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

An, Chansik; Kim, Dong Wook; Park, Young Nyun; Chung, Yong Eun; Rhee, Hyungjin; Kim, Do Young

doi:10.1148/radiol.15142394

Cited by 185 publications

(155 citation statements)

References 45 publications

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“…This proportion is similar to that in our recent study in which 4.9% of 225 HCCs showed IRE and were thus categorized as LR-M [5], but lower than that in our earlier study in which 11.8% of the 187 HCCs showed IRE [3]. A likely reason for this discrepancy is our strict criteria for evaluation of IRE in the current study; we considered IRE to be positive only when both of the two reviewers agreed on its presence.…”

Section: Discussionsupporting

confidence: 85%

“…This study aimed to seek a histopathologic explanation for the results of our previous HCC studies in which IRE was an independent imaging feature associated with poor prognosis after curative resection [3,5]. We found that the histopathologic features of IRE-HCCs included sinusoid-like microvascular pattern, macrotrabecular pattern, a high proportion of tumor necrosis and fibrous stroma, and expression of stemness markers, which have been reported as characteristics of aggressive and poor prognostic HCCs [20,21,23,25,43].…”

Section: Discussionmentioning

confidence: 83%

“…A likely reason for this discrepancy is our strict criteria for evaluation of IRE in the current study; we considered IRE to be positive only when both of the two reviewers agreed on its presence. In contrast, in our initial study [3], we were less conservative, and IRE was considered to be positive when one of the two reviewers, not both of them, determined its presence. Indeed, even in the current study, the second radiologist was less conservative in determining the presence of IRE and classified 9.3% as IRE-HCCs, which is a similar proportion to that observed in our initial study.…”

Section: Discussionmentioning

confidence: 91%

“…However, some HCCs display an atypical enhancement pattern of peripheral irregular rim-like enhancement (IRE) with central hypoenhancing areas in the arterial phase. HCCs with such IRE patterns (IRE-HCCs) were reported in 5-13% of patients undergoing curative resection or radiofrequency ablation [3][4][5]. The IRE pattern is not a typical imaging feature of HCC; it is a finding usually indicative of other hepatic malignancies such as cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma, which generally show worse prognoses than HCC [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated that IRE-HCCs show more rapid progression and worse prognosis after curative resection, radiofrequency ablation, or transarterial chemoembolization compared to non-IRE-HCCs [3][4][5][10][11][12]. The unique radiologic features of IRE-HCCs suggest that they might be associated with distinctive histopathologic characteristics responsible for their aggressive tumor behavior.…”

Section: Introductionmentioning

confidence: 99%

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Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

Rhee

An²,

Kim

et al. 2018

Liver Cancer

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Background and Aims: The purpose of our study was to examine the histopathologic characteristics of hepatocellular carcinoma (HCC) with irregular rim-like arterial phase enhancement (IRE), which has been reported to be associated with more aggressive tumor behavior. Methods: We investigated 84 pathologically confirmed HCCs in 84 patients who underwent curative hepatic resection after gadoxetate-enhanced magnetic resonance imaging between January 2008 and February 2013. Two abdominal radiologists independently reviewed these images and classified HCCs into two categories: HCC showing IRE (IRE-HCC) and HCC showing hypoenhancement or diffuse arterial enhancement (non-IRE-HCC). Twenty-two HCCs were classified as IRE-HCCs, and 51 were classified as non-IRE-HCCs concordantly by both reviewers. The remaining 11 HCCs, on whose radiologic classifications the reviewers disagreed, were classified as HCCs with intermediate enhancement patterns. The HCC clinicopathologic characteristics and patient outcomes were then compared. Results: IRE-HCCs showed more frequent microvascular invasion (91 vs. 35%), lower microvascular density (246.5 vs. 426.5/mm²), higher proportions of sinusoid-like microvascular pattern (55 vs. 0%) and macrotrabecular pattern (45 vs. 0%), and larger areas of tumor necrosis (15 vs. 0%) and fibrous stroma (8.3 vs. 2.1%) than non-IRE-HCCs. IRE-HCCs also expressed higher levels of immunomarkers of hypoxia (carbonic anhydrase IX, 64 vs. 8%) and stemness (EpCAM, 50 vs. 20%). p values were < 0.001 for all comparisons except for EpCAM (p = 0.026). HCCs with intermediate enhancement patterns showed mixed/intermediate pathologic features from both IRE- and non-IRE-HCCs. IRE-HCC patients showed poorer 5-year disease-free survival after curative resection than non-IRE-HCC patients (p = 0.005). Conclusions: IRE-HCCs demonstrate aggressive histopathologic features, including more hypoxic and fibrotic tumor microenvironments and increased stemness, compared to non-IRE-HCCs. IRE might therefore serve as a noninvasive imaging biomarker for aggressive HCC.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

