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Hepatobiliary-phase gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid MRI for pretreatment prediction of efficacy-to-standard-therapies based on Barcelona Clinic Liver Cancer algorithm: an up-to-date review

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Abstract

Recent advances in systemic therapy have had major impacts on treatment strategies for hepatocellular carcinoma (HCC). The 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines incorporate a new section on clinical decision-making for personalized medicine, although the first treatment suggested by the BCLC guidelines is based on solid scientific evidence. More than ever before, the appropriate treatment strategy must be selected prior to the initiation of therapy for HCC. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) is essential for liver imaging and the hepatobiliary phase (HBP) of EOB-MRI reflects the expression of organic anion transporting polypeptide (OATP) transporters. Molecules associated with OATP expression are relevant in the molecular classification of HCC subclasses, and EOB-MRI is becoming increasingly important with advances in the molecular and genetic understanding of HCC. In this review, we describe imaging findings for the pretreatment prediction of response to standard therapies for HCC based on the BCLC algorithm using the HBP of EOB-MRI, with specific attention to the molecular background of OATPs. A more complete understanding of these findings will help radiologists suggest appropriate treatments and clinical follow-ups and could lead to the development of more personalized treatment strategies in the future.

Clinical relevance statement

In the coming era of personalized medicine, HBP of EOB-MRI reflecting molecular and pathological factors could play a predictive role in the therapeutic efficacy of HCC and contribute to treatment selection.

Key Points

• Imaging features of hepatobiliary phase predict treatment efficacy prior to therapy and contribute to treatment choice.

• Wnt/β-catenin activation associated with organic anion transporting polypeptide expression is involved in the tumor immune microenvironment and chemo-responsiveness.

• Peritumoral hypointensity of hepatobiliary phase reflecting microvascular invasion affects the therapeutic efficacy of locoregional to systemic therapy.

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Abbreviations

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

cTACE:

Conventional transarterial chemoembolization

DEB-TACE:

Drug-eluting bead transarterial chemoembolization

EOB-MRI:

Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid

HAIC:

Hepatic arterial infusion chemotherapy

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

HNF4α:

Hepatocyte nuclear factor 4α

ICI:

Immune checkpoint inhibitor

IDR:

Intrahepatic distant recurrence

IM:

Intrahepatic metastasis

LIRADS:

Liver Imaging Reporting and Data System

LT:

Liver transplantation

MTA:

Molecularly targeted agent

MVI:

Microvascular invasion

NASH:

Non-alcoholic steatohepatitis

OATP:

Organic anion transporting polypeptides

OS:

Overall survival

PD-1:

Programmed cell death-1

PD-L1:

Programmed death-ligand 1

PHLF:

Post-hepatectomy liver failure

PS:

Performance status

RER:

Relative enhancement ratio

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

SLCO1B3 :

Solute carrier organic anion transporter 1B3

TACE:

Transarterial chemoembolization

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  1. Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan

    Kiyoyuki Minamiguchi, Mariko Irizato, Ryosuke Taiji, Hideyuki Nishiofuku, Nagaaki Marugami & Toshihiro Tanaka

  2. Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan

    Tomoko Uchiyama

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  1. Kiyoyuki Minamiguchi
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Toshihiro Tanaka received a research grant from Guerbet Jp and Doctor-NET Inc. and lecture fees from Eisai Co., Ltd. None of the other authors have potential conflict of interest to declare.

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Minamiguchi, K., Irizato, M., Uchiyama, T. et al. Hepatobiliary-phase gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid MRI for pretreatment prediction of efficacy-to-standard-therapies based on Barcelona Clinic Liver Cancer algorithm: an up-to-date review. Eur Radiol 33, 8764–8775 (2023). https://doi.org/10.1007/s00330-023-09950-0

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