scholarly journals MRI Features for Predicting Microvascular Invasion of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Liver Cancer ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 94-106
Author(s):  
Seung Baek Hong ◽  
Sang Hyun Choi ◽  
So Yeon Kim ◽  
Ju Hyun Shim ◽  
Seung Soo Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Meta Analysis ◽  
Diagnostic Odds Ratio ◽  
Microvascular Invasion ◽  
Hepatobiliary Phase ◽  
Phase Imaging ◽  
Arterial Enhancement ◽  
Mri Features ◽  
Peritumoral Enhancement

<b><i>Purpose:</i></b> Microvascular invasion (MVI) is an important prognostic factor in patients with hepatocellular carcinoma (HCC). However, the reported results of magnetic resonance imaging (MRI) features for predicting MVI of HCC are variable and conflicting. Therefore, this meta-analysis aimed to identify the significant MRI features for MVI of HCC and to determine their diagnostic value. <b><i>Methods:</i></b> Original studies reporting the diagnostic performance of MRI for predicting MVI of HCC were identified in MEDLINE and EMBASE up until January 15, 2020. Study quality was assessed using QUADAS-2. A bivariate random-effects model was used to calculate the meta-analytic pooled diagnostic odds ratio (DOR) and 95% confidence interval (CI) for each MRI feature for diagnosing MVI in HCC. The meta-analytic pooled sensitivity and specificity were calculated for the significant MRI features. <b><i>Results:</i></b> Among 235 screened articles, we found 36 studies including 4,274 HCCs. Of the 15 available MRI features, 7 were significantly associated with MVI: larger tumor size (&#x3e;5 cm) (DOR = 5.2, 95% CI [3.0–9.0]), rim arterial enhancement (4.2, 95% CI [1.7–10.6]), arterial peritumoral enhancement (4.4, 95% CI [2.8–6.9]), peritumoral hypointensity on hepatobiliary phase imaging (HBP) (8.2, 95% CI [4.4–15.2]), nonsmooth tumor margin (3.2, 95% CI [2.2–4.4]), multifocality (7.1, 95% CI [2.6–19.5]), and hypointensity on T1-weighted imaging (T1WI) (4.9, 95% CI [2.5–9.6]). Both peritumoral hypointensity on HBP and multifocality showed very high meta-analytic pooled specificities for diagnosing MVI (91.1% [85.4–94.8%] and 93.3% [74.5–98.5%], respectively). <b><i>Conclusions:</i></b> Seven MRI features including larger tumor size, rim arterial enhancement, arterial peritumoral enhancement, peritumoral hypointensity on HBP, nonsmooth margin, multifocality, and hypointensity on T1WI were significant predictors for MVI of HCC. These MRI features predictive of MVI can be useful in the management of HCC.

scholarly journals Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mengqi Huang ◽  
Bing Liao ◽  
Ping Xu ◽  
Huasong Cai ◽  
Kun Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prediction Model ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Microvascular Invasion ◽  
Arterial Phase ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Tumor Margin ◽  
Enhanced Mri

Objective. To investigate the imaging features observed in preoperative Gd-EOB-DTPA-dynamic enhanced MRI and correlated with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods. 66 HCCs in 60 patients with preoperative Gd-EOB-DTPA-dynamic enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, peritumor enhancement during mid-arterial phase, peritumor hypointensity during hepatobiliary phase, signal intensity ratio on DWI and apparent diffusion coefficients (ADC), T1 relaxation times, and the reduction rate between pre- and postcontrast enhancement images were assessed. Correlation between these features and histopathological presence of MVI was analyzed to establish a prediction model. Results. Histopathology confirmed that MVI were observed in 17 of 66 HCCs. Univariate analysis showed tumor size (p=0.003), margin (p=0.013), peritumor enhancement (p=0.001), and hypointensity during hepatobiliary phase (p=0.004) were associated with MVI. A multiple logistic regression model was established, which showed tumor size, margin, and peritumor enhancement were combined predictors for the presence of MVI (α=0.1). R2 of this prediction model was 0.353, and the sensitivity and specificity were 52.9% and 93.0%, respectively. Conclusion. Large tumor size, irregular tumor margin, and peritumor enhancement in preoperative Gd-EOB-DTPA-dynamic enhanced MRI can predict the presence of MVI in HCC.