Rhee

An²,

Kim

et al. 2018

Liver Cancer

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MRI‐Based Radiomics: Associations With the Recurrence‐Free Survival of Patients With Hepatocellular Carcinoma Treated With Conventional Transcatheter Arterial Chemoembolization

Song

Guo

et al. 2019

Magnetic Resonance Imaging

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BackgroundPreoperative estimation of hepatocellular carcinoma (HCC) recurrence after conventional transcatheter arterial chemoembolization (c‐TACE) is crucial for subsequent follow‐up and therapy decisions.PurposeTo evaluate the associations of radiomics models based on pretreatment contrast‐enhanced MRI, a clinical‐radiological model and a combined model with the recurrence‐free survival (RFS) of patients with HCC after c‐TACE, and to develop a radiomics nomogram for individual RFS estimations and risk stratification.Study TypeRetrospective.PopulationIn all, 184 consecutive HCC patients.Field Strength/Sequence1.5T or 3.0T, including T2WI, T1WI, and contrast‐enhanced T1WI.AssessmentAll HCC patients were randomly divided into the training (n = 110) and validation datasets (n = 74). Radiomics signatures capturing intratumoral and peritumoral expansion (1, 3, and 5 mm) were constructed, and the radiomics models were set up using least absolute shrinkage and selection operator (LASSO) Cox regression. Clinical‐radiological features were identified by univariate and multivariate Cox regression. The clinical‐radiological model and the combined model fusing the radiomics signature with the clinical‐radiological risk factors were developed by a multivariate Cox proportional hazard model. A radiomics nomogram derived from the combined model was established.Statistical TestsLASSO Cox regression, univariate and multivariate Cox regression, Kaplan–Meier analysis were performed. The discrimination performance of each model was quantified by the C‐index.ResultsAmong the different peritumoral expansion models, only the 3‐mm peritumoral expansion model (C‐index, 0.714) showed a comparable performance (P = 0.4087) to that of the portal venous phase intratumoral model (C‐index, 0.727). The combined model showed the best performance and the C‐index was 0.802. Kaplan–Meier analysis showed that the cutoff values of the combined model relative to a median value (1.7426) perfectly stratified these patients into high‐risk and low‐risk subgroups.Data ConclusionThe combined model is more valuable than the clinical‐radiological model or radiomics model alone for evaluating the RFS of HCC patients after c‐TACE, and the radiomics nomogram can be used to preoperatively and individually estimate RFS.Level of Evidence: 3Technical Efficacy Stage: 4J. Magn. Reson. Imaging 2020;52:461–473.

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Prediction Model for Intermediate‐Stage Hepatocellular Carcinoma Response to Transarterial Chemoembolization

Jia

Yan

et al. 2020

Magnetic Resonance Imaging

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Background: The outcome of intermediate-stage hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) is greatly heterogeneous. Current means for predicting HCC response to TACE are lacking. Purpose: To investigate whether the combination of parameters derived from amide proton transfer (APT) and intravoxel incoherent motion (IVIM) imaging, and morphological characteristics of tumor can establish a better prediction model than the univariant model for HCC response to TACE. Study Type: Prospective. Subjects: 56 patients with intermediate-stage HCC (50 males and six females). Field Strength/Sequences: 3.0T; T 2-weighted-fast spin echo, 3D liver acquisition with volume flex, single-shot fast spin echo-planar imaging (EPI), spin echo-EPI. Assessment: Pretreatment APT signal intensities (SIs), apparent diffusion coefficient (ADC), true molecular diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) for tumor, peritumoral, and normal tissues were measured. Follow-up MRI scanning was performed, and the patients were classified as responders or nonresponders based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Statistical Tests: The imaging parameters were compared among the three tissues and between the two groups using analysis of variance (ANOVA) or two-sample t-test. The prediction model's variables were derived from univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance. Results: Based on the logistic regression analysis results, we established a prediction model that integrated the APT SI and D values in the tumor tissue and the tumor size. ROC analyses revealed that the model was better able to predict tumor response to TACE (area under the ROC curve = 0.851) than the individual parameters on their own. Data Conclusion: A prediction model incorporating pretreatment APT SI, D in the tumor tissue and tumor size may be useful for predicting the response of intermediate-stage HCC to TACE. Level of Evidence: 1 Technical Efficacy: Stage 1

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

Cited by 185 publications

References 45 publications

Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

MRI‐Based Radiomics: Associations With the Recurrence‐Free Survival of Patients With Hepatocellular Carcinoma Treated With Conventional Transcatheter Arterial Chemoembolization

Prediction Model for Intermediate‐Stage Hepatocellular Carcinoma Response to Transarterial Chemoembolization

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