Application Of DWI And HBP In Prediction Of The Grade Of Hepatocellular Carcinoma

Purpose To study if certain MRI sequence alone i.e.signal intensity of lesion in DWI or HBP of Gadoxetic enhanced MRI can predict the grade of hepatocellular carcinoma.Method and Material The institution ethics committee granted the permission to do this retrospective study.The study was done in patients visiting the first hospital of Jilin University from June 2015 to October 2016.A total of 37 patients with surgically resected hepatocellular carcinoma were selected.There were 29 males and 8 females.All the selected patient had viral hepatitis and cirrhosis.There were 42 lesion in total.Only lesion with confirmed pathology of hepatocellular carcionoma were taken in the study group.The Gd-EOB-DTPA enhanced MRI had to be done before the surgery were only selected in this study group.Patient without pathology or patient with contrast enhanced MRI after the surgery were not included in the study.Two MRI sequence were analyzed for the study DWI in high b value(b value = 800)and hepatobiliary phase of gadoxetic enhanced MRI.DWI signal intensity were defined as hyperintense(n = 32)and iso or hypointense(n = 9).HBP signal intensity were defined as low intensity(n= 35)and high intensity(n=7).DWI with hyperintense signal and well differentiated HCC(n=0);hyperintense lesion and moderate differentiated HCC(n= 25)and hyperintense lesion and poorly differentiated HCC(n=8).DWI with iso or hypointense signal and well differentiated HCC(n=5),hypontense signal and moderate differentiated HCC(n=4)and iso/hypointense lesion and poor differentiated HCC(n=0).HBP with low signal intensity and well differentiated HCC(n=4),moderate differentiated HCC(n= 25)and poor differentiated HCC(n=6).HBP with high signal intensity and well differentiated HCC(n=1),moderate differentiated HCC(n =4)and poorly differentiated HCC(n=2).Each sequence signal intensity statistically compared with individual histological grades by Wilcoxon signed ranked test.ResultsThis study showed that DWI and hyperintensity had significant p value for moderately differentiated(p value < 0.000001)and for poorly differentiated(p value < 0.005).DWI for well differentiated HCC which were iso or hypointense was significant(p value < 0.025).The HBP low signal intensity and moderately differentiated HCC the p value was 0.00001 and low signal with poorly differentiated HCC the p value < 0.014.Both low signal and moderately differentiated and poorly differentiated HCC were significant in detecting.For the high signal when compared to histopathology grade the p values were not significant.Conclusion DWI is useful MRI sequence in predicting grade of hepatocellular carcinoma where hyperintense lesion is moderate or poor grade HCC and iso/hypointense lesion is well differentiated HCC.