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Pre-operative ADC predicts early recurrence of HCC after curative resection

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

Abstract

Objectives

To assess a correlation between the preoperative diffusion-weighted imaging (DWI) and early recurrence (<2 years) and to determine the best DWI parameters as the risk factor of early recurrence after surgery in single hepatocellular carcinoma (HCC).

Methods

The study included 114 patients with surgically resected single HCC (≤5 cm) who underwent preoperative magnetic resonance imaging (MRI) with DWI. Radiologists evaluated the diffusion restriction of the tumours using qualitative assessment and the mean and minimum apparent diffusion coefficient values (ADCmean and ADCmin) of the tumours using quantitative measurement. Clinical and laboratory findings and DWI parameters as a risk factor for early recurrence were identified by using Cox proportional hazards model.

Results

No significant difference was observed in early recurrence rates of HCCs between those with and those without diffusion restriction (p = 0.484). Early recurrence rates of HCCs with ADCmean and ADCmin values lower than the optimal cut-offs (1.023 and 0.773 × 10-3 mm2/s, respectively) were significantly higher compared with those with values higher than the optimal cut-offs (p = 0.001 and p < 0.001, respectively). In the multivariable analysis, tumour size [hazard ratio (HR) per centimetre, 2.011; 95% CI, 1.304-3.102; p = 0.002] and ADCmin ≤0.773 × 10-3 mm2/s (HR, 13.339; 95% CI, 4.422-40.240; p < 0.001) were independent risk factors for early HCC recurrence.

Conclusions

DWI is a promising imaging tool for early recurrence of HCC. Among qualitative and quantitative assessments of DWI, ADCmin is a significant risk factor for early recurrence after surgery in single HCC.

Key Points

• The performance of minimum apparent diffusion coefficient (ADCmin) is significantly better than that of mean apparent diffusion coefficient (ADCmean) for identifying early recurrence.

• ADCmin is a significantly independent risk factor of early HCC recurrence after surgery.

• ADCmin correlates with early recurrence after curative resection of single HCC, reflecting histopathological features of the tumours including histological grade and microvascular invasion.

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Abbreviations

AFP:

Alpha-fetoprotein

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

MVI:

Microvascular invasion

PIVKA-II:

Protein induced by vitamin K absence or antagonist-II

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea

    Sunyoung Lee, Seong Hyun Kim, Jeong Ah Hwang & Ji Eun Lee

  2. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Sunyoung Lee

  3. Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Korea

    Jeong Ah Hwang

  4. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Korea

    Ji Eun Lee

  5. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea

    Sang Yun Ha

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  1. Sunyoung Lee
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Correspondence to Seong Hyun Kim.

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Guarantor

The scientific guarantor of this publication is Seong Hyun Kim.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Lee, S., Kim, S.H., Hwang, J.A. et al. Pre-operative ADC predicts early recurrence of HCC after curative resection. Eur Radiol 29, 1003–1012 (2019). https://doi.org/10.1007/s00330-018-5642-5

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  • DOI: https://doi.org/10.1007/s00330-018-5642-5

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