The Roles of Diffusion Kurtosis Imaging and Intravoxel Incoherent Motion Diffusion-Weighted Imaging Parameters in Preoperative Evaluation of Pathological Grades and Microvascular Invasion in Hepatocellular Carcinoma

Abstract

BackgroundCurrently, there are disputes about the parameters of diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and diffusion-weighted imaging (DWI) in predicting pathological grades and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). The aim of our study was to investigate and compare the predictive power of DKI and IVIM-DWI parameters for preoperative evaluation of pathological grades and MVI in HCC.MethodsPubMed, Web of Science, and Embase databases were searched for relevant studies published from inception to October 2021. Review Manager 5.3 was used to summarize standardized mean differences (SMDs) of mean kurtosis (MK), mean diffusivity (MD), tissue diffusivity (D), pseudo diffusivity (D*), perfusion fraction (f), mean apparent diffusion coefficient (ADCmean), and minimum apparent diffusion coefficient (ADCmin). Stata12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC). Overall, 42 up-to-standard studies with 3,807 cases of HCC were included in the meta-analysis.ResultsThe SMDs of ADCmean, ADCmin, and D values, but not those of D* and f values, significantly differed between well, moderately, and poorly differentiated HCC (P < 0.01). The sensitivity, specificity, and AUC of the MK, D, ADCmean, and ADCmin for preoperative prediction of poorly differentiated HCC were 69%/94%/0.89, 87%/80%/0.89, 82%/75%/0.86, and 83%/64%/0.81, respectively. In addition, the sensitivity, specificity, and AUC of the D and ADCmean for preoperative prediction of well-differentiated HCC were 87%/83%/0.92 and 82%/88%/0.90, respectively. The SMDs of ADCmean, ADCmin, D, MD, and MK values, but not f values, showed significant differences (P < 0.01) between MVI-positive (MVI+) and MVI-negative (MVI-) HCC. The sensitivity and specificity of D and ADCmean for preoperative prediction of MVI+ were 80%/80% and 74%/71%, respectively; the AUC of the D (0.87) was significantly higher than that of ADCmean (0.78) (Z = −2.208, P = 0.027). Sensitivity analysis showed that the results of the above parameters were stable and reliable, and subgroup analysis confirmed a good prediction effect.ConclusionDKI parameters (MD and MK) and IVIM-DWI parameters (D value, ADCmean, and ADCmin) can be used as a noninvasive and simple preoperative examination method to predict the grade and MVI in HCC. Compared with ADCmean and ADCmin, MD and D values have higher diagnostic efficacy in predicting the grades of HCC, and D value has superior diagnostic efficacy to ADCmean in predicting MVI+ in HCC. However, f value cannot predict the grade or MVI in HCC.

Dual-Energy Computed Tomography Iodine Imaging Combined with Laboratory Data for Preoperative Evaluation of Microvascular Invasion in Patients with Hepatocellular Carcinoma: A Two-Center Study

“…survival in patients with HCC has remarkably improved owing to the recent advances in imaging diagnosis, surgical techniques, targeted therapies, and immunotherapy [20][21][22][23][24]. Despite these advancements, patients diagnosed with HCC and MVI for the rst time present with low 5-year survival rates.…”

The Feasibility of Using Tri-Exponential Intra-Voxel Incoherent Motion DWI for Identifying the Microvascular Invasion in Hepatocellular Carcinoma

“…In these studies, it was found that only IVIM-derived D t showed statistical significance, while D p and f exhibited high variance and did not demonstrate statistical differences, consistent with our findings. 22 , 23 , 26 , 27 The liver exhibits distinctive histological features, encompassing various types of vessels such as arteries/arterioles, portal veins/venules, and hepatic veins/venules. In addition, it contains sinusoid capillaries, bile ducts, and an extensive lymphatic system.…”

“…Our findings are consistent with previous publications that have identified significantly lower diffusion coefficients as indicators of MVI-positive HCC. [22][23][24] 2) D f , on the other hand, reflects perfusion-related diffusion. While exuberant neovascularization is essential to meet the demands of oxygen and nutrient supply during hepatocarcinogenesis, these neovascular vessels are often characterized by vascular leakage and defective vascular remodeling.…”

Clinical and imaging features preoperative evaluation of histological grade and microvascular infiltration of hepatocellular carcinoma

“…Studying the correlation between imaging signs and histological classification can help clinicians choose appropriate preoperative treatment strategies. The postoperative survival rate of patients with well- and moderately differentiated HCC is significantly higher than that of patients with poorly differentiated HCC, and the 5-year postoperative recurrence rate of poorly differentiated HCC is as high as 70% [ 21 ]. For MVI-positive patients, the surgical resection area or radiofrequency ablation area must be expanded and systemic adjuvant therapy must be performed [ 22 ].…”