MRI analysis of relative tumor enhancement in liver metastases and correlation with immunohistochemical features

Abstract

Objective: Investigate the association between the relative tumor enhancement (RTE) of gadoxetic acid across various MRI phases and immunohistochemical (IHC) features in patients with liver metastases (LM) from colorectal cancer (CRC), breast cancer (BC), and pancreatic cancer (PC).

Methods: A retrospective analysis was conducted on 68 patients with LM who underwent 1.5-T MRI scans. Non-contrast and contrast-enhanced T1-weighted (T1-w) gradient echo (GRE) sequences were acquired before LM biopsy. RTE values among LM groups were compared by cancer type using analysis of variance. The relationships between RTE and IHC features tumor stroma ratio, cell count, Ki67 proliferation index, and CD45 expression were evaluated using Spearman's rank correlation coefficients.

Results: Significant differences in RTE were observed across different MRI phases among patients with BCLM, CRCLM, and PCLM: arterial phase (0.75 ± 0.42, 0.37 ± 0.36, and 0.44 ± 0.19), portal venous phase (1.09 ± 0.41, 0.59 ± 0.44, and 0.53 ± 0.24), and venous phase (1.11 ± 0.45, 0.65 ± 0.61, and 0.50 ± 0.20). In CRCLM, RTE inversely correlated with mean Ki67 (r = -0.50, p = 0.01) in the hepatobiliary phase. Negative correlations between RTE and CD45 expression were found in PCLM and CRCLM in the portal venous phase (r = -0.69, p = 0.01 and r = -0.41, p = 0.04) and the venous phase (r = -0.65, p = 0.01 and r = -0.44, p = 0.02).

Conclusion: Significant variations in RTE were identified among different types of LM, with correlations between RTE values and IHC markers such as CD45 and Ki67 suggesting that RTE may serve as a non-invasive biomarker for predicting IHC features in LM.

Critical relevance statement: RTE values serve as a predictive biomarker for IHC features in liver metastasis, potentially enhancing non-invasive patient assessment, disease monitoring, and treatment planning.

Key points: Few studies link gadoxetic acid-enhanced MRI with immunohistochemistry in LM. RTE varies by liver metastasis type and correlates with CD45 and Ki67. RTE reflects IHC features in LM, aiding non-invasive assessment.

Keywords: Breast cancer; Colorectal cancer; Immunohistochemistry; Magnetic resonance imaging; Pancreas cancer.

Fig. 1

Flow chart of data acquisition

Fig. 2

MRI findings of a BCLM. a MRI-guided biopsy image showing needle position. A rectangular region of interest is placed within the lesion in each phase according to the needle position on the biopsy image. b Non-contrast T1w MRI image. The SI at this stage is measured at 100. c Arterial phase T1w MRI image. The SI in this phase is 165, resulting in an RTE of 0.65. d Portal-venous phase T1w image. The SI in this phase is 130, with an RTE of 0.30. e Venous phase T1w image. The SI in this phase is 125, corresponding to an RTE of 0.25. f Hepatobiliary phase T1w image. In this phase, the SI drops to 40, resulting in a negative RTE of −0.60

Fig. 3

IHC analysis of a BC liver metastasis. a Biopsy cylinder stained with H&E illustrating the tissue architecture. b H&E staining. The cell count is 166. Tumor-stroma ratio is 15%. c Image stained with MIB-1 for Ki-67. The Ki-67 index, indicating proliferative activity, is 40%. d CD45-stained section. The mean number of CD45-positive cells is 1