Nomogram Estimating Vessels Encapsulating Tumor Clusters in Hepatocellular Carcinoma From Preoperative Gadoxetate Disodium‐Enhanced MRI

Abstract

Background Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has potential to improve treatment decisions. Purpose To develop and validate a nomogram based on gadoxetate disodium‐enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection. Study Type Retrospective. Population A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147). Field Strength/Sequence A3.0 T/turbo spin‐echo T2‐weighted, spin‐echo echo‐planar diffusion‐weighted, and 3D T1‐weighted gradient‐echo sequences. Assessment A set of previously reported VETC‐ and/or prognosis‐correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression‐based nomogram was then constructed using the significant factors for VETC pattern. The nomogram‐estimated VETC stratification was assessed for its association with recurrence. Statistical Tests Fisher exact test, t‐test or Mann–Whitney test, logistic regression analyses, Harrell's concordance index (C‐index), nomogram, Kaplan–Meier curves and log‐rank tests. P value < 0.05 was considered statistically significant. Results Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring‐like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C‐index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram‐estimated high‐risk VETC group and low‐risk VETC group were found (2‐year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively). Data Conclusion The nomogram integrating gadoxetate disodium‐enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC. Evidence Level 4 Technical Efficacy Stage 2

Correlations behind macrotrabecular‐massive and vessels encapsulating tumor cluster patterns in hepatocellular carcinoma

“…Their models were established after deep learning of the radiomic features of intratumoral and peritumoral tissues and are as follows: on non-rim dh-APHE, the tumor signal intensity (SI)/liver SI ratio is ≥1.135 in AP, and the tumor SI/liver SI ratio in HPB is ≤0.585, conferring high accuracy for predicting VETC-HCC. Furthermore, heterogeneous enhancement is an important factor in assessing VETC patterns, with positive VETC patterns being more frequently found when heterogeneous enhancement includes irregular ring-like structures or septum-like structures [51]. The imaging features of two HCC subtypes are shown in Table 1.…”

Deep Learning Radiomics Model of Dynamic Contrast‐Enhanced MRI for Evaluating Vessels Encapsulating Tumor Clusters and Prognosis in Hepatocellular Carcinoma

“…However, evaluating VETC patterns preoperatively remains challenging because VETC can only be diagnosed by surgical specimens. Some studies have tried to use preoperative imaging to noninvasive evaluate VETC 8–12 . Computed tomography (CT) or MRI features, such as types of enhancement pattern, intratumoral necrosis, tumor size, and non‐rim diffuse and heterogeneous arterial phase hyperenhancement (non‐rim dh‐APHE), have been reported to be associated with VETC 8–11 .…”

“…[8][9][10][11][12] Computed tomography (CT) or MRI features, such as types of enhancement pattern, intratumoral necrosis, tumor size, and non-rim diffuse and heterogeneous arterial phase hyperenhancement (non-rim dh-APHE), have been reported to be associated with VETC. [8][9][10][11] Yu et al predicted the preoperative VETC and prognosis of HCC patients based on radiomics features of the hepatobiliary phase (HBP) of gadolinium-ethoxybenzyldiethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. 12 However, the criteria for preoperative imaging diagnosis of VETC have not been widely accepted, and more robust evidence is needed.…”

Editorial for “Nomogram Estimating Vessels Encapsulating Tumor Clusters in Hepatocellular Carcinoma From Preoperative Gadoxetate Disodium‐Enhanced MRI”

“…6,7 In this issue of Journal of Magnetic Resonance Imaging, the authors reported MR imaging features that can predict the presence of VETC pattern, and tumor size, presence of heterogeneous enhancement, and necrosis were significantly associated with the VETC pattern. 8 In addition, the authors developed a nomogram based on MR imaging features to predict the presence of VETC pattern with a good discrimination performance. This study had several strengths.…”

“…The nomogram based on MR imaging features including tumor size, heterogeneous enhancement, and presence of necrosis was an accurate model to predict the VETC pattern and predictive of high recurrence after surgery. 8 Given that, MR imaging features that can predict the presence of VETC would be helpful for HCC management by accurately estimating the risk of tumor recurrence, ultimately leading to the selection of optimal treatment plans.…”