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

Abstract

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

Editorial for “Preoperative Gadoxetic Acid‐EnhancedMRIFeatures for Evaluation of Vessels Encapsulating Tumor Clusters and Microvascular Invasion in Hepatocellular Carcinoma: Creating Nomograms for Risk Assessment”

“…7 This hypovascular pattern frequently correlated with tumor necrosis, which was also found to predict MTM-HCC with high specificity. 8,9 This agrees with the findings of Feng et al, who showed that macrotrabecular-massive HCC and vessels encapsulating tumor clusters patterns share common imaging features such as large tumor size and necrosis. 10 Finally, imaging findings associated with the presence of both MVI and VETC were arterial peritumoral enhancement and low relative intensity ratio on HBP images, which are both recognized as predictors of MVI.…”

“…More interestingly, patterns identified as predictors of VETC included ≥50% arterial phase hypovascular component, which have been previously observed in macrotrabecular‐massive HCCs, an aggressive subtype of HCC associated with poor prognosis 7 . This hypovascular pattern frequently correlated with tumor necrosis, which was also found to predict MTM‐HCC with high specificity 8,9 . This agrees with the findings of Feng et al, who showed that macrotrabecular‐massive HCC and vessels encapsulating tumor clusters patterns share common imaging features such as large tumor size and necrosis 10 …”