwent resection or transplantation. Evaluation of such imaging features after SIRT or sorafenib treatment is lacking in the literature.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma

et al. 2021

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Summary Aims To investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC). Design Patients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values. The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression. Results Three hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin–bilirubin (ALBI) score, liver–spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS. LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD. Conclusions Imaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.

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“…Diffusion weighted imaging is another promising MRI feature to predict HCC treatment outcome. A single center trial reported lower apparent diffusion coefficient values, which predicted early recurrence after LT ( 51 ). However, the heterogenous nature of HCC, especially in larger lesions, could potentially limit the value of the diffusion technique in more advanced patients outside MC.…”

Section: Beyond Afp–pet Hepatobiliary Mri and Other Biomarkersmentioning

confidence: 99%

Patient Selection for Downstaging of Hepatocellular Carcinoma Prior to Liver Transplantation—Adjusting the Odds?

Seehofer¹,

Petrowsky²,

Schneeberger³

et al. 2022

Transpl Int

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Background and Aims: Morphometric features such as the Milan criteria serve as standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Since it has been recognized that these criteria are too restrictive and do not adequately display the tumor biology, additional selection parameters are emerging.Methods: Concise review of the current literature on patient selection for downstaging and LT for HCC outside the Milan criteria.Results: The major task in patients outside the Milan criteria is the need for higher granularity with patient selection, since the benefit through LT is not uniform. The recent literature clearly shows that beneath tumor size and number, additional selection parameters are useful in the process of patient selection for and during downstaging. For initial patient selection, the alpha fetoprotein (AFP) level adds additional information to the size and number of HCC nodules concerning the chance of successful downstaging and LT. This effect is quantifiable using newer selection tools like the WE (West-Eastern) downstaging criteria or the Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful, especially in the high risk group of patients outside the University of California San Francisco (UCSF) criteria. After this entry selection, the clinical course during downstaging procedures concerning the tumor and the AFP response is of paramount importance and serves as an additional final selection tool.Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more and more sophisticated, but are still imperfect. The implementation of molecular knowledge will hopefully support a more specific risk prediction for HCC patients in the future, but do not provide a profound basis for clinical decision-making at present.

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Diffusion-weighted imaging for identifying patients at high risk of tumor recurrence following liver transplantation

Cited by 12 publications

References 28 publications

A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI

A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI

Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma

Patient Selection for Downstaging of Hepatocellular Carcinoma Prior to Liver Transplantation—Adjusting the Odds?

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