Clinical Value Of Preoperative MRI To Evaluating The Histological Differentiation Of Hepatocellular Carcinoma And Risk Of Early Recurrence After Curative Resection

Part?:Evaluation of histological differentiation of hepatocellular carcinoma by the whole-volume histogram analysis of apparent diffusion coefficient in Preoperative MRIPurpose:This study aimed to explore the value of whole-volume histogram analysis of the apparent diffusion coefficient in preoperative MRI for predicting the histological differentiation of hepatocellular carcinoma.Materials and methods:This retrospective study involved 111 HCC patients,including 21 well-,64 moderately-and 26 poorly-differentiated HCCs,from October2014 to July 2016.All patients received MR scanning within 2 weeks before hepatic resection.ADC values including whole-volume histogram analysis of apparent diffusion coefficient?wADC?and conventional ADC?cADC?were measured by MRI.The average value of ADC(wADC_mean,cADC_mean)and the minimum value of ADC(wADC_min,cADC_min)were obtained.The relationship between ADC values and histologic differentiation were compared by one-way analysis of variance?ANOVA?.Receiver operating characteristic?ROC?curves of ADC values were generated to calculate the optimal cut-off values,sensitivity and specificity.Results:The ADC values of HCC increased as histological differentiation increased?P<0.001?.The wADC_min and cADC_min showed significant differences between different histological differentiation of HCC?P<0.001,respectively?.There were significant differences between wADC_mean and cADC_mean in poorly-differentiated HCC and moderately-differentiated HCC?P<0.05,respectively?,there was no significant differences between wADC_mean and cADC_mean in moderately-differentiated HCC and well-differentiated HCC?P>0.05,respectively?.The wADC_min,wADC_mean,cADC_min and cADC_mean have a positive correlation with histological grade of HCC?r=0.71,0.33,0.58,0.40,respectively?.The area under the ROC curve of wADC_min in the poorly-moderately differentiated group and well-moderately differentiated group were 0.89 and 0.84,respectively.The diagnostic efficacy was higher than wADC_mean,cADC_min,and cADC_mean,respectively?P<0.05,respectively?.Conclusion:The preoperative whole-volume histogram analysis of ADC is a helpful imaging tool for predicting histological differentiation of HCC,and wADC_minin has the best diagnostic performance.Part ?: MRI evaluation for the early recurrence risk after curative resection of hepatocellular carcinomaPurpose: This study aimed to explore the value of preoperative MRI features of LI-RADS for the early recurrence after curative resection of hepatocellular carcinoma?HCC?.Materials and methods: The retrospective study included 112 patients with a diagnosis of LR-5 and underwent hepatic resection from October 2013 to July 2015.Two radiologists independently evaluated the following MR features based on LI-RADS?v2018?,including non-rim arterial phase hyperenhancement?APHE?,non-peripheral washout,enhancing capsule,fat in mass,corona enhancement,mosaic architecture,nodule-in-nodule architecture,blood products in mass,tumor size,apparent diffusion coefficient?ADC?value and tumor-to-liver signal intensity ratio on T2-weighted image?T2WI-SIR?.Logistic regression analyses was performed to identify significant MR features for predicting early recurrence.Diagnostic performance of significant MR features,identified with multivariate analysis,for predicting early recurrence were analyzed.Results: Twenty-nine?25.9%?of the 112 patients had early recurrence.Compared with non-early recurrence patients,the early recurrence patients were significant differences in tumor size,enhancing capsule,fat in mass,corona enhancement,T2WI-SIR,ADCmin and ADCmean?P<0.05 in all cases?.In the multivariate Logistic regression analyses identified that tumor size >4.5cm [odds ratio ?OR?= 5.92;95% confidence interval?CI?: 1.45²4.14;P = 0.013],ADCmin ?0.65 × 10-3mm2/s?OR = 5.41;95% CI: 1.39²1.00;P = 0.015?,and the presence of corona enhancement?OR = 5.09;95%CI: 1.22²1.21;P = 0.025?were independent risk factors for predicting early recurrence of HCC.When two of the three independent risk factors were combined,the specificity was 90.4%.When all three independent risk factors were satisfied,the specificity was 95.2%.Conclusion: Preoperative MRI features of LI-RADS can be used to predict early recurrence after curative resection of hepatocellular carcinoma.Tumor size>4.5cm,ADCmin?0.65×10-3mm2/s,and the presence of corona enhancement are the significant MR features for predicting early recurrence after curative resection of HCC.A combination of different independent risk factors for predicting early recurrence with specificity more than 90%.