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MRI features of histologic subtypes of hepatocellular carcinoma: correlation with histologic, genetic, and molecular biologic classification

  • Hepatobiliary-Pancreas
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Abstract

HCC is a heterogeneous group of tumors in terms of histology, genetic aberration, and protein expression. Advancements in imaging techniques have allowed imaging diagnosis to become a critical part of managing HCC in the clinical setting, even without pathologic diagnosis. With the identification of many HCC subtypes, there is increasing correlative evidence between imaging phenotypes and histologic, molecular, and genetic characteristics of various HCC subtypes. In this review, current knowledge of histologic heterogeneity of HCC correlated to features on gadolinium-enhanced dynamic liver MRI will be discussed. In addition, HCC subtype classification according to transcriptomic profiles will be outlined with descriptions of histologic, genetic, and molecular characteristics of some relatively well-established morphologic subtypes, namely the low proliferation class (steatohepatitic HCC and CTNNB1-mutated HCC) and the high proliferation class (macrotrabecular-massive HCC (MTM-HCC), scirrhous HCC, and CK19-positive HCC). Characteristics of sarcomatoid HCC and fibrolamellar HCC will also be discussed. Further research on radiological characteristics of HCC subtypes may ultimately enable non-invasive diagnosis and serve as a biomarker in predicting prognosis, molecular characteristics, and therapeutic response. In the era of precision medicine, a multidisciplinary effort to develop an integrated radiologic and clinical diagnostic system of various HCC subtypes is necessary.

Key Points

• HCC is a heterogeneous group of tumors in terms of histology, genetic aberration, and protein expression, which can be divided into many subtypes according to transcriptome profiles.

• There is increasing evidence of a correlation between imaging phenotypes and histologic, genetic, and molecular biologic characteristics of various HCC subtypes.

• Imaging characteristics may ultimately enable non-invasive diagnosis and subtype characterization, serving as a biomarker for predicting prognosis, molecular characteristics, and therapeutic response.

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Abbreviations

3D:

Three-dimensional

AFP:

Alpha-fetoprotein

AP:

Arterial phase

CK:

Cytokeratin

CNR:

Contrast-to-noise ratio

CTNNB1:

Catenin beta 1

DN:

Dysplastic nodules

EMT:

Epithelial-to-mesenchymal transition

EpCAM:

Epithelial cell adhesion molecules

FGF19:

Fibroblast growth factor 19

GA:

Gadoxetic acid

HBP:

Hepatobiliary phase

HepPar-1:

Hepatocyte Paraffin-1

HNF4α:

Hepatocyte nuclear factor 4α

MTM-HCC:

Macrotrabecular-massive HCC

N/C ratio:

Nuclear-to-cytoplasmic ratio

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

OATP1B3:

Organic anion transporting polypeptide 1B3

PVP:

Portal venous phase

SI:

Signal intensity

TP53:

Tumor protein p53

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Acknowledgements

We are grateful to JH Kim, I Joo, and JM Lee for supplying cross-sectional and pathologic images of fibrolamellar HCC.

Funding

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

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Authors and Affiliations

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

    Ja Kyung Yoon, Jin-Young Choi & Hyungjin Rhee

  2. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Nyun Park

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  1. Ja Kyung Yoon
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  2. Jin-Young Choi
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  3. Hyungjin Rhee
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  4. Young Nyun Park
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Correspondence to Jin-Young Choi.

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Yoon, J.K., Choi, JY., Rhee, H. et al. MRI features of histologic subtypes of hepatocellular carcinoma: correlation with histologic, genetic, and molecular biologic classification. Eur Radiol 32, 5119–5133 (2022). https://doi.org/10.1007/s00330-022-08643-4

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  • DOI: https://doi.org/10.1007/s00330-022-08643-4

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