Gadoxetic acid-enhanced MRI combined with T1 mapping and clinical factors to predict Ki-67 expression of hepatocellular carcinoma

Ganbin Qiu; Jincan Chen; Weixiong Liao; Yonghui Liu; Zhongyan Wen; Yue Zhao

doi:10.3389/fonc.2023.1134646

Gadoxetic acid-enhanced MRI combined with T1 mapping and clinical factors to predict Ki-67 expression of hepatocellular carcinoma

Front Oncol. 2023 Jun 30:13:1134646. doi: 10.3389/fonc.2023.1134646. eCollection 2023.

Authors

Ganbin Qiu^{1

2}, Jincan Chen², Weixiong Liao¹, Yonghui Liu², Zhongyan Wen², Yue Zhao^{3

4}

Affiliations

¹ Imaging Department of Zhaoqing Medical College, Zhaoqing, China.
² Department of Radiology, The First People's Hospital of Zhaoqing, Zhaoqing, China.
³ Department of Radiology, Central People's Hospital of Zhanjiang, Zhanjiang, China.
⁴ Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.

Abstract

Objectives: To explore the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) combined with T1 mapping and clinical factors for Ki-67 expression in hepatocellular carcinoma (HCC).

Methods: A retrospective study was conducted on 185 patients with pathologically confirmed solitary HCC from two institutions. All patients underwent preoperative T1 mapping on gadoxetic acid-enhanced MRI. Patients from institution I (n = 124) and institution II (n = 61) were respectively assigned to the training and validation sets. Univariable and multivariable analyses were performed to assess the correlation of clinico-radiological factors with Ki-67 labeling index (LI). Based on the significant factors, a predictive nomogram was developed and validated for Ki-67 LI. The performance of the nomogram was evaluated on the basis of its calibration, discrimination, and clinical utility.

Results: Multivariable analysis showed that alpha-fetoprotein (AFP) levels > 20ng/mL, neutrophils to lymphocyte ratio > 2.25, non-smooth margin, tumor-to-liver signal intensity ratio in the hepatobiliary phase ≤ 0.6, and post-contrast T1 relaxation time > 705 msec were the independent predictors of Ki-67 LI. The nomogram based on these variables showed the best predictive performance with area under the receiver operator characteristic curve (AUROC) 0.899, area under the precision-recall curve (AUPRC) 0.946 and F1 score of 0.912; the respective values were 0.823, 0.879 and 0.857 in the validation set. The Kaplan-Meier curves illustrated that the cumulative recurrence probability at 2 years was significantly higher in patients with high Ki-67 LI than in those with low Ki-67 LI (39.6% [53/134] vs. 19.6% [10/51], p = 0.011).

Conclusions: Gadoxetic acid-enhanced MRI combined with T1 mapping and several clinical factors can preoperatively predict Ki-67 LI with high accuracy, and thus enable risk stratification and personalized treatment of HCC patients.

Keywords: hepatocellular carcinoma; Ki-67; T1 mapping; magnetic resonance imaging; nomogram.

Grants and funding

This study was funded by the Science and Technology innovation of Zhaoqing City, Guangdong Province, China under Grant (No. 2019N008). This work was supported by Medical Scientific Research Foundation of Guangdong Province, China under Grant (No. B2020225).