Values Of Gd-EOB-DTPA-enhanced MRI In Evaluating The Microvascular Invasion For Hepatocellular Carcinoma

Objective To investigate the predictive value of preoperative dynamic Gd-EOB-DTPA-enhanced MRI and ADC values for histopathological microvascular invasion(MVI)of hepatocellular carcinoma(HCC),and to explore the effect of MVI on hepatocellular carcinoma recurrence.Methods A retrospective analysis of dynamic Gd-EOB-DTPA-enhanced MRI of 126 patients with HCC who perform surgery and confirmed by pathology from September 2013 to October 2018 in First Affiliated Hospital of Guangxi Medical University.All patients underwent preoperative plain scan,enhancement,diffusion-weighted imaging and T1 mapping on 3.0T MRI scanner.Features including tumor size,signal homogeneity,tumor margin,tumor capsule,peritumor enhancement during arterial phase,peritumor hypointensity during hepatobiliary phase were assessed,and apparent diff usion coefficient(ADC),T1 relaxation times(T1mapping)of the tumor solid region were measured.The MVI and tumor differentiation were recorded pathologically.All study cases were divided to non-MVI(M-)group and MVI(M+)group according to pathological tumors MVI.Independent sample t test or X list were used to analyze and compare the general clinical data,MR characteristics of tumor andtumor differentiation of two groups.Multiple logistic regression analyses were performed to determine the correlation of above indexes,postoperative recurrence and MVI.Receiver operating characteristiccurve(ROC)analysis was used to evaluate AFP,tumor diameter,tumor margin and peritumor hypointensity.Results The data from total of 126 HCC patients,104 males and 22 females,were collected and analyzed.There are 43 patients have MVI and 83 patients have no MVI according to Postoperative pathology findings.There were no statistically significant differences in gender(p=0.217),age(p=0.648),BMI(p=0.947),and smoking history(p=0.454)between the M+ and M-groups,but AFP(p=0.001).In preoperative imaging data and postoperative histopathological grading,M+ and M-groups were statistically different in tumor size,signal homogeneity,tumor margin,tumor capsule,peritumor hypointensity,and tumor pathological differentiation and MVI(All p<0.05),but the number of tumor lesions(p=0.319),peritumoral enhancement(p=0.103),ADC value(p=0.582),T1 mapping value(p=0.611)and MVI were not statistically significant.Corrected gender,age,BMI,drinking history factors,multivariate analysis found that AFP≥400ng/ml(OR=3.385,p=0.006)、 tumor diameter ≥ 3cm(OR = 6.479,p < 0.001),signal unevenness(OR = 3.801,p=0.002),incomplete capsule(OR = 5.793),p<0.001),irregular edge(OR=6.479,p=0.008)and peritumor hypointensity(OR=6.505,p<0.001)are independent risk factors for MVI.When the above five MR features coexist,the OR value is11.543(p=0.001).The area under the ROC curve(AUC)in AFP≥400ng/ml、tumor diameter,marginal morphology,and peritumoral low signal were0.625(95CI: 0.534-0.710),0.716(95CI: 0.625-0.790),0.606(95CI: 0.515-0.692),and 0.722(95CI: 0.636-0.798),when two of the above three characteristicsappeared,the AUC is 0.746(95CI: 0.660-0.819)for predicting MVI with74.42% sensitivity and 74.70% specificity.When the three MR characteristics coexist,the AUC is 0.621(95CI: 0.530-0.706)with 30.23% sensitivity and93.98% specificity.A total of 74 patients were followed up for 1 year,including51 cases in the M-group,13 cases had recurrence,and 23 cases in the M+ group,12 cases had recurrence.The difference was statistically significant(p<0.05).Conclusion Preoperative dynamic Gd-EOB-DTPA-enhanced MRI has predictive value for MVI in HCC.AFP,the tumor diameter,tumor margin and peritumor hypointensity in the hepatobiliary phase are independent risk factors for MVI.The larger the transverse diameter of the tumor,the more blurred the boundary and peritumor hypointensity in the hepatobiliary phase found,the greater the risk of MVI development.The higher the risk of MVI,the higher the recurrence rate of the tumor after 1 years of surgery and the earlier the recurrence time.