The Study Of Imaging And Pathological Characteristics Of Hepatocellular Carcinoma With Enhanced MRI

Part 1.Gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced Magnetic Resonance Imaging for Gross Classification of Hepatocellular CarcinomaObjective:The purpose of the retrospective study is to evaluate the utility of contrast-enhanced computed tomography(CE-CT)combined with gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI)for diagnosis and classification of HCCs prior to surgery,and to evaluate of prediction performance of EOB-MRI?CE-CT and EOB-MRI plus CE-CT in the gross classification of HCC comparing with the general specimen after operation.Methods:From July 2014 to May 2013,a total of 94 consecutive HCC patients underwent CE-CT,EOB-MRI and curative hepatectomy in the Department of Hepatobiliary Surgery at Nanjing Drum Tower Hospital were included in our study.The imaging data,clinical data and pathological data of all patients were analyzed and compared with the general specimens after the operation.The morphological classification of the gross specimen after operation was the gold standard.HCC gross classification via EOB-MRI was performed mainly using coronal and axial plane in the hepatobiliary phase.HCC gross classifcation via CE-CT was based on the arterial,portal and equilibrium phases.Results:Based on pathological macroscopic examination of the 94 HCCs,38(40.4%)fell into simple nodular(SN),26(27.7%)SN with extranodular growth(SN-EG),21(22.3%)confluent multinodular(CMN),and nine(9.6%)infiltrative type(IF).Therefore,38 nodules(40.4%)were classified as SN and the remaining 56 nodules(59.6%)as non-SN.For the diagnosis of non-SN,the area under the ROC curve(AUCs,95%confidence interval)for CE-CT,EOB-MRI and CE-CT plus EOB-MRI was 0.765(0.666-0.846),0.877(0.793-0.936),and 0.908(0.830-0.958).In the diagnosis and prediction performance,EOB-MRI plus CE-CT and EOB-MRI were significantly better than the enhanced CT(P=0.034 and P=0.006).There was no significant difference between EOB-MRI plus CE-CT and EOB-MRI(P=0.088).EOB-MRI plus CE-CT and EOB-MRI were significantly better than the enhanced CT in HCC?3.0 cm(P=0.016 and P=0.005),however,there was no significant difference between the three in HCC>3.0cm(P=0.821,P=0.361 and P=0.005).The sensitivity,specificity,and accuracy were 71.4%,81.6%,and 75.5%in CE-CT;96.4%,78.9%,and 89.3%in EOB-MRI;and 98.2%,84.2%,and 92.5%in CE-CT plus EOB-MRI,respectively.Combination of CE-CT with EOB-MRI can offers more accurate imaging evaluation than individual modality in the gross classification of HCCs.Conclusions:1.EOB-MRI was obviously superior to CT in predicting the gross classification of HCC.When combined with both,it could show better prediction performance,but the difference had no statistical significance compared with MRI alone.2.The superiority of EOB-MRI hepatobiliary phase for tumor display and gross classification was more obvious in HCC>3.0cm.Part 2.Preoperative Gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI for Predicting Microvascular Invasion in Patients with Hepatocellular CarcinomaObjective:Microvascular invasion(MVI)is considered to be one of the most important risk factors that affect the prognosis of hepatocellular carcinoma(HCC)patients.However,there is no effective prediction method for MVI before operation,which affects the selection of individual treatment plan for HCC patients.This study aimed to investigate the specific imaging features of Gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI(EOB-MRI)for predicting MVI in patients with HCC before operative,and to evaluate the prediction efficiency of each specific image features for predicting MVI.Methods:In this study,we retrospectively analyzed the clinicopathologic and radiological data of 147 patients with HCC who underwent preoperative EOB-MRI examination and curative hepatectomy or liver transplantation from July 2014 to June 2017 in the Department of hepatobiliary surgery,Drum Tower Hospital of Nanjing Medical University.According to the clinicopathological and radiological features of 147 cases of HCC,the independent risk factors of MVI were calculated by univariate and multivariate Logistic regression analysis,and the predictive effectiveness of their separate and combined