scholarly journals Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Haoyu Hu ◽  
Shuo Qi ◽  
Silue Zeng ◽  
Peng Zhang ◽  
Linyun He ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
High Risk ◽  
Predictive Model ◽  
Tumor Size ◽  
Microvascular Invasion ◽  
Low Risk ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Anatomical Resection ◽  
Anatomic Resection

Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein &gt;15 ng/mL, neutrophil to lymphocyte ratio &gt;3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size &gt;5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size &gt;5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size &gt;5 cm executing AR is of great necessity.

scholarly journals Value of gadoxetic acid-enhanced MRI for microvascular invasion of small hepatocellular carcinoma: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meng Zhou ◽  
Dan Shan ◽  
Chunhui Zhang ◽  
Jianhua Nie ◽  
Guangyu Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Microvascular Invasion ◽  
Hepatobiliary Phase ◽  
Phase Imaging ◽  
Imaging Features ◽  
Small Hepatocellular Carcinoma ◽  
Halo Sign ◽  
Rim Enhancement

Abstract Background The objective of this study was to analyze the accuracy of gadolinium–ethoxybenzyl–diethylenetriamine penta–acetic acid enhanced magnetic resonance imaging (Gd–EOB–DTPA–MRI) for predicting microvascular invasion (MVI) in patients with small hepatocellular carcinoma (sHCC) preoperatively. Methods A total of 60 sHCC patients performed with preoperative Gd–EOB–DTPA–MRI in the Harbin Medical University Cancer Hospital from October 2018 to October 2019 were involved in the study. Univariate and multivariate analyses were performed by chi–square test and logistic regression analysis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Gd–EOB–DTPA–MRI were performed by receiver operating characteristic (ROC) curves. Results Univariate analysis indicated that alanine aminotransferase (≥ 39.00U/L), poorly differentiated pathology, and imaging features including grim enhancement, capsule enhancement, arterial halo sign and hepatobiliary features (tumor highly uptake, halo sign, spicule sign and brush sign) were associated with the occurrence of MVI (p < 0.05). Multivariate analysis revealed that rim enhancement and hepatobiliary spicule sign were independent predictors of MVI (p < 0.05). The area under the ROC curve was 0.917 (95% confidence interval 0.838–0.996), and the sensitivity was 94.74%. Conclusions The morphologies of hepatobiliary phase imaging, especially the spicule sign, showed high accuracy in diagnosing MVI of sHCC. Rim enhancement played a significant role in diagnosing MVI of sHCC.

scholarly journals A Nomogram Predicting Microvascular Invasion Risk in BCLC 0/A Hepatocellular Carcinoma after Curative Resection

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Shuai-Xiang Gao ◽  
Rui Liao ◽  
Hua-Qiang Wang ◽  
Dan Liu ◽  
Fang Luo
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Training Group ◽  
Microvascular Invasion ◽  
Arterial Phase ◽  
Ct Value ◽  
Delayed Phase ◽  
Curative Hepatectomy ◽  
Peritumoral Enhancement

Background. Numerous studies have shown that hepatocellular carcinoma (HCC) without microvascular invasion (MVI) may have better outcomes. This study established a preoperative MVI risk nomogram mainly incorporating three related risk factors of MVI in BCLC 0/A HCC after surgery. Methods. Independent predictors for the risk of MVI were investigated, and an MVI risk nomogram was established based on 60 patients in the training group who underwent curative hepatectomy for BCLC 0/A HCC and validated using a dataset in the validation group. Results. Univariate analysis in the training group showed that hepatitis viral B (HBV) DNA (P=0.034), tumor size (P<0.001), CT value in the venous phase (P=0.039), CT value in the delayed phase (P=0.017), peritumoral enhancement (P=0.013), visible small blood vessels in the arterial phase (P=0.002), and distance from the tumor to the inferior vena cava (IVC) (DTI, P=0.004) were risk factors significantly associated with the presence of MVI. According to multivariate analysis, the independent predictive factors of MVI, including tumor size (P=0.002), CT value in the delayed phase (P=0.018), and peritumoral enhancement (P=0.057), were incorporated in the corresponding nomogram. The nomogram displayed an unadjusted C-index of 0.851 and a bootstrap-corrected C-index of 0.832. Calibration curves also showed good agreement on the presence of MVI. ROC curve analyses showed that the nomogram had a large AUC (0.851). Conclusions. The proposed nomogram consisting of tumor size, CT value in the delayed phase, and peritumoral enhancement was associated with MVI risk in BCLC 0/A HCC following curative hepatectomy.

