Evaluation of Preoperative Microvascular Invasion in Hepatocellular Carcinoma Through Multidimensional Parameter Combination Modeling Based on Gd-EOB-DTPA MRI

Abstract

Background and Aims:The study established and compared the efficacy of the clinicoradiological model, radiomics model and clinicoradiological-radiomics hybrid model in predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC) using gadolinium ethoxybenzyl diethylene triaminepentaacetic acid (Gd-EOB-DTPA) enhanced MRI. Methods: This was a study that enrolled 602 HCC patients from two institutions. Least absolute shrinkage and selection operator (Lasso) method was used to screen for the most important clinicoradiological and radiomics features that predict MVI pre-operatively. Three machine learning algorithms were used to establish the clinicoradiological, radiomics, and clinicoradiological-radiomics hybrid models. Area under the curve (AUC) of receiver operating characteristic (ROC) curves and Delong's test were used to compare and quantify the predictive performance of the models. Results: The AUCs of the clinicoradiological model in training and validation cohorts were 0.793 and 0.701, respectively. The radiomics signature of arterial phase (AP) images alone achieved satisfying predictive efficacy for MVI, with AUCs of 0.671 and 0.643 in training and validation cohort, respectively. The combination of clinicoradiological factors and fusion radiomics signature of AP and VP images achieved AUCs of 0.824 and 0.801 in training and validation cohorts, 0.812 and 0.805 in prospective validation and external validation cohorts, respectively. The hybrid model provided the best prediction results. The results of the Delong test revealed that there were statistically significant differences among the clinicoradiological-radiomics hybrid model, clinicoradiological model, and radiomics model (p<0.05). Conclusions: The combination of clinicoradiological factors and fusion radiomics signature of AP and VP images based on Gd-EOB-DTPA-enhanced MRI can effectively predict MVI.

The role of cold ischemia time and hypothermic perfusion in predicting early hepatocellular carcinoma recurrences after liver transplantation

“…Further studies are required to detection rate of MVI at preoperative imaging in cases with HCC. [29][30][31] The most interesting finding in our cohort was the association between cold ischemia time (CIT) and HCC recurrences. Longer CIT leads to higher cellular damage during organ retrieval and preparation, which can be directly correlated to the degree of ischemic-reperfusion injury (IRI).…”

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

“…Peritumoral HBP hypointensity indicates an impaired function of normal hepatic parenchymal cells surrounding the tumor due to the invasion of small branches of portal vein, resulting in reduced expression of organic anion transporting polypeptide and thus diminished or lost uptake of Gd-EOB-DTPA. 2 Regarding intratumor fat, the detection rate of MRI is significantly higher than that of CT, mainly because an MRI study includes multiple imaging sequences, such as chemical shift imaging, which has been recognized as the most accurate method for fat quantification. 34 A previous study has shown that intratumor fat is more common in well-differentiated HCC due to transient hypoxia in the early HCC formation.…”

“…In addition, MRI peritumoral HBP hypointensity and non‐intratumor fat were independent risk factors for discriminating MTM‐HCC. Peritumoral HBP hypointensity indicates an impaired function of normal hepatic parenchymal cells surrounding the tumor due to the invasion of small branches of portal vein, resulting in reduced expression of organic anion transporting polypeptide and thus diminished or lost uptake of Gd‐EOB‐DTPA 2 . Regarding intratumor fat, the detection rate of MRI is significantly higher than that of CT, mainly because an MRI study includes multiple imaging sequences, such as chemical shift imaging, which has been recognized as the most accurate method for fat quantification 34 .…”

“…1 MTM-HCC has a lower morbidity rate than classical HCC but has a high risk of recurrence and a low survival rate after surgery. 2 MTM-HCC has a solid ability to activate angiogenesis. 3 Recent studies have shown that MTM-HCCs are correlated with hepatitis B virus (HBV) infection, 4 and with strong vascular invasion and metastatic potential.…”

“…Macrotrabecular‐massive hepatocellular carcinoma (MTM‐HCC), a specific subtype of HCC, was recognized in the HCC classification of the World Health Organization (WHO) in 2019 1 . MTM‐HCC has a lower morbidity rate than classical HCC but has a high risk of recurrence and a low survival rate after surgery 2 . MTM‐HCC has a solid ability to activate angiogenesis 3 .…”