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Comparison of imaging findings of macrotrabecular-massive hepatocellular carcinoma using CT and gadoxetic acid–enhanced MRI

  • Gastrointestinal
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Abstract

Objectives

To investigate the imaging findings of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) on CT and MRI, and examine their diagnostic performance and prognostic significance.

Methods

We retrospectively enrolled 220 consecutive patients who underwent hepatic resection between June 2009 and December 2013 for single treatment–naïve HCC, who have preoperative CT and gadoxetic acid–enhanced MRI. Independent reviews of histopathology and imaging were performed by two reviewers. Previously reported imaging findings, LI-RADS category, and CT attenuation of MTM-HCC were investigated. The diagnostic performance of the MTM-HCC diagnostic criteria was compared across imaging modalities.

Results

MTM-HCC was associated with ≥ 50% arterial phase hypovascular component, intratumoral artery, arterial phase peritumoral enhancement, and non-smooth tumor margin on CT and MRI (p < .05). Arterial phase hypovascular components were less commonly observed on MRI subtraction images than on CT or MRI, while non-rim arterial phase hyperenhancement and LR-5 were more commonly observed on MRI subtraction images than on MRI (p < .05). MTM-HCC showed lower tumor attenuation in the CT arterial phase (p = .01). Rhee’s criteria, defined as ≥ 50% hypovascular component and ≥ 2 ancillary findings (intratumoral artery, arterial phase peritumoral enhancement, and non-smooth tumor margin), showed similar diagnostic performance for MRI (sensitivity, 41%; specificity, 97%) and CT (sensitivity, 31%; specificity, 94%). Rhee’s criteria on CT were independent prognostic factors for overall survival.

Conclusion

The MRI diagnostic criteria for MTM-HCC are applicable on CT, showing similar diagnostic performance and prognostic significance. For MTM-HCC, arterial phase subtraction images can aid in the HCC diagnosis by depicting subtle arterial hypervascularity.

Key points

• MTM-HCC on CT demonstrated previously described MRI findings, including arterial phase hypovascular component, intratumoral artery, arterial phase peritumoral enhancement, and necrosis.

• The MRI diagnostic criteria for MTM-HCC were also applicable to CT, showing comparable diagnostic performance and prognostic significance.

• On arterial phase subtraction imaging, MTM-HCC more frequently demonstrated non-rim enhancement and LR-5 and less frequently LR-M than MRI arterial phase, which may aid in the diagnosis of HCC.

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Abbreviations

APHE:

Arterial phase hyperenhancement

CT:

Computed tomography

ER:

Early recurrence

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

MTM-HCC:

Macrotrabecular-massive hepatocellular carcinoma

OS:

Overall survival

ROI:

Region of interest

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Funding

This study was supported by a grant from the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2020R1C1C1003887).

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea

    Hyunho Cha, Jin-Young Choi, Myeong-Jin Kim, Mi-Suk Park & Hyungjin Rhee

  2. Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea

    Young Nyun Park

  3. Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea

    Kyunghwa Han

  4. Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea

    Mi Jang

Authors
  1. Hyunho Cha
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  2. Jin-Young Choi
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  4. Kyunghwa Han
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  7. Mi-Suk Park
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  8. Hyungjin Rhee
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Corresponding author

Correspondence to Hyungjin Rhee.

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Guarantor

The scientific guarantor of this publication is Professor Hyungjin Rhee.

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

The statistical analyses were conducted under the direction of an experienced statistician (Kyunghwa Han, Ph. D.). She also participated in our manuscript as one of the authors.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

All of our 220 subjects have been previously reported in our previous study (J Hepatol. 2021 Jan; 74(1): 109–121); in fact, 88 patients (40%) and 132 patients (60%) overlapped with the training and validation sets of the previous study. The prior study dealt with MRI findings of MTM-HCC, whereas in this manuscript we investigated CT findings of MTM-HCC in comparison with MRI findings.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Cha, H., Choi, JY., Park, Y.N. et al. Comparison of imaging findings of macrotrabecular-massive hepatocellular carcinoma using CT and gadoxetic acid–enhanced MRI. Eur Radiol 33, 1364–1377 (2023). https://doi.org/10.1007/s00330-022-09105-7

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  • DOI: https://doi.org/10.1007/s00330-022-09105-7

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