Preoperative Gadoxetic Acid-Enhanced MRI Features for Evaluation of Vessels Encapsulating Tumor Clusters and Microvascular Invasion in Hepatocellular Carcinoma: Creating Nomograms for Risk Assessment

Qi Qu; Zixin Liu; Mengtian Lu; Lei Xu; Jiyun Zhang; Maotong Liu; Jifeng Jiang; Chunyan Gu; Qinrong Ma; Aina Huang; Xueqin Zhang; Tao Zhang

doi:10.1002/jmri.29187

Preoperative Gadoxetic Acid-Enhanced MRI Features for Evaluation of Vessels Encapsulating Tumor Clusters and Microvascular Invasion in Hepatocellular Carcinoma: Creating Nomograms for Risk Assessment

J Magn Reson Imaging. 2023 Dec 20. doi: 10.1002/jmri.29187. Online ahead of print.

Authors

Qi Qu^{1

2}, Zixin Liu^{1

2}, Mengtian Lu^{1

2}, Lei Xu², Jiyun Zhang², Maotong Liu², Jifeng Jiang², Chunyan Gu³, Qinrong Ma³, Aina Huang², Xueqin Zhang², Tao Zhang²

Affiliations

¹ Nantong University, Nantong, Jiangsu, China.
² Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China.
³ Department of Pathology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China.

PMID: 38116997
DOI: 10.1002/jmri.29187

Abstract

Background: Vessels encapsulating tumor cluster (VETC) and microvascular invasion (MVI) have a synergistic effect on prognosis assessment and treatment selection of hepatocellular carcinoma (HCC). Preoperative noninvasive evaluation of VETC and MVI is important.

Purpose: To explore the diagnosis value of preoperative gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI) features for MVI, VETC, and recurrence-free survival (RFS) in HCC.

Study type: Retrospective.

Population: 240 post-surgery patients with 274 pathologically confirmed HCC (allocated to training and validation cohorts with a 7:3 ratio) and available tumor marker data from August 2014 to December 2021.

Field strength/sequence: 3-T, T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging.

Assessment: Three radiologists subjectively reviewed preoperative MRI, evaluated clinical and conventional imaging features associated with MVI+, VETC+, and MVI+/VETC+ HCC. Regression-based nomograms were developed for HCC in the training cohort. Based on the nomograms, the RFS prognostic stratification system was further. Follow-up occurred every 3-6 months.

Statistical tests: Chi-squared test or Fisher's exact test, Mann-Whitney U-test or t-test, least absolute shrinkage and selection operator-penalized, multivariable logistic regression analyses, receiver operating characteristic analysis, Harrell's concordance index (C-index), Kaplan-Meier plots. Significance level: P < 0.05.

Results: In the training group, 44 patients with MVI+ and 74 patients with VETC+ were histologically confirmed. Three nomograms showed good performance in the training (C-indices: MVI+ vs. VETC+ vs. MVI+/VETC+, 0.892 vs. 0.848 vs. 0.910) and validation (C-indices: MVI+ vs. VETC+ vs. MVI+/VETC+, 0.839 vs. 0.810 vs. 0.855) cohorts. The median follow-up duration for the training cohort was 43.6 (95% CI, 35.0-52.2) months and 25.8 (95% CI, 16.1-35.6) months for the validation cohort. Patients with either pathologically confirmed or nomogram-estimated MVI, VETC, and MVI+/VETC+ suffered higher risk of recurrence.

Data conclusion: GA-enhanced MRI and clinical variables might assist in preoperative estimation of MVI, VETC, and MVI+/VETC+ in HCC.

Evidence level: 4 TECHNICAL EFFICACY: Stage 2.

Keywords: gadoxetic acid; hepatocellular carcinoma; microvessel; nomograms.

Abstract

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