Pathobiological and Radiological Approach For Hepatocellular Carcinoma Subclassification

Area of Science:

• Hepatobiliary imaging
• Oncologic pathology
• Radiology

Background:

• Classic imaging and histopathological features of hepatocellular carcinoma (HCC) are insufficient for predicting patient prognosis.
• Advances in imaging and histopathology necessitate novel methods for assessing HCC aggressiveness.

Purpose of the Study:

• To establish a correlation between novel morphovascular patterns of HCC and their magnetic resonance imaging (MRI) characteristics.
• To identify pre-operative MRI markers indicative of biologically aggressive HCC.

Main Methods:

• Histopathological analysis and immunohistochemistry (CD34, Nestin) were used to classify four HCC morphovascular patterns in 39 liver nodules from 22 patients.
• MRI was performed using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid to evaluate nodule characteristics.

Main Results:

• Three of the four morphovascular HCC patterns exhibited distinct MRI features.
• Pattern D (aggressive HCCs with CD34+/Nestin+ neovascularization) showed isointensity on T1-weighted imaging (T1-WI) in 83% and hyperintensity on T2-weighted imaging (T2-WI) in 50% of cases.
• Five HCCs (Pattern A) were misclassified as non-malignant on MRI due to early vascularization and low aggressiveness.

Conclusions:

• A subclassification of HCC based on morphovascular patterns is feasible in the pre-operative setting using MRI.
• MRI can effectively differentiate HCC morphovascular patterns, aiding in the pre-operative identification of biologically aggressive tumors.