Susceptibility-Weighted Imaging for the Noncontrast Evaluation of Hepatocellular Carcinoma: A Prospective Study with Histopathologic Correlation

Abstract

BackgroundSpecific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent.Methods86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity.ResultsHistopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31).ConclusionsSWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.

Use of Susceptibility-Weighted Imaging (SWI) in the Detection of Brain Hemorrhagic Metastases from Breast Cancer and Melanoma

“…[5] Due to the distinct intralesional susceptibility signal(s) within brain lesions, SWI in conjunction with conventional MRI has been previously used in glioma grading as well as in the differential diagnosis of enhancing brain lesions. [6-8] With respect to solid tumors, SWI has been recently used to understand the primary tumor characteristics of patients with clear-cell type renal cell [9-10], hepatocellular [11], and prostate carcinomas. [12] A single study investigated the sensitivity of detecting hemorrhage in brain metastases from patients with lung cancer compared to conventional contrast enhanced MRI sequences.…”

Susceptibility-Weighted Imaging Manifestations in the Brain of Wilson’s Disease Patients

“…In these studies, hypointensity on filtered phase images was consistent with pathological iron deposition regions, and the phase values were closely correlated with disease duration and clinical scores, making them useful as in vivo biomarkers to objectively evaluate disease status. Furthermore, SWI has also been used to investigate age-related iron deposition [ 20 ], splenic siderotic lesions [ 21 ] and hepatocellular carcinoma [ 22 ].…”

Magnetic resonance imaging ancillary features used in Liver Imaging Reporting and Data System: An illustrative review

“…In addition, the incremental value of this feature relating to HCC diagnosis may be modest because it is uncommon in small HCCs. Some authors have studied the accuracy of this finding and have reported a sensitivity of up to 63% (in studies with limited population), and more recently of up to 31% using conventional MR sequences[ 39 , 40 , 41 ]. Nonetheless, this feature may be helpful for the diagnosis of large hypovascular HCCs in which arterial hyperenhancement is often more difficult to appreciate (Figure 13 ) and is also being recognized for its prognostic value[ 38 ].…”

“…The presence of intralesional or peri-lesional hemorrhage in the absence of previous biopsy, intervention or trauma is also an ancillary feature favoring HCC, as it is associated with HCC expansion[ 41 ]. In MRI, blood products usually manifest as areas with predominantly high signal intensity on T1-WI and heterogeneous, and predominantly low signal intensity on T2-WI.…”