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

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.

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Magnetic Resonance Imaging for Surveillance of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11091665 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1665

Author(s):

Dong Hwan Kim ◽

Sang Hyun Choi ◽

Ju Hyun Shim ◽

So Yeon Kim ◽

Seung Soo Lee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Magnetic Resonance ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Early Stage ◽

Meta Analysis ◽

Random Effects Model ◽

Resonance Imaging ◽

Meta Regression

Our meta-analysis aimed to evaluate the diagnostic performance of surveillance magnetic resonance imaging (sMRI) for detecting hepatocellular carcinoma (HCC), and to compare the diagnostic performance of sMRI between different protocols. Original articles about the diagnostic accuracy of sMRI for detecting HCC were found in major databases. The meta-analytic pooled sensitivity and specificity of sMRI for detecting HCC were determined using a bivariate random effects model. The pooled sensitivity and specificity of full MRI and abbreviated MRI protocols were compared using bivariate meta-regression. In the total seven included studies (1830 patients), the pooled sensitivity of sMRI for any-stage HCC and very early-stage HCC were 85% (95% confidence interval, 79–90%; I2 = 0%) and 77% (66–85%; I2 = 32%), respectively. The pooled specificity for any-stage HCC and very early-stage HCC were 94% (90–97%; I2 = 94%) and 94% (88–97%; I2 = 96%), respectively. The pooled sensitivity and specificity of abbreviated MRI protocols were 87% (80–94%) and 94% (90–98%), values that were comparable with those of full MRI protocols (84% [76–91%] and 94% [89–99%]; p = 0.83). In conclusion, sMRI had good sensitivity for detecting HCC, particularly very early-stage HCC. Abbreviated MRI protocols for HCC surveillance had comparable diagnostic performance to full MRI protocols.

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

Contrast Media & Molecular Imaging ◽

10.1155/2018/9674565 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 10

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.

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A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma: A systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-017-15491-6 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 8

Author(s):

HangTong Hu ◽

Qiao Zheng ◽

Yang Huang ◽

Xiao Wen Huang ◽

Zhi Cheng Lai ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Meta Analysis ◽

Microvascular Invasion ◽

Preoperative Imaging ◽

Tumor Margin

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Diagnostic Performance of KLCA-NCC 2018 Criteria for Hepatocellular Carcinoma Using Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11101763 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1763

Author(s):

Dong Hwan Kim ◽

Bohyun Kim ◽

Seo Yeon Youn ◽

Hokun Kim ◽

Joon-Il Choi

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Meta Analysis ◽

Threshold Effect ◽

Resonance Imaging ◽

Study Heterogeneity ◽

Meta Regression ◽

Meta Regression Analysis

Several imaging-based systems have been proposed for the diagnosis of hepatocellular carcinoma (HCC) using magnetic resonance imaging (MRI), reflecting geographical differences in the clinical environment for HCC. We conducted a systematic review and meta-analysis to determine the performance of the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria for the MRI diagnosis of HCC. Original studies reporting the performance of the KLCA-NCC 2018 criteria for the diagnosis of HCC using MRI were identified in MEDLINE and EMBASE until 29 March 2021. The meta-analytic pooled sensitivity and specificity of the KLCA-NCC 2018 criteria for diagnosing HCC were calculated using a bivariate random-effects model. A meta-regression analysis was performed to explore study heterogeneity further. Eight studies involving 1690 HCCs reported the accuracy of the KLCA-NCC 2018 imaging criteria. The pooled sensitivity and specificity of the definite HCC criteria for diagnosing HCC were 81% (95% confidence interval, 76–85%; I2 = 86%) and 90% (86–93%; I2 = 23%), respectively. For five available studies, the pooled sensitivity and specificity of the definite HCC criteria for diagnosing HCCs smaller than 20 mm were 80% (72–86%; I2 = 76%) and 91% (86–94%; I2 = 0%), respectively. A considerable threshold effect with a correlation coefficient of 0.667 was observed. The results of the meta-regression analysis revealed that the accuracy of the definite HCC criteria differed significantly depending on the type of MRI contrast agent (p = 0.01). In conclusion, the KLCA-NCC 2018 criteria had good overall diagnostic performance in diagnosing HCC. Substantial study heterogeneity was observed for sensitivity, which was significantly influenced by the type of contrast agent and by a threshold effect.

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

Liver Cancer ◽

10.1159/000513704 ◽

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

Purpose: 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. Methods: 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. Results: 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 (>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). Conclusions: 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.

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

Cancer Cell International ◽

10.1186/s12935-021-01790-6 ◽

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.

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