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Can IVIM help predict HCC recurrence after hepatectomy?

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the diagnostic performance of intravoxel incoherent motion (IVIM) parameters to predict tumor recurrence after hepatectomy in patients with hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC).

Materials and methods

One hundred and fifty-seven patients (mean age 52.54 ± 11.32 years, 87% male) with surgically and pathologically confirmed HCC were included. Regions of interests were drawn including the tumors by two independent radiologists. ADC and IVIM-derived parameters (true diffusion coefficient [D]; pseudodiffusion coefficient [D*]; pseudodiffusion fraction [f]) were obtained preoperatively. The Cox proportional hazards model was used to analyze the predictors associated with tumor recurrence after hepatectomy.

Results

Forty-seven of 157 (29.9%) patients experienced tumor recurrence. The multivariate Cox proportional hazards model revealed that a D value < 0.985 × 10−3 mm2/s (hazard ratio (HR), 0.190; p = 0.023) was a risk factor for tumor recurrence. Additional risk factors included younger age (HR, 0.328; p = 0.034) and higher serum alpha-fetoprotein (AFP) level (HR, 2.079; p = 0.013). Further, receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the obtained Cox regression model improved from 0.68 for the combination of AFP and age alone to 0.724 for the combination of D value, AFP, and age.

Conclusion

The D value derived from the IVIM model is a potential biomarker for the preoperative prediction of recurrence after hepatectomy in patients with HCC. When combined with age and AFP levels, D can improve the predictive performance for tumor recurrence.

Key Points

• The recurrence rate of HCC after hepatectomy was higher in patients with ADC, D, and f values that were lower than the optimal cutoff values.

• The optimal cutoff values of ADC, D, D*, and f for predicting recurrence in HBV associated HCC were 0.858 × 10−3 mm2/s, 0.985 × 10−3 mm2/s, 12.5 × 10−3 mm2/s, and 23.4%, respectively.

• The D value derived from IVIM diffusion-weighted imaging may be a useful biomarker for preoperative prediction of recurrence after hepatectomy in patients with HCC. When combined with age and AFP levels, D can improve the predictive performance for tumor recurrence.

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Abbreviations

ADC:

Apparent diffusion coefficient

AFP:

Alpha-fetoprotein

AUC:

Area under the curve

CI:

Confidence interval

D :

True diffusion coefficient

D*:

Pseudodiffusion coefficient

f :

Pseudodiffusion fraction

HBP:

Hepatobiliary phase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

ICC:

Intra-class correlation coefficient

IVIM:

Intravoxel incoherent motion

ROC:

Receiver operating characteristic

T2WI:

T2-weighted imaging

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Funding

The authors state that this study has received funding by National Natural Science Foundation of China grant 81271562 (JW) and Science and Technology Program of Guangzhou, China 201704020016 (JW).

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Author notes

  1. Yao Zhang and Sichi Kuang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, People’s Republic of China

    Yao Zhang, Sichi Kuang, Qungang Shan, Dailin Rong, Hao Yang, Jun Wu, Jingbiao Chen, Bingjun He, Ying Deng & Jin Wang

  2. Philips Intergrated Solution Center, Guangzhou, People’s Republic of China

    Zhongping Zhang

  3. Edinburgh Imaging, School of Clinical Sciences, University of Edinburgh, Edinburgh, EH16 4TJ, UK

    Neil Roberts

  4. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (SYSU), No 107, Yanjiang Road, West, Guangzhou, 510120, People’s Republic of China

    Jun Shen

  5. Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Sudhakar K. Venkatesh

Authors
  1. Yao Zhang
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Corresponding author

Correspondence to Jin Wang.

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The scientific guarantor of this publication is Jin Wang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Zhang, Y., Kuang, S., Shan, Q. et al. Can IVIM help predict HCC recurrence after hepatectomy?. Eur Radiol 29, 5791–5803 (2019). https://doi.org/10.1007/s00330-019-06180-1

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