scholarly journals The effects of several postoperative adjuvant therapies for hepatocellular carcinoma patients with microvascular invasion after curative resection: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiarui Yang ◽  
Hao Liang ◽  
Kunpeng Hu ◽  
Zhiyong Xiong ◽  
Mingbo Cao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Conservative Treatment ◽  
Curative Resection ◽  
Postoperative Radiotherapy ◽  
Meta Analysis ◽  
Microvascular Invasion ◽  
Cochrane Library ◽  
Conservative Group ◽  
Adjuvant Therapies ◽  
Significant Difference

Abstract Background For patients with hepatocellular carcinoma (HCC) with microvascular invasion (MVI) after curative resection, the effects of various postoperative adjuvant therapies are not summarized in detail, and the comparison between the effects of various adjuvant therapies is still unclear. Thus, we collected existing studies on postoperative adjuvant therapies for patients with HCC with MVI after curative resection and analyzed the effects of various adjuvant therapies. Method We collected all studies on postoperative adjuvant therapy for patients with HCC with MVI after curative resection from PubMed, EMBASE, Cochrane Library and SinoMed ending on May 1, 2019. Overall survival (OS) and disease-free/recurrence-free survival (RFS) between each group were compared in these studies by calculating the pooled hazard ratio (HR) and 95% confidence interval (CI). All statistical analyses were assessed by two authors independently. Result A total of 13 studies were included in this study, including 824 postoperative adjuvant transarterial chemoembolization (pa-TACE) patients, 90 postoperative radiotherapy patients, 57 radiofrequency ablation (RFA)/re-resection patients, 16 sorafenib patients and 886 postoperative conservative treatment patients. The results showed that pa-TACE significantly improved OS and RFS compared with postoperative conservative treatment in patients with HCC with MVI after curative resection (HR: 0.64, 95% CI: 0.55–0.74, p < 0.001; HR: 0.70, 95% CI: 0.62–0.78, p < 0.001, respectively). There was no significant difference in OS between pa-TACE and radiotherapy in patients with HCC with MVI (HR: 1.75, 95% CI: 0.92–3.32, p = 0.087). RFS in patients with HCC with MVI after pa-TACE was worse than that after postoperative adjuvant radiotherapy (HR: 2.29, 95% CI: 1.43–3.65, p < 0.001). The prognosis of pa-TACE and RFA/re-resection in patients with MVI with recurrent HCC had no significant differences (HR: 0.65, 95% CI: 0.09–4.89, p = 0.671). Adjuvant treatments significantly improved the OS and RFS of patients compared with the postoperative conservative group (HR: 0.580, 95% CI: 0.480–0.710, p < 0.001; HR: 0.630, 95% CI: 0.540–0.740, p < 0.001, respectively). Conclusion Compared with postoperative conservative treatment, pa-TACE, postoperative radiotherapy and sorafenib can improve the prognosis of patients with hepatocellular carcinoma with microvascular invasion after curative resection. Postoperative radiotherapy can reduce the recurrence of patients with HCC with MVI after curative resection compared with pa-TACE.

scholarly journals Evaluation of alpha-l-fucosidase for the diagnosis of hepatocellular carcinoma based on meta-analysis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Lei Xi ◽  
Chunqing Yang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Operating Characteristic ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Diagnostic Odds Ratio ◽  
Diagnostic Value ◽  
Receiver Operating Characteristic Curves ◽  
Sensitivity Specificity ◽  
Review Manager

AbstractObjectivesThe main aim of the present study was to assess the diagnostic value of alpha-l-fucosidase (AFU) for hepatocellular carcinoma (HCC).MethodsStudies that explored the diagnostic value of AFU in HCC were searched in EMBASE, SCI, and PUBMED. The sensitivity, specificity, and DOR about the accuracy of serum AFU in the diagnosis of HCC were pooled. The methodological quality of each article was evaluated with QUADAS-2 (quality assessment for studies of diagnostic accuracy 2). Receiver operating characteristic curves (ROC) analysis was performed. Statistical analysis was conducted by using Review Manager 5 and Open Meta-analyst.ResultsEighteen studies were selected in this study. The pooled estimates for AFU vs. α-fetoprotein (AFP) in the diagnosis of HCC in 18 studies were as follows: sensitivity of 0.7352 (0.6827, 0.7818) vs. 0.7501 (0.6725, 0.8144), and specificity of 0.7681 (0.6946, 0.8283) vs. 0.8208 (0.7586, 0.8697), diagnostic odds ratio (DOR) of 7.974(5.302, 11.993) vs. 13.401 (8.359, 21.483), area under the curve (AUC) of 0.7968 vs. 0.8451, respectively.ConclusionsAFU is comparable to AFP for the diagnosis of HCC.

