MRI Features for Predicting Microvascular Invasion of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Purpose: Microvascular invasion (MVI) is an important prognostic factor in patients with hepatocellular carcinoma (HCC). However, the reported results of magnetic resonance imaging (MRI) features for predicting MVI of HCC are variable and conflicting. Therefore, this meta-analysis aimed to identify the significant MRI features for MVI of HCC and to determine their diagnostic value. Methods: Original studies reporting the diagnostic performance of MRI for predicting MVI of HCC were identified in MEDLINE and EMBASE up until January 15, 2020. Study quality was assessed using QUADAS-2. A bivariate random-effects model was used to calculate the meta-analytic pooled diagnostic odds ratio (DOR) and 95% confidence interval (CI) for each MRI feature for diagnosing MVI in HCC. The meta-analytic pooled sensitivity and specificity were calculated for the significant MRI features. Results: Among 235 screened articles, we found 36 studies including 4,274 HCCs. Of the 15 available MRI features, 7 were significantly associated with MVI: larger tumor size (>5 cm) (DOR = 5.2, 95% CI [3.0–9.0]), rim arterial enhancement (4.2, 95% CI [1.7–10.6]), arterial peritumoral enhancement (4.4, 95% CI [2.8–6.9]), peritumoral hypointensity on hepatobiliary phase imaging (HBP) (8.2, 95% CI [4.4–15.2]), nonsmooth tumor margin (3.2, 95% CI [2.2–4.4]), multifocality (7.1, 95% CI [2.6–19.5]), and hypointensity on T1-weighted imaging (T1WI) (4.9, 95% CI [2.5–9.6]). Both peritumoral hypointensity on HBP and multifocality showed very high meta-analytic pooled specificities for diagnosing MVI (91.1% [85.4–94.8%] and 93.3% [74.5–98.5%], respectively). Conclusions: Seven MRI features including larger tumor size, rim arterial enhancement, arterial peritumoral enhancement, peritumoral hypointensity on HBP, nonsmooth margin, multifocality, and hypointensity on T1WI were significant predictors for MVI of HCC. These MRI features predictive of MVI can be useful in the management of HCC.

Diagnostic Accuracy of Artificial Intelligence Based on Imaging Data for Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…SVM is a good classifier, but it may not get good performance when it is directly used for classification, but if it can be combined with a good feature selection algorithm, the classification performance will be greatly improved. showed a similar conclusion that arterial enhancement and arterial peritumoral enhancement were significant predictors for MVI of HCC (50). However, in this study, the results of meta-regression showed no significant difference in the AP or PVP.…”

“…A meta-analysis of MRI features for predicting MVI of HCC performed by Hong et al. showed a similar conclusion that arterial enhancement and arterial peritumoral enhancement were significant predictors for MVI of HCC ( 50 ). However, in this study, the results of meta-regression showed no significant difference in the AP or PVP.…”

Radiomics Models for Predicting Microvascular Invasion in Hepatocellular Carcinoma: A Systematic Review and Radiomics Quality Score Assessment

“…Microvascular invasion (MVI) has been recognized as an independent predictor for early recurrence and poor prognosis after liver resection or transplantation in hepatocellular carcinoma (HCC) [ 1 , 2 ]. Its reported incidence ranges from 15% to 57% according to different diagnostic criteria and study population [ 3 ].…”

“…Medical imaging has evolved from a primarily diagnostic tool to an essential role in clinical decision making. Clinically, radiologists use pattern recognition after establishing links between radiological features at CT or MRI images and MVI [ 4 , 5 ], such as arterial peritumoral enhancement, non-smooth tumor margins, and rim arterial enhancement [ 2 ]. The Liver Imaging Reporting and Data System (LI-RADS) has recently been developed and has evolved as a comprehensive and standardized diagnostic algorithm for HCC imaging reporting [ 6 ].…”

Drug-Eluting Bead Transarterial Chemoembolization Combined with FOLFOX-Based Hepatic Arterial Infusion Chemotherapy for Large or Huge Hepatocellular Carcinoma

“…Large or huge HCC is often found associated with infiltrative pathological characteristics, ie, micro- or macro-vascular invasion, 19 , 29 , 30 which is usually presented as a non-smooth tumor margin or macrovascular invasion at imaging. 24 , 31 In our study, huge HCC had a higher proportion of non-smooth tumor margin or macrovascular invasion than large HCC (85.7% vs 65.7%).…”