Gadoxetic acid-enhanced MRI with a focus on LI-RADS v2018 imaging features predicts the prognosis after radiofrequency ablation in small hepatocellular carcinoma

Ruizhi Wang; Hengtian Xu; Wufei Chen; Liang Jin; Zhuangxuan Ma; Lei Wen; Hongwei Wang; Kun Cao; Xia Du; Ming Li

doi:10.3389/fonc.2023.975216

Gadoxetic acid-enhanced MRI with a focus on LI-RADS v2018 imaging features predicts the prognosis after radiofrequency ablation in small hepatocellular carcinoma

Front Oncol. 2023 Feb 2:13:975216. doi: 10.3389/fonc.2023.975216. eCollection 2023.

Authors

Ruizhi Wang¹, Hengtian Xu², Wufei Chen¹, Liang Jin¹, Zhuangxuan Ma¹, Lei Wen², Hongwei Wang³, Kun Cao⁴, Xia Du², Ming Li¹

Affiliations

¹ Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China.
² Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
³ Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China.
⁴ Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.

Abstract

Introduction: Gadoxetic acid-enhanced magnetic resonance imaging (MRI) contributes to evaluating the prognosis of small hepatocellular carcinoma (sHCC) following treatment. We have investigated the potential role of gadoxetic acid-enhanced MRI based on LI-RADS (Liver Imaging Reporting and Data System) v2018 imaging features in the prognosis prediction of patients with sHCC treated with radiofrequency ablation (RFA) as the first-line treatment and formulated a predictive nomogram.

Methods: A total of 204 patients with sHCC who all received RFA as the first-line therapy were enrolled. All patients had undergone gadoxetic acid-enhanced MRI examinations before RFA. Uni- and multivariable analyses for RFS were assessing using a Cox proportional hazards model. A novel nomogram was further constructed for predicting RFS. The clinical capacity of the model was validated according to calibration curves, the concordance index (C-index), and decision curve analyses.

Results: Alpha fetoprotein (AFP) > 100 ng/ml (HR, 2.006; 95% CI, 1.111-3.621; P = 0.021), rim arterial phase hyperenhancement (APHE) (HR, 2.751; 95% CI, 1.511-5.011; P = 0.001), and targetoid restriction on diffusion-weighted imaging (DWI) (HR, 3.289; 95% CI, 1.832-5.906; P < 0.001) were considered as the independent risk features for recurrence in patients with sHCC treated with RFA. The calibration curves and C-indexes (C-index values of 0.758 and 0.807) showed the superior predictive performance of the integrated nomogram in both the training and validation groups.

Discussion: The gadoxetic acid-enhanced MRI features based on LI-RADS v2018, including rim APHE, targetoid restriction on DWI, and the AFP level, are the independent risk factors of recurrence in patients with sHCC treated with RFA as the first-line therapy. The predictive clinical-radiological nomogram model was constructed for clinicians to develop individualized treatment and surveillance strategies.

Keywords: gadoxetic acid-enhanced MRI; nomogram; prognosis; radiofrequency ablation; small hepatocellular carcinoma.

Grants and funding

This study has received funding by National Natural Science Foundation of China (no. 61976238), Shanghai “Rising Stars of Medical Talent” Youth Development Program “Outstanding Youth Medical Talents” [SHWJRS (2021)-99], Scientific Research Program of Shanghai Science and Technology Commission (Reference: 20Y11902900), and the “Future Star” of famous doctors’ training plan of Fudan University.