application were calculated.Results:According to the postoperative pathological examination,there were 49 cases of MVI positive and 98 cases of MVI negative in 147 patients.Univariate logistic regression analysis showed that tumor size(P=0.001),non single nodular(Non-SN)tumor in hepatobiliary phase(HBP)(P<0.001),peritumoral enhancement in arterial phase(AP)(P=0.016),arterial rim enhancement in AP(P=0.014),tumor iso/hyperintensity on HBP(P=0.001)and peritumoral hypointensity on HBP(P<0.001)were predictors for MVI.Three EOB-MR imaging features were independently predictors for MVI:Non-SN tumor in HBP(odds ratio[OR]=5.075;95%confidence interval[CI]:1.587-16.223,P=0.006),tumor iso/hyperintensity on HBP(OR==2.750,95%CI:2.679-18.977,P=0.030),peritumoral hypointensity on HBP(OR=7.130,95%CI:2.679-18.977,P<0.001).The sensitivity of the specific imaging features for predicting MVI was 89.8%,57.1%and 61.2%,and the specificity was 51%,72.4%and 89.8%,respectively.When two of three imaging features were combined,the specificity was 85.7%,90.8%,96.9%,respectively.When all three imaging features were satisfied,the specificity was 98.0%.Conclusions:The novel risk classification of MVI based on histopathological features is valuable for predicting prognosis of HCC patients without macroscopic vascular invasion after hepatectomyThree EOB-MR imaging features,including Non-SN tumor in HBP,tumor iso/hyperintensity on HBP and peritumoral hypointensity on HBP,were independently predictors for MVI.A combination of two or more of the three imaging features at the same time,the specificity for predicting MVI is high.Part 3.The Correlation Between Signal Intensity in Hepatobiliary Phase of EOB-MRI and Clinicopathological Features in Patients With Hepatocellular CarcinomaObjective:This study aims to investigate the correlation between signal intensity in hepatobiliary phase of EOB-MRI and clinicopathological features in patients with hepatocellular carcinoma,and analyze the effect of signal heterogeneity in hepatobiliary phase of EOB-MRI on the prognosis of patients with hepatocellular carcinoma.Methods:In this study,we retrospectively analyzed the clinicopathologic and radiological data of 110 patients with HCC who underwent preoperative EOB-MRI examination and curative hepatectomy or liver transplantation from July 2014 to July 2017 in the Department of hepatobiliary surgery,Drum Tower Hospital of Nanjing Medical University.According to the difference of signal intensity in HBP of 110 cases of HCC,they were divided into hypointensity group(n=86)and mix/hyperintensity group(n=24).The correlation between signal heterogeneity in hepatobiliary phase of EOB-MRI and clinicopathological features was analyzed.The independent risk factors of early recurrence rate were calculated by univariate and multivariate regression analysis,and the prognosis of HCC patients was analyzed by Kaplan-Meier survival analysis and Cox proportional hazards models.Results:A total of 86 cases with hypointensity and 24 cases with mix/hyperintensity in 110 patients.There was a significant correlation between the signal intensity in HBP and the size of the tumor and MVI(P=0.030 and P=0.040),but there was no significant correlation between the degree of differentiation,histological type,macrovascular invasion,bile duct or the nerve invasion,and the satellite focus(P=0.875,P=0.163,P=0.526,P=0.354,P=0.451 and P=0.920).The signal intensity of HCC in HBP was related to the expression of OATP8 on HCC cell membrane.Multivariate analysis showed that gross classification of HCC(HR=0.105,95%CI:0.014-0.780,P=0.028)?satellite focus(HR=0.215,95%CI:0.068-0.682,P=0.009)and signal intensity in HBP(HR=0.448,95%CI:0.205-0.979,P=0.044)were independent risk factors for early recurrence rate.Kaplan-Meier survival analysis indicated that there was significant difference in the early recurrence rate between the two groups(P=0.032).Conclusions:Signal heterogeneity of HCC in HBP was associated with tumor size and MVI,and had no significant correlation with the degree of tumor differentiation.Signal heterogeneity was related to the expression of OATP8 on the cell membrane of HCC.Signal heterogeneity in HBP,gross classification and satellite focus were independent risk factors for early recurrence rate.