Preoperative prediction of cytokeratin-19 expression for hepatocellular carcinoma using T1 mapping on gadoxetic acid-enhanced MRI combined with diffusion-weighted imaging and clinical indicators

Yue Zhao; Xiaoliang Tan; Jingmu Chen; Hongweng Tan; Huasheng Huang; Peng Luo; Yongsheng Liang; Xinqing Jiang

doi:10.3389/fonc.2022.1068231

Preoperative prediction of cytokeratin-19 expression for hepatocellular carcinoma using T1 mapping on gadoxetic acid-enhanced MRI combined with diffusion-weighted imaging and clinical indicators

Front Oncol. 2023 Jan 19:12:1068231. doi: 10.3389/fonc.2022.1068231. eCollection 2022.

Authors

Yue Zhao^{1

2}, Xiaoliang Tan¹, Jingmu Chen¹, Hongweng Tan³, Huasheng Huang¹, Peng Luo¹, Yongsheng Liang¹, Xinqing Jiang^{1

2}

Affiliations

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

Abstract

Objectives: To explore the value of T1 mapping on gadoxetic acid-enhanced magnetic resonance imaging (MRI) in preoperative predicting cytokeratin 19 (CK19) expression for hepatocellular carcinoma (HCC).

Methods: This retrospective study included 158 patients from two institutions with surgically resected treatment-native solitary HCC who underwent preoperative T1 mapping on gadoxetic acid-enhanced MRI. Patients from institution I (n = 102) and institution II (n = 56) were assigned to training and test sets, respectively. univariable and multivariable logistic regression analyses were performed to investigate the association of clinicoradiological variables with CK19. The receiver operating characteristic (ROC) curve and precision-recall (PR) curve were used to evaluate the performance for CK19 prediction. Then, a prediction nomogram was developed for CK19 expression. The performance of the prediction nomogram was evaluated by its discrimination, calibration, and clinical utility.

Results: Multivariable logistic regression analysis showed that AFP>400ng/ml (OR=4.607, 95%CI: 1.098-19.326; p=0.037), relative apparent diffusion coefficient (rADC)≤0.71 (OR=3.450, 95%CI: 1.126-10.567; p=0.030), T1 relaxation time in the 20-minute hepatobiliary phase (T1rt-HBP)>797msec (OR=4.509, 95%CI: 1.301-15.626; p=0.018) were significant independent predictors of CK19 expression. The clinical-quantitative model (CQ-Model) constructed based on these significant variables had the best predictive performance with an area under the ROC curve of 0.844, an area under the PR curve of 0.785 and an F1 score of 0.778. The nomogram constructed based on CQ-Model demonstrated satisfactory performance with C index of 0.844 (95%CI: 0.759-0.908) and 0.818 (95%CI: 0.693-0.902) in the training and test sets, respectively.

Conclusions: T1 mapping on gadoxetic acid-enhanced MRI has good predictive efficacy for preoperative prediction of CK19 expression in HCC, which can promote the individualized risk stratification and further treatment decision of HCC patients.

Keywords: T1 mapping; cytokeratin 19; hepatocellular carcinoma; magnetic resonance imaging; nomogram.