Prediction of Microvascular Invasion and Recurrence After Curative Resection of LI-RADS Category 5 Hepatocellular Carcinoma on Gd-BOPTA Enhanced MRI

Abstract

Objective: This study aims to investigate the predictive value of Gadobenate dimeglumine (Gd-BOPTA) enhanced MRI features on microvascular invasion (MVI) and recurrence in patients with Liver Imaging Reporting and Data System (LI-RADS) category 5 hepatocellular carcinoma (HCC).

Methods: A total of 132 patients with LI-RADS category 5 HCC who underwent curative resection and Gd-BOPTA enhanced MRI at our hospital between January 2016 and December 2018 were retrospectively analyzed. Qualitative evaluation based on LI-RADS v2018 imaging features was performed. Logistic regression analyses were conducted to assess the predictive significance of these features for MVI, and the Cox proportional hazards model was used to identify postoperative risk factors of recurrence. The recurrence-free survival (RFS) was analyzed by using the Kaplan-Meier curve and Log rank test.

Results: Multivariate logistic regression analysis identified that corona enhancement (odds ratio [OR] = 3.217; p < 0.001), internal arteries (OR = 4.147; p = 0.004), and peritumoral hypointensity on hepatobiliary phase (HBP) (OR = 5.165; p < 0.001) were significantly associated with MVI. Among the 132 patients with LR-5 HCC, 62 patients experienced postoperative recurrence. Multivariate Cox regression analysis showed that mosaic architecture (hazard ratio [HR] = 1.982; p = 0.014), corona enhancement (HR = 1.783; p = 0.039), and peritumoral hypointensity on HBP (HR = 2.130; p = 0.009) were risk factors for poor RFS.

Conclusion: MRI features based on Gd-BOPTA can be noninvasively and effectively predict MVI and recurrence of LR-5 HCC patients.

Keywords: hepatocellular carcinoma; magnetic resonance imaging; microvascular invasion; prognosis.

Figure 1

Flowchart of the study population.

Figure 2

Kaplan–Meier curves of imaging features for RFS in LR-5 HCCs. (A) Mosaic architecture (absent) and Mosaic architecture (present) (Log rank test, p =0.034). (B) Corona enhancement (absent) and Corona enhancement (present) (Log rank test, p <0.0001). (C) Peritumoral hypointensity on HBP (absent) and Peritumoral hypointensity on HBP (present) (Log rank test, p <0.0001).

Figure 3

Images of a 54-year-old man with chronic hepatitis B infection, categorized as LR-5 HCC with MVI and recurrence. (A) Heterogeneous mass with mosaic architecture on T2WI; (B) Non-rim arterial phase hyperenhancement (APHE) on the arterial phase, with corona enhancement and internal arteries (white arrow). (C) Peritumoral hypointensity (white arrow) in the hepatobiliary phase.

Figure 4

MR images of a 48-year-old man with chronic hepatitis B infection, categorized as LR-5 HCC without MVI and non-recurrence. (A) Non-rim arterial phase hyperenhancement (APHE) on the arterial phase. (B) Non-peripheral washout on the portal venous phase. (C) The lesion of hypointense on the HBP image.