Impact of apparent diffusion coefficient on prognosis of early hepatocellular carcinoma: a case control study

Abstract

Background: We investigated the usefulness of apparent diffusion coefficients (ADC) from diffusion-weighted images (DWI) obtained using magnetic resonance imaging (MRI) for prognosis of early hepatocellular carcinoma (HCC): Barcelona Clinic Liver Cancer (BCLC) stage 0 and A.

Methods: We enrolled 102 patients who had undergone surgical resection for early HCC: BCLC stage 0 and A, and calculated their minimum ADC using DWI-MRI. We divided patients into ADC^High (n = 72) and ADC^Low (n = 30) groups, and compared clinicopathological factors between the two groups.

Results: The ADC^Low group showed higher protein induced by vitamin K absence-II (PIVKA-II) levels (p = 0.02) compared with the ADC^High group. In overall survival, the ADC^Low group showed significantly worse prognosis than the ADC^High group (p < 0.01). Univariate analysis identified multiple tumors, infiltrative growth, high PIVKA-II, and low ADC value as prognostic factors. Multivariate analysis identified infiltrative growth and low ADC value as an independent prognostic factor.

Conclusion: ADC values can be used to estimate the prognosis of early HCC.

Keywords: Apparent diffusion coefficient; Hepatocellular carcinoma; Magnetic resonance imaging; Prognostic prediction.

Fig. 1

Calculation of ADC values using SYNAPSE VINCENT. This application automatically calculates mean, minimum, and maximum values within free-form green outlines (manual tracing)

Fig. 2

ROC analysis to determine appropriate cut-off value for minimum ADC values. Cut-off value was 0.84 × 10^− 3mm²/s with area under the curve of 0.62

Fig. 3

Overall survival rate of ADC^Low and ADC^High groups. The ADC^Low group showed significantly worse prognosis than the ADC^High group (p < 0.01)

Fig. 4

Disease-free survival rate of ADC^Low and ADC^High groups. There was no significant difference between the two groups

Fig. 5

Recurrent patterns of ADC^Low and ADC^High groups. The ADC^Low group showed significantly higher rates of multiple liver and extra-hepatic recurrence (p < 0.05)

Fig. 6

Rate of early recurrence within 2 years of surgery. The ADC^Low group showed higher rates of early recurrence compared with the ADC^High group (p < 0.01)