Radiologic Detectability of Minute Portal Venous Invasion in Hepatocellular Carcinoma

Nishie, Akihiro; Yoshimitsu, Kengo; Asayama, Yoshiki; Irié, Hiroyuki; Tajima, Tsuyoshi; Hirakawa, Masakazu; Ishigami, Kousei; Nakayama, Tomohiro; Kakihara, Daisuke; Nishihara, Yunosuke; Taketomi, Akinobu; Honda, Hiroshi

doi:10.2214/ajr.07.2810

Cited by 82 publications

(63 citation statements)

References 19 publications

(17 reference statements)

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“…One of the limitations of our study is that we did not compare the relative accuracy between peritumoral hypointensity and other imaging findings that have been described in previous studies (10,33,34,37). Nishie et al (37) and Shirabe et al (33) showed that the areas of peritumoral hemodynamic change or perfusion defects seen on CT during arterioportography (CTAP) or hepatic arteriography (CTHA) were larger in HCCs with minute portal invasion.…”

Section: Discussionmentioning

confidence: 82%

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

Kim

Jeon

et al. 2011

Magnetic Resonance Imaging

167

150

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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.

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Section: Discussionmentioning

confidence: 82%

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

Kim

Jeon

et al. 2011

Magnetic Resonance Imaging

167

150

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“…Recently, several reports have described peritumoral enhancement as a parameter that is suggestive of an increased risk of microvascular tumour invasion [10][11][12]. Kim et al [12] stated that irregular circumferential peritumoral enhancement is a risk factor for microvascular AFP, a-fetoprotein; HBV, hepatitis B virus; HCV, hepatitis C virus; SD, standard deviation.…”

Section: Discussionmentioning

confidence: 99%

“…Miyata et al [11] reported that distortion of corona enhancement and a tumorous arterioportal shunt on CT hepatic arteriography could be significant predictors of portal vein tumour invasion. Nishie et al [10] reported that the size of the peritumoral enhancement was a significant risk factor for microvascular invasion. In our study, peritumoral enhancement in triphasic CT study was not a statistically significant risk factor for microvascular tumour invasion.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Rc²,

Cw³

et al. 2012

BJR

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Objective: The aim of this study was to diagnose microvascular invasion in patients with solitary hepatocellular carcinoma (HCC) from pre-operative CT imaging. Methods: 102 patients with solitary HCC who underwent curative hepatectomy were retrospectively included in our study. The pre-operative 3-phase CT imaging and laboratory data for the 102 patients were reviewed. Tumour size, tumour margin, peritumoral enhancement and a-fetoprotein level were assessed. Surgical pathology was reviewed; tumour differentiation, liver fibrosis score and microvascular invasion were recorded. Results: The histopathological results revealed that 50 HCCs were positive and the other 52 were negative for microvascular invasion. Univariate analysis revealed that tumour size (p50.036), higher Edmondson-Steiner grade (p50.047) and non-smooth tumour margin (p,0.001) showed statistically significant associations with microvascular invasion. Multivariate logistic regression analysis showed that non-smooth tumour margin had a statistically significant association with microvascular invasion only (p,0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the non-smooth tumour margin in the prediction of microvascular invasion were 66%, 86.5%, 82.5% and 72.6%, respectively. Conclusion: Non-smooth tumour margin in pre-operative CT had a statistically significant association with microvascular invasion. More aggressive treatment should be considered in HCC patients with suspected positive microvascular invasion. Hepatic resection is a potentially curative treatment modality for patients with hepatocellular carcinoma (HCC) [1][2][3][4]. Histopathological vascular tumour invasion is a well-known major prognostic factor for patients with HCC who have undergone hepatic resection or liver transplantation [5][6][7][8]. Iwatsuki et al [9] reported that microvascular and macrovascular invasions were associated with a 4.4-and 15-fold increased risk of recurrence, respectively, for patients who had undergone liver transplantation. Because microvascular tumour invasion has a significant impact on recurrence and prognosis, preoperative diagnosis of microvascular invasion is needed.Radiological detection of microvascular tumour invasion may facilitate the pre-operative prediction of a patient's prognosis. Many researchers have tried to elucidate microvascular invasion based on pre-operative imaging studies, including CT during hepatic angiography, dynamic MRI and superparamagnetic iron oxideenhanced MRI [10][11][12][13]. However, radiological findings suggestive of microvascular invasion in pre-operative CT have not yet been well established. The purpose of our study was to diagnose microvascular invasion in patients with solitary HCC from pre-operative triphasic CT findings. Methods and materials PatientsApproval for retrospective study was obtained from our institutional review board. Between January 2007 and December 2009, 153 patients with HCC who underwent elective curative hepatectomy in our institution were...

