European Radiology

, Volume 28, Issue 2, pp 506–513 | Cite as

Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis

  • Matteo Renzulli
  • Federica Buonfiglioli
  • Fabio Conti
  • Stefano Brocchi
  • Ilaria Serio
  • Francesco Giuseppe Foschi
  • Paolo Caraceni
  • Giuseppe Mazzella
  • Gabriella Verucchi
  • Rita Golfieri
  • Pietro Andreone
  • Stefano Brillanti



To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis.


Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48–74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA.


After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0–318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10–20 mm in 27, 20–50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54–84), even in 17/29 nodules with 10–20 mm diameter (58.6%, CI: 39–76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22–47) (p= 0.0007). MVI did not correlate with history of previous HCC.


HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients.

Key Points

In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy.

HCC presents imaging features of microvascular invasion, predictive of more aggressive progression.

Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.


Hepatitis C Liver neoplasms Computed tomography Magnetic resonance imaging Drug side effects 



Barcelona clinic liver cancer


Confidence interval


Computed tomography


Direct-acting antiviral


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


Magnetic resonance imaging


Microvascular invasion


Non-smooth tumour margins


Odds ratio


Percutaneous ethanol injection


Peritumoral enhancement


Radiofrequency ablation


Sustained virological response


Transarterial chemoembolisation


Two-trait predictor of venous invasion



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

Compliance with ethical standards


The scientific guarantor of this publication is Stefano Brillanti, M.D., Department of Medical and Surgical Sciences, University of Bologna, Italy.

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.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• retrospective

• case-control study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Matteo Renzulli
    • 1
  • Federica Buonfiglioli
    • 2
  • Fabio Conti
    • 2
  • Stefano Brocchi
    • 1
  • Ilaria Serio
    • 3
  • Francesco Giuseppe Foschi
    • 4
  • Paolo Caraceni
    • 5
  • Giuseppe Mazzella
    • 5
  • Gabriella Verucchi
    • 2
  • Rita Golfieri
    • 1
  • Pietro Andreone
    • 2
  • Stefano Brillanti
    • 2
    • 6
  1. 1.Department of Diagnostic Medicine and PreventionSant’Orsola-Malpighi HospitalBolognaItaly
  2. 2.Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMECUniversity of BolognaBolognaItaly
  3. 3.Department of Digestive DiseasesSant’Orsola-Malpighi HospitalBolognaItaly
  4. 4.Division of Internal MedicineOspedale di FaenzaFaenzaItaly
  5. 5.Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
  6. 6.U.O. di GastroenterologiaBolognaItaly

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