The Diagnostic Value Of Diffusion-weighted Imaging In Microvascular Invasion Of Hepatocellular Carcinoma

Objective:By studying the diffusion-weighted imaging(DWI)in predicting microvascular invasion(MVI)of hepatocellular carcinoma(HCC),and to compare the diagnostic value of different diffusion parameters for MVI.Methods:We retrospectively evaluated 44 patients with HCC who underwent surgical resection and confirmed by pathology from January 2019 to November 2020.According to the pathological results,they were divided into MVI positive group and MVI negative group.All patients were examined by T1 WI,T2WI,dynamic contrast enhancement and DWI sequence of 3.0T MR..We recorded the clinical and preoperative imaging data of the patients,including gender,age,basic liver disease,whether have liver cirrhosis,preoperative alpha fetoprotein(AFP)level;tumor maximum diameter,tumor number,tumor edge morphology,tumor internal changes(whether have bleeding,death,steatosis,etc.),tumor tissue grading;and measured the tumor ADC value,ADC slow value,and the peritumoral / tumor ADC ratio and peritumoral / tumor ADCslow ratio were calculated.SPSS25.0 software was used for statistical analysis.T-test was used to analyze the measurement data if they were normal distribution and expressed as mean ±standard deviation;rank sum test was used to analyze the ordered rank variable data;chi-square test or Fisher’s exact test was used to compare the count data as percentage;binary logistic regression analysis was used to predict the independent factors of MVI status;Receiver operating characteristic curve(ROC)was used to show the accuracy of each feature in predicting MVI status;two tailed test was used,P < 0.05 showed that there was statistical difference.Resutls:There were 18 cases in MVI positive group and 26 cases in MVI negative group.After analyzing the clinicopathological data,there were statistical differences as follows: the level of AFP in MVI positive group was significantly lower than that in MVI negative group(P = 0.000);the histological grade of tumor in MVI positive group was more likely to show poor differentiation(P = 0.034).There were statistical differences in the conventional imaging features between the two groups as follows:the maximum diameter of the tumor in the MVI positive group was significantly larger than that in the MVI negative group(P = 0.000);the tumor in the MVI positive group was more likely to show irregular shape(P = 0.001);the tumor in the MVI positive group was more likely to have bleeding(P = 0.002).The differences of DWI parameters between the two groups were as follows: the peritumoral / tumor ADCslow ratio in MVI positive group was higher than that in MVI negative group(P= 0.003);the mean ADCslow values in MVI positive group was lower than that in MVI negative group(P = 0.010).Binary logistic regression analysis showed that tumor mean ADCslow values and maximum diameter were independent risk factors for MVI.The area under the ROC curve(AUC)of MVI positive prediction was 0.827 for tumor maximum diameter,0.738 for negative value of mean ADCslow value,0.906 for tumor maximum diameter combined with negative value of mean ADCslow value.Conclusion:The mean tumor ADCslow values and the maximum diameter of tumor were independent risk factors for MVI status.In addition,the maximum diameter of tumor combined with the mean tumor ADCslow values is more effective in predicting the MVI status of HCC.