Diagnostic performance of imaging features in the HBP of gadoxetate disodium-enhanced MRI for microvascular invasion in hepatocellular carcinoma: a meta-analysis

2021 ◽  
pp. 028418512110388
Author(s):  
Yuhui Deng ◽  
Dawei Yang ◽  
Hui Xu ◽  
Ahong Ren ◽  
Zhenghan Yang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Microvascular Invasion ◽  
Index Test ◽  
Imaging Features ◽  
Gadoxetate Disodium ◽  
Reference Test ◽  
Tumor Margin ◽  
Meta Regression

Background Microvascular invasion (MVI) is a major risk factor for early recurrence in patients with hepatocellular carcinoma (HCC). Preoperative accurate evaluation of the presence of MVI could enormously benefit its treatment and prognosis. Purpose To evaluate and compare the diagnostic performance of two imaging features (non-smooth tumor margin and peritumor hypointensity) in the hepatobiliary phase (HBP) to preoperatively diagnose the presence of MVI in HCC. Material and Methods Original articles were collected from Medline/PubMed, Web of Science, EMBASE, and the Cochrane Library up to 17 January 2021 linked to gadoxetate disodium–enhanced magnetic resonance imaging (MRI) on 1.5 or 3.0 T. The pooled sensitivity, specificity, and summary area under the receiver operating characteristic curve (AUC) were calculated and meta-regression analyses were performed. Results A total of 14 original articles involving 2193 HCCs were included. The pooled sensitivity and specificity of non-smooth tumor margin and peritumor hypointensity were 73% and 61%, and 43% and 90%, respectively, for the diagnosis of MVI in HCC. The summary AUC of non-smooth tumor margin (0.74) was comparable to that of peritumor hypointensity (0.76) ( z = 0.693, P = 0.488). The meta-regression analysis identified four covariates as possible sources of heterogeneity: average size; time interval between index test and reference test; blindness to index test during reference test; and risk of bias score. Conclusion This meta-analysis showed moderate and comparable accuracy for predicting MVI in HCC using either non-smooth tumor margin or peritumor hypointensity in HBP. Four discovered covariates accounted for the heterogeneity.

Postsurgical multiple-sites sampling procedure for the precise detection of microvascular invasion of hepatocellular carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15657-e15657
Author(s):  
Qian Zhou ◽  
Lili Chen ◽  
Shuling Chen ◽  
Qinghua Cao ◽  
Sui Peng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Validation Cohort ◽  
Normal Liver ◽  
Liver Parenchyma ◽  
Sampling Procedure ◽  
Microvascular Invasion ◽  
Sampling Location ◽  
Sample Collection ◽  
Positive Rate

e15657 Background: Microvascular invasion (MVI) is an important risk factor of recurrence for hepatocellular carcinoma (HCC). We aimed to explore the relationship of the number of sampling sites (NuSS) and sampling location with positive rate of MVI, and investigate cut-off values for NuSS. Methods: From May 2010 to Feb 2017, 910 HCC patients undergone hepatectomy with well-preserved tissue blocks were retrospectively enrolled. Associations between NuSS and positive rates of MVI were investigated. The thresholds of NuSS according to different factors were determined by Chow test and Breakpoints function, and validated prospectively in 118 patients. In validation cohort, MVI positive rates in different sampling locations were estimated. Results: The positive rates of MVI increased as NuSS increased ( P < 0.001). Tumor size and number were two factors influencing NuSS. A minimum of four, six, eight and eight sampling sites were required for detecting MVI in solitary tumors measuring 1.0-3.0 cm, 3.1-4.9 cm and ≥ 5.0 cm and multiple tumors. The positive rates of MVI as per developed thresholds were significantly higher in all the tumor subgroups of validation cohort than those in routine clinical practice in training cohort (46.7% vs. 20.6%, P= 0.048; 44.4% vs. 24.4%, P= 0.025; 73.3% vs. 50.3%, P= 0.004; 67.7% vs. 45.4%, P= 0.026). The positive rates of MVI in tumor interface were higher than those in proximal and distal paracancerous and normal liver parenchyma. Conclusions: The different thresholds of NuSS according to tumor size and number, and sampling distribution according to location provided evidences of standardized sample collection of liver cancer specimen for accurate MVI diagnosis.

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