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Abdominal Imaging

, Volume 39, Issue 6, pp 1202–1212 | Cite as

Histological grade of hepatocellular carcinoma correlates with arterial enhancement on gadoxetic acid-enhanced and diffusion-weighted MR images

  • Wei-Chou Chang
  • Ran-Chou Chen
  • Chen-Te Chou
  • Chun-Yi Lin
  • Chih-Yung Yu
  • Chang-Hsien Liu
  • Jung-Mao Chou
  • Hsian-He Hsu
  • Guo-Shu Huang
Article

Abstract

Purpose

To retrospectively determine the correlation between heptic tumor signal intensity on gadoxetic acid-enhanced and diffusion-weighted MR images and histopathological grading of hepatocellular carcinoma (HCC).

Methods

We retrospectively reviewed the MR images of 79 patients with 141 surgically resected HCCs. The signal intensity and its relationship with histopathological grade were assessed. We measured the apparent diffusion correlation (ADC) values and calculated arterial enhancement ratios, washout ratios, and relative intensity ratios of HCCs relative to the surrounding liver parenchyma in gadoxetic-enhanced MR images in order to determine their relationship to the histological grade.

Results

Morphological evaluation showed that larger tumor size and extrahepatic extension were associated with higher histologic grade (p < 0.01). Multivariate logistic regression showed that low ADC value and low relative intensity ratio in the arterial phase (RIRa) predict high histological grade. ADC value (cut-off 1.7 × 10−3 mm2/s, sensitivity 82.4%, specificity 83.2%) was the best predictor of well-differentiated HCC, and RIRa (cut-off 0.93, sensitivity 81.4%, specificity 93.9%) was superior to ADC for predicting poorly differentiated HCC.

Conclusion

Relative low arterial enhancement on gadoxetic acid-enhanced MR images and low ADC are predictive of worse histological grades of HCC.

Keywords

Hepatocellular carcinoma Histological grading Gadoxetic acid-enhanced hepatobiliary phase Magnetic resonance imaging Diffusion-weighted imaging 

Notes

Acknowledgments

We would like to give special thanks to Benjamin Yeh, MD, from the University of California, San Francisco, for his guidance and help. We also thank the Research Office for Health Data, Department of Education and Research, Taipei City Hospital, Taiwan for their valuable contributions in data management and statistical analysis. This research was supported by the National Science Council Grant (NSC 100-2314-B-010-012-MY2) and Tri-Service General Hospital Research Grant (TSGH-C101-053).

Conflict of interest

The authors report no conflicts of interest.

