Evaluation and Prognostication of Gd-EOB-DTPA MRI and CT in Patients With Macrotrabecular-Massive Hepatocellular Carcinoma

Jie Cheng; Xiaofeng Li; Limei Wang; Fengxi Chen; Yiman Li; Guojiao Zuo; Mi Pei; Huarong Zhang; Linze Yu; Chen Liu; Jian Wang; Qi Han; Ping Cai; Xiaoming Li

doi:10.1002/jmri.29052

Evaluation and Prognostication of Gd-EOB-DTPA MRI and CT in Patients With Macrotrabecular-Massive Hepatocellular Carcinoma

J Magn Reson Imaging. 2023 Oct 15. doi: 10.1002/jmri.29052. Online ahead of print.

Authors

Jie Cheng^{1

2}, Xiaofeng Li³, Limei Wang^{1

2}, Fengxi Chen^{1

2}, Yiman Li^{1

2}, Guojiao Zuo^{1

2}, Mi Pei^{1

2}, Huarong Zhang⁴, Linze Yu⁵, Chen Liu^{1

2}, Jian Wang^{1

2}, Qi Han^{1

2}, Ping Cai^{1

2}, Xiaoming Li^{1

2}

Affiliations

¹ Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
² 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
³ Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁴ Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
⁵ School of Medical Imaging, North Sichuan Medical College, Nanchong, China.

PMID: 37840197
DOI: 10.1002/jmri.29052

Abstract

Background: Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is highly aggressive. Comparing the diagnosis ability of CT and gadoxetate disodium (Gd-EOB-DTPA) MRI for MTM-HCC are lacking.

Purpose: To compare the performance of Gd-EOB-DTPA MRI and CT for differentiating MTM-HCC from non-MTM-HCC, and determine the prognostic indicator.

Study type: Retrospective.

Subjects: Post-surgery HCC patients, divided into the training (N = 272) and external validation (N = 44) cohorts.

Field strength/sequence: 3.0 T, T1-weighted imaging, in-opp phase, and T1-weighted volumetric interpolated breath-hold examination/liver acquisition with volume acceleration; enhanced CT.

Assessment: Three radiologists evaluated clinical characteristics (sex, age, liver disease, liver function, blood routine, alpha-fetoprotein [AFP] and prothrombin time international normalization ratio [PT-INR]) and imaging features (tumor length, intratumor fat, hemorrhage, arterial phase peritumoral enhancement, intratumor necrosis or ischemia, capsule, and peritumoral hepatobiliary phase [HBP] hypointensity). Compared the performance of CT and MRI for diagnosing MTM-HCC. Follow-up occurred every 3-6 months, and nomogram demonstrated the probability of MTM-HCC.

Statistical tests: Fisher test, t-test or Wilcoxon rank-sum test, area under the curve (AUC), 95% confidence interval (CI), multivariable logistic regression, Kaplan-Meier curve, and Cox proportional hazards. Significance level: P < 0.05.

Results: Gd-EOB-DTPA MRI (AUC: 0.793; 95% CI, 0.740-0.839) outperformed CT (AUC: 0.747; 95% CI, 0.691-0.797) in the training cohort. The nomogram, incorporating AFP, PT-INR, and MRI features (non-intratumor fat, incomplete capsule, intratumor necrosis or ischemia, and peritumoral HBP hypointensity) demonstrated powerful performance for diagnosing MTM-HCC with an AUC of 0.826 (95% CI, 0.631-1.000) in the external validation cohort. Median follow-up was 347 days (interquartile range [IQR], 606 days) for the training cohort and 222 days (IQR, 441 days) for external validation cohort. Intratumor necrosis or ischemia was an independent indicator for poor prognosis.

Data conclusion: Gd-EOB-DTPA MRI might assist in preoperative diagnosis of MTM-HCC, and intratumor necrosis or ischemia was associated with poor prognosis.

Evidence level: 4 TECHNICAL EFFICACY: Stage 2.

Keywords: Gd-EOB-DTPA; computed tomography; hepatocellular carcinoma; macrotrabecular-massive; magnetic resonance imaging.

Grants and funding

CSTB2022NSCQMSX1371/National Natural Science Foundation of Chongqing