Preoperative Gd-EOB-DTPA-enhanced MRI may help predict macrotrabecular-massive subtype and postoperative recurrence
Li Yang1,2, Fei Wu1, Wentao Wang1
1Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China.
Objective:
To assess the preoperative Gd-EOB-DTPA-enhanced MRI findings of macrotrabecular-massive (MTM) subtype and 3-year recurrence after surgery in small hepatocellular carcinoma (sHCC).
Materials And Methods:
Three hundred and fifteen consecutive patients (training cohort: n = 226; validation cohort: n = 89) with surgically confirmed sHCC (≤ 3 cm) and preoperative Gd-EOB-DTPA-enhanced MRI were retrospectively included. Significant predictors for MTM-sHCC were identified by univariate and multivariate analyses; a logistic regression model and nomogram were built. Kaplan-Meier analysis, log-rank test, and Cox proportional hazard regression were employed to assess 3-year recurrence after hepatectomy.
Results:
Hypovascular component ≥ 20%, intratumoral artery, and incomplete capsule in Gd-EOB-DTPA-enhanced MRI were independent factors for predicting MTM-sHCC. Areas under the curves of the logistic regression model of combining three predictors were 0.73 (95% CI: 0.67-0.79) and 0.75 (95% CI: 0.65-0.84) in the training and validation sets, respectively, and the sensitivity and specificity in validation set were 77.4% and 72.4%. Combining two or three significant imaging predictors was significantly associated with 3-year recurrence (HR = 2.55, 95% CI: 1.24-5.22; p = 0.011). Recurrence-free survival was significantly lower in patients with two or three significant predictors than in those with none in both the training (p = 0.028) and validation cohorts (p = 0.002).
Conclusions:
Preoperative Gd-EOB-DTPA-enhanced MRI findings, including hypovascular component ≥ 20%, intratumoral artery, and incomplete capsule, may help noninvasive prediction of MTM-sHCC and 3-year recurrence after surgery.
Key Points:
Question It is to assess the imaging findings of MTM subtype and 3-year recurrence after surgery in sHCC. Findings Hypovascular component ≥ 20%, intratumoral artery, and incomplete capsule were independent factors for predicting MTM-sHCC. Clinical relevance Gd-EOB-DTPA-enhanced MRI findings for MTM-sHCC may be a useful predictor for 3-year recurrence.