References

  1. 1.
    Tamura S, Kato T, Berho M, et al. (2001) Impact of histological grade of hepatocellular carcinoma on the outcome of liver transplantation. Arch Surg 136:25–30PubMedCrossRefGoogle Scholar
  2. 2.
    Klintmalm GB (1998) Liver transplantation for hepatocellular carcinoma: a registry report of the impact of tumor characteristics on outcome. Ann Surg 228:479–490PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Wayne JD, Lauwers GY, Ikai I, et al. (2002) Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg 235:722–730PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Zavaglia C, De Carlis L, Alberti AB, et al. (2005) Predictors of long-term survival after liver transplantation for hepatocellular carcinoma. Am J Gastroenterol 100:2708–2716PubMedCrossRefGoogle Scholar
  5. 5.
    Cillo U, Vitale A, Bassanello M, et al. (2004) Liver transplantation for the treatment of moderately or well-differentiated hepatocellular carcinoma. Ann Surg 239:150–159PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Esnaola NF, Lauwers GY, Mirza NQ, et al. (2002) Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation. J Gastrointest Surg 6:224–232PubMedCrossRefGoogle Scholar
  7. 7.
    Saito K, Moriyasu F, Sugimoto K, et al. (2012) Histological grade of differentiation of hepatocellular carcinoma: comparison of the efficacy of diffusion-weighted MRI with T2-weighted imaging and angiography-assisted CT. J Med Imaging Radiat Oncol 56:261–269PubMedCrossRefGoogle Scholar
  8. 8.
    Xu PJ, Yan FH, Wang JH, et al. (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34:506–512PubMedCrossRefGoogle Scholar
  9. 9.
    Miller FH, Hammond N, Siddiqi AJ, et al. (2010) Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 32:138–147PubMedCrossRefGoogle Scholar
  10. 10.
    Kim AY, Kim YK, Lee MW, et al. (2012) Detection of hepatocellular carcinoma in gadoxetic acid-enhanced MRI and diffusion-weighted MRI with respect to the severity of liver cirrhosis. Acta Radiol 53:830–838PubMedCrossRefGoogle Scholar
  11. 11.
    Rhee H, Kim MJ, Park MS, et al. (2012) Differentiation of early hepatocellular carcinoma from benign hepatocellular nodules on gadoxetic acid-enhanced MRI. Br J Radiol 85:e837–e844PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Kim HY, Choi JY, Kim CW, et al. (2012) Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging predicts the histological grade of hepatocellular carcinoma only in patients with Child-Pugh class A cirrhosis. Liver Transpl 18:850–857PubMedCrossRefGoogle Scholar
  13. 13.
    An C, Park MS, Jeon HM, et al. (2012) Prediction of the histopathological grade of hepatocellular carcinoma using qualitative diffusion-weighted, dynamic, and hepatobiliary phase MRI. Eur Radiol 22:1701–1708PubMedCrossRefGoogle Scholar
  14. 14.
    Kogita S, Imai Y, Okada M, et al. (2010) Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol 20:2405–2413PubMedCrossRefGoogle Scholar
  15. 15.
    Lee S, Kim SH, Park CK, et al. (2010) Comparison between areas with Gd-EOB-DTPA uptake and without in hepatocellular carcinomas on Gd-EOB-DTPA-enhanced hepatobiliary-phase MR imaging: pathological correlation. J Magn Reson Imaging 32:719–725PubMedCrossRefGoogle Scholar
  16. 16.
    Choi JY, Kim MJ, Park YN, et al. (2011) Gadoxetate disodium-enhanced hepatobiliary phase MRI of hepatocellular carcinoma: correlation with histological characteristics. Am J Roentgenol 197:399–405CrossRefGoogle Scholar
  17. 17.
    Sandrasegaran K, Tahir B, Patel A, et al. (2013) The usefulness of diffusion-weighted imaging in the characterization of liver lesions in patients with cirrhosis. Clin Radiol 68:708–715PubMedCrossRefGoogle Scholar
  18. 18.
    Nishie A, Tajima T, Asayama Y, et al. (2011) Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol 80:e29–e33PubMedCrossRefGoogle Scholar
  19. 19.
    Frericks BB, Loddenkemper C, Huppertz A, et al. (2009) Qualitative and quantitative evaluation of hepatocellular carcinoma and cirrhotic liver enhancement using Gd-EOB-DTPA. Am J Roentgenol 193:1053–1060CrossRefGoogle Scholar
  20. 20.
    Willatt JM, Hussain HK, Adusumilli S, et al. (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330PubMedCrossRefGoogle Scholar
  21. 21.
    Choi JW, Lee JM, Kim SJ, et al. (2013) Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR Images and their value as an imaging biomarker. Radiology 267:776–786PubMedCrossRefGoogle Scholar
  22. 22.
    Kitao A, Matsui O, Yoneda N, et al. (2012) Hypervascular hepatocellular carcinoma: correlation between biologic features and signal intensity on gadoxetic acid-enhanced MR images. Radiology 265:780–789PubMedCrossRefGoogle Scholar
  23. 23.
    Yamada I, Aung W, Himeno Y, et al. (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623PubMedCrossRefGoogle Scholar
  24. 24.
    Heo SH, Jeong YY, Shin SS, et al. (2010) Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor. Korean J Radiol 11(295):303Google Scholar
  25. 25.
    Pawlik TM, Delman KA, Vauthey JN, et al. (2005) Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 11:1086–1092PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Wei-Chou Chang
    • 1
    • 2
  • Ran-Chou Chen
    • 1
    • 3
  • Chen-Te Chou
    • 1
    • 4
  • Chun-Yi Lin
    • 1
  • Chih-Yung Yu
    • 2
  • Chang-Hsien Liu
    • 2
  • Jung-Mao Chou
    • 5
  • Hsian-He Hsu
    • 2
  • Guo-Shu Huang
    • 2
  1. 1.Department of Biomedical Imaging and Radiological SciencesNational Yang-Ming Medical UniversityTaipeiTaiwan, ROC
  2. 2.Department of RadiologyTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan, ROC
  3. 3.Department of RadiologyTaipei City HospitalTaipeiTaiwan, ROC
  4. 4.Department of RadiologyChang-Hua Christian HospitalChanghuaTaiwan, ROC
  5. 5.Department of PathologyTaipei City HospitalTaipeiTaiwan, ROC

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