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Preoperative prediction of pathologic grade of HCC on gadobenate dimeglumine-enhanced dynamic MRI

  • Magnetic Resonance
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Abstract

Purpose

To evaluate the value of gadobenate dimeglumine–enhanced MRI in predicting the pathologic grade of hepatocellular carcinoma (HCC).

Materials and methods

Patients with pathologically proven HCC who underwent preoperative gadobenate dimeglumine–enhanced dynamic MRI were included. Two radiologists blinded to pathology results evaluated images in consensus. Lesions were evaluated quantitatively in terms of ratio of enhancement (RE), and qualitatively based on image features related to tumor aggressiveness. Logistic regression and ROC analyses were used to determine the value of these parameters to predict pathologic grade.

Results

In total, 221 patients (194 males, 27 females, aged 52.9 ± 11.7 years) with 49 poorly differentiated HCCs and 172 well/moderately differentiated HCCs were evaluated. Features significantly related to poorer pathologic grade at univariate analysis included lower RE in the early arterial phase (EAP) (p = 0.001), nonsmooth margins (p = 0.001), absence of capsule (p < 0.001), arterial peritumoral hyperenhancement (p < 0.001), higher AFP (p = 0.004), multiple tumors (p = 0.026), and larger tumor size (p = 0.028). At multivariate analysis, lower RE (EAP) (OR = 0.144, p = 0.002), absence of capsule (OR = 0.281, p = 0.004), and arterial peritumoral hyperenhancement (OR = 4.117, p < 0.001) were independent predictive factors for poorer pathologic grade. ROC analysis showed lower RE (EAP) was predictive of poorer pathologic grade (AUC = 0.667). AUC increased to 0.797 when combined with absence of capsule and presence of peritumoral hyperenhancement.

Conclusions

Lower RE (EAP), absence of capsule, and arterial peritumoral hyperenhancement were predictive biomarkers for poorer pathologic grade of HCC on gadobenate dimeglumine–enhanced dynamic MRI.

Key Points

• Gadobenate dimeglumine–enhanced dynamic MRI was a useful quantitative biomarker for preoperative prediction of pathologic grade in patients with HCC.

• Lower RE in the early arterial phase, absence of capsule, and arterial peritumoral hyperenhancement were potential imaging indicators for preoperative prediction of poorer pathologic grade of HCC on gadobenate dimeglumine–enhanced MRI.

• A lower RE in the early arterial phase was effective at predicting poorer pathologic grade of HCCs but prediction is improved when combined with absence of capsule and presence of peritumoral hyperenhancement.

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Abbreviations

AP:

Arterial phase

DCE:

Dynamic contrast enhancement

DP:

Delayed phase

EAP:

Early arterial phase

EPVP:

Early portal venous phase

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LAP:

Late arterial phase

LPVP:

Late portal venous phase

MD:

Moderate differentiation

PD:

Poor differentiation

PVP:

Portal venous phase

RE:

Ratio of enhancement

SBRT:

Stereotactic body radiation therapy

SI:

Signal intensity

TACE:

Transarterial chemoembolization

TARE:

Transarterial radioembolization

WD:

Well differentiation

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Funding

The authors state that this study has received funding by the National Natural Science Foundation of China grant 91959118 (JW), Science and Technology Program of Guangzhou, China grant 201704020016 (JW), SKY Radiology Department International Medical Research Foundation of China Z-2014-07-1912-15 (JW), Clinical Research Foundation of the 3rd Affiliated Hospital of Sun Yat-Sen University YHJH201901 (JW), and Key Research and Development Program of Guangdong Province 2019B020235002 (JW).

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Author notes

  1. Dailin Rong and Weimin Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of China

    Dailin Rong, Weimin Liu, Sichi Kuang, Sidong Xie, Feifei Chen, Qianwei Xie, Qiuxia Luo, Bingjun He, Yao Zhang, Ying Deng & Jin Wang

  2. Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of China

    Zhanhong Chen

  3. Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People’s Republic of China

    Hao Yang

  4. Department of Radiology, The People’s Hospital of Gaoyao District, No. 72 Tianning Road, Zhaoqing, Guangdong, 526060, People’s Republic of China

    Simin Chen

Authors
  1. Dailin Rong
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  14. Jin Wang
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Corresponding author

Correspondence to Jin Wang.

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The scientific guarantor of this publication is Jin Wang.

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

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Written informed consent was waived by the Institutional Review Board.

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•Retrospective

•Diagnostic or prognostic study

•Performed at one institution

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Rong, D., Liu, W., Kuang, S. et al. Preoperative prediction of pathologic grade of HCC on gadobenate dimeglumine-enhanced dynamic MRI. Eur Radiol 31, 7584–7593 (2021). https://doi.org/10.1007/s00330-021-07891-0

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