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Macrotrabecular-massive hepatocellular carcinoma: imaging identification and prediction based on gadoxetic acid–enhanced magnetic resonance imaging

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

Abstract

Objectives

To identify image features of macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC) and to determine its role in predicting MTM-HCC.

Methods

Patients who underwent preoperative gadoxetic acid-enhanced MRI and with surgery proven HCC were retrospectively included. Imaging features were assessed according to Liver Imaging Reporting and Data System. Quantitative measurements were recorded. Clinical characteristics and imaging findings were compared between MTM-HCCs and non-MTM-HCCs. Predictive factors of MTM-HCC were screened with univariate analyses and then identified with multivariate logistic regression. A regression-based diagnostic model was constructed. ROC analyses were used to determine cutoff values, AUC, and corresponding 95% confidence interval (CI) of findings. The diagnostic performance was validated by 10-fold cross-validation.

Results

One hundred and forty-one patients with 37 MTM-HCCs were included. Multivariate analyses identified high platelet count (≥ 163.5 × 103/ul, odds ratio = 3.20; 95% CI: 1.29, 7.96; p = 0.012), low tumor-to-liver ADC ratio (≤ 1.05, odds ratio = 3.05; 95% CI, 1.23 - 7.55; p = 0.016), and necrosis or severe ischemia (odds ratio = 11.61; 95% CI, 3.99 - 33.76, p < 0.001) as independent predictors of MTM-HCC. Necrosis or severe ischemia alone helped identify 86% MTM-HCCs with a specificity of 66%. The average AUCs were 0.81 (95% CI: 0.71, 0.90) for the regression-based diagnostic model, with a sensitivity of 57% and specificity of 92%.

Conclusions

Necrosis or severe ischemia was a sensitive imaging feature of MTM-HCC. Noninvasive prediction of this subtype can be achieved with good accuracy and excellent specificity when findings were combined.

Key Points

• The macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC) represents an aggressive subtype of HCC and is associated with poor prognosis.

• Imaging features of necrosis or severe ischemia alone helped identify 86% MTM-HCCs with a specificity of 66%.

• A regression-based diagnostic model including high platelet count (≥ 163.5 × 10 3 /ul), low tumor-to-liver ADC ratio (≤ 1.05), and necrosis or severe ischemia can provide noninvasive assessment of MTM-HCC with good accuracy and high specificity.

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Abbreviations

ADC:

Apparent diffusion coefficient

APF:

Alpha-fetoprotein

AUC:

Area under the ROC curve

CI:

Confidence interval

cv.AUC:

Cross-validated AUC

HBP:

Hepatobiliary phase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MTM:

Macrotrabecular-massive

ROC:

Receiver operating characteristic

SI:

Signal intensity

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Funding

This study has received funding from the National Nature Science Foundation of China (Grant Number 81771797) and Science and Technology Support Program of Sichuan Province (Grant Number 2017SZ0003).

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Author notes

  1. Jie Chen and Chunchao Xia contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China

    Jie Chen, Chunchao Xia, Ting Duan, Hanyu Jiang, Xijiao Liu, Zhen Zhang, Zheng Ye, Ronghui Gao & Bin Song

  2. Department of Radiology, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China

    Likun Cao

  3. Laboratory of Pathology, West China Hospital, Sichuan University, No.88 South Keyuan Road, Chengdu, 610041, China

    Zhenru Wu & Yujun Shi

Authors
  1. Jie Chen
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  12. Bin Song
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Corresponding authors

Correspondence to Yujun Shi or Bin Song.

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Guarantor

The scientific guarantor of this publication is Bin Song (songlab_radiology@163.com, Tel: +86 189-8060-1592, No.37 Guoxue Alley, Chengdu, 610041, China).

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

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Chen, J., Xia, C., Duan, T. et al. Macrotrabecular-massive hepatocellular carcinoma: imaging identification and prediction based on gadoxetic acid–enhanced magnetic resonance imaging. Eur Radiol 31, 7696–7704 (2021). https://doi.org/10.1007/s00330-021-07898-7

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  • DOI: https://doi.org/10.1007/s00330-021-07898-7

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