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“…However, this contradiction may be due to lower contrast resolution of CT and single arterial phase imaging. Nishie et al (23) evaluated the same topic from a different point of view and reported that the area of peritumoral enhancement might be larger in the MVI group, particularly in small HCCs (≤3 cm) with positive and negative predictive values of 71.4% and 75%, respectively (23).…”

Section: Peritumoral Enhancementmentioning

confidence: 99%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is responsible for high incidence of cancer-related mortality worldwide (1, 2). Diagnosis of HCC is a well-known topic, and now it can be made solely by imaging findings in cirrhosis (3,4). Advances in imaging procedures and intense follow-up of high-risk patients led to increased early detection of HCC and better treatment options (5, 6). However, even in good surgical candidates, long-term survival rates remain unsatisfactory because of high recurrence (7,8). Presence of microvascular invasion (MVI) has been reported to be one of the most important risk factors related to postsurgery tumor recurrence (9-11). Presence of MVI alters the surgical procedure. MVI is a prognostic factor associated with lower survival and higher recurrence rates. Prediction of MVI may also affect locoregional treatments along with chemotherapy protocols. This review will focus on all aspects of MVI. The effect of microvascular invasion on survivalEarly tumor recurrence is linked to increased mortality rate. Lim et al. (9) reported that MVI is a more prominent tumor recurrence predictor than the Milan criteria for HCC after surgical resection. The patients who fulfill the Milan criteria should have a solitary tumor not exceeding 5 cm or three or fewer tumors with the largest not exceeding 3 cm, and no evidence of macrovascular invasion or extrahepatic metastasis (5, 9). Lim et al. (9) concluded that patients (without MVI) exceeding the Milan criteria could achieve comparable overall survival rates after surgical resection, relative to patients within the Milan criteria. However, overall survival decreased significantly with MVI, independently of the Milan criteria.In a different study, authors grouped the patients into mild (one to five invaded vessels) and severe (more than five invaded vessels) MVI groups (5). They found that the three-year recurrence-free survival rates for patients with and without MVI were 27.7% and 62.5%, respectively. They also reported that recurrence-free survival rates at two years for patients without MVI, with mild MVI, and severe MVI were 75.9%, 47.2%, and 32.7%, respectively (5). Goh et al. (12) studied patients who had surgical resection of multifocal HCC and revealed that the presence of MVI and the number of nodules (which is also a result of MVI) were more important prognostic factors than tumor size (12). They also suggested that the current American Joint Committee for Cancer TNM staging system, which uses tumor size, but not MVI, as prognostic criteria for multifocal HCC, needs to be revised (12). The indicators of microvascular invasionDespite its significance in HCC assessment, MVI can rarely be diagnosed preoperatively. However, the presence of MVI may be predicted by key radiologic findings and specific lab- We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule...

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Radiologic Detectability of Minute Portal Venous Invasion in Hepatocellular Carcinoma

Abstract: The area of peritumoral hemodynamic change in HCC patients with minute portal invasion (group 1) may be larger than in those without it (group 0), especially when tumors are small.

Cited by 82 publications

References 19 publications

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

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

Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Microvascular invasion in hepatocellular carcinoma

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