Prediction of microvascular invasion of hepatocellular carcinoma: Usefulness of peritumoral hypointensity seen on gadoxetate disodium‐enhanced hepatobiliary phase images

Abstract

Purpose: To determine whether peritumoral hypointensity seen on hepatobiliary phase images of preoperative gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) is useful for predicting microvascular invasion of hepatocellular carcinoma (HCC). Materials and Methods:This study was approved by the Institutional Review Board. In all, 104 HCC masses in 104 patients who had undergone EOB-MRI and liver surgery within 1 month after EOB-MRI were evaluated. Two radiologists independently recorded the presence of a peritumoral hypointensity on hepatobiliary phase. Interobserver agreement was assessed and consensus records were used. Tumor size was measured. A chi-square test and independent t-test were used for univariate analysis. Multiple logistic regression was performed to determine factors for predicting microvascular invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of peritumoral hypointensity were calculated.Results: Sixty HCCs had microvascular invasion and 44 did not. Interobserver agreement in determining peritumoral hypointensity was excellent (k ¼ 0.83). By univariate analysis, peritumoral hypointensity and tumor size were significant for predicting microvascular invasion of HCC. On multiple logistic regression analysis, only peritumoral hypointensity was significant in predicting microvascular invasion of HCC (P ¼ 0.013). The sensitivity, specificity, PPV, and NPV of peritumoral hypointensity were 38.3%, 93.2%, 88.5%, and 52.6%, respectively. Conclusion:Peritumoral hypointensity on the hepatobiliary phase of EOB-MRI is not sensitive but has high specificity for predicting microvascular invasion of HCC.

CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features

“…The same finding after injection of gadobenate was found to predict microvascular invasion in univariate but not in multivariate analyses (112). Finally, peritumoral hypointensity seen on gadoxetate disodium-enhanced hepatobiliary phase images was shown in a retrospective study to be a specific, although insensitive, marker for microvascular invasion; the authors attributed the peritumoral hypointensity to altered expression of OATP or MRP2 receptors in the hepatic parenchyma caused by hemodynamic changes associated with tumor obstruction of minute portal veins (113).…”

Single Hepatocellular Carcinoma: Preoperative MR Imaging to Predict Early Recurrence after Curative Resection

“…that preoperative imaging findings of HCC could be used to predict early recurrence after hepatic resection. Findings such as peritumoral parenchymal enhancement at magnetic resonance (MR) imaging or computed tomography (CT) and peritumoral hypointensity and/or irregular tumor margin in the hepatobiliary phase of MR imaging may be useful for predicting microvascular invasion, a known risk factor for early recurrence (16)(17)(18)(19)(20)(21). Other imaging features, such as rim enhancement in the arterial phase of dynamic CT or MR imaging (22,23) and an irregular tumor margin and signal intensity on hepatobiliary images at gadoxetic acid-enhanced MR imaging, have been suggested as useful findings to predict tumor behavior (7,18,24).…”

Efficacy of Contrast-Enhanced Ultrasound Washout Rate in Predicting Hepatocellular Carcinoma Differentiation

“…Hence, computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) features have been used to predict tumor grade, with mixed results (Chandarana et al 2011;Chou et al 2012;Esnaola et al 2002;Hayashi et al 2002;Jonas et al 2001;Kenmochi et al 1987;Kim et al 2012;Marelli et al 2008;Nakashima et al 1999;Pawlik et al 2005;Rodriguez-Peralvarez et al 2013;Suh et al 2012;Witjes et al 2012;Zhang et al 2014). Tumor progression along the multistep pathway from regenerative nodules to HCC is accompanied by a decrease in both normal arterial and portal blood flow and a concurrent disappearance of normal intranodular vessels.…”