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Detecting microvascular invasion in hepatocellular carcinoma using the impeded diffusion fraction technique to sense macromolecular coordinated water

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objectives

Impeded diffusion fraction (IDF) is a novel and promising diffusion-weighted imaging (DWI) technique that allows for the detection of various diffusion compartments, including macromolecular coordinated water, free diffusion, perfusion, and cellular free water. This study aims to investigate the clinical potential of IDF-DWI in detecting microvascular invasion (MVI) in hepatocellular carcinoma (HCC).

Methods

66 patients were prospectively included. Metrics derived from IDF-DWI and the apparent diffusion coefficient (ADC) were calculated. Multivariate logistic regression was employed to identify clinical risk factors. Diagnostic performance was evaluated using the area under the receiver operating characteristics curve (AUC-ROC), the area under the precision-recall curve (AUC-PR), and the calibration error (cal-error). Additionally, a power analysis was conducted to determine the required sample size.

Results

The results suggested a significantly higher fraction of impeded diffusion (FID) originating from IDF-DWI in MVI-positive HCCs (p < 0.001). Moreover, the ADC was found to be significantly lower in MVI-positive HCCs (p = 0.019). Independent risk factors of MVI included larger tumor size and elevated alpha-fetoprotein (AFP) levels. The nomogram model incorporating ADC, FID, tumor size, and AFP level yielded the highest diagnostic accuracy for MVI (AUC-PR = 0.804, AUC-ROC = 0.783, cal-error = 0.044), followed by FID (AUC-PR = 0.693, AUC-ROC = 0.760, cal-error = 0.060) and ADC (AUC-PR = 0.570, AUC-ROC = 0.651, cal-error = 0.164).

Conclusion

IDF-DWI shows great potential in noninvasively, accurately, and preoperatively detecting MVI in HCC and may offer clinical benefits for prognostic prediction and determination of treatment strategy.

Graphical abstract

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Abbreviations

MVI:

Microvascular invasion

HCC:

Hepatocellular carcinoma

IDF:

Impeded diffusion fraction

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

AUC-ROC:

Area under the receiver operating characteristics curve

AUC-PR:

Area under the precision-recall curve

Cal-Error:

Calibration error

AFP:

Alpha-fetoprotein

D f :

Diffusion coefficient of free diffusion

F f :

Volume fraction of free diffusion

F C :

Volume fraction of the subcellular component

F fc :

Volume fraction of cellular free (uncoordinated) water fraction

F ID :

Volume fraction of impeded (coordinated) water fraction

F P :

Volume fraction of vascular perfusion

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Acknowledgements

This study has received funding by the National Natural Science Foundation of China (grant number 82371923), the National Natural Science Foundation of China (grant number 82171897), Shanghai Municipal Health Commission (grant number 202240152), and Science and Technology Commission of Shanghai Municipality (grant number 23Y11907400).

Funding

This study has received funding by the National Natural Science Foundation of China (Grant number 82371923), the National Natural Science Foundation of China (Grant number 82171897), Shanghai Municipal Health Commission (Grant number 202240152), and Science and Technology Commission of Shanghai Municipality (Grant number 23Y11907400).

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Author notes

  1. Yunfei Zhang and Ruofan Sheng have contributed equally to this work.

Authors and Affiliations

  1. Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Yunfei Zhang, Ruofan Sheng & Mengsu Zeng

  2. Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Yunfei Zhang, Ruofan Sheng, Chun Yang & Mengsu Zeng

  3. School of Biomedical Engineering, State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech Univerisity, Shanghai, 200032, China

    Yongming Dai

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  1. Yunfei Zhang
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Zhang, Y., Sheng, R., Yang, C. et al. Detecting microvascular invasion in hepatocellular carcinoma using the impeded diffusion fraction technique to sense macromolecular coordinated water. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04230-x

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