Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Eur Radiol. 2020 Feb;30(2):987-995. doi: 10.1007/s00330-019-06424-0. Epub 2019 Aug 30.
To investigate the value of preoperative gadoxetic acid-enhanced MRI for tumor staging and recurrence prediction of hepatocellular carcinoma (HCC) after primary liver transplantation (LT).
This multicenter retrospective study included 122 recipients who underwent living donor LT (LDLT) for untreated HCC and pre-transplant gadoxetic acid-enhanced MRI from January 2009 to December 2013. Disease-free survival (DFS) was evaluated. Milan criteria, tumor grade, and microvascular invasion (MVI) were analyzed on the pathological examination of the explanted liver.
The 1-, 3-, 5-, and 7-year DFS rates were 93.3%, 90.7%, 88.9%, and 86.1%, respectively. In the multivariable analysis, independent predictors of HCC recurrence were "beyond the Milan criteria" (hazard ratio [HR], 3.54; 95% confidence interval [CI], 1.13-11.12; p = 0.030) and peritumoral hypointensity on hepatobiliary phase (HBP) (HR, 18.30; 95% CI, 4.33-77.34; p < 0.001). Pre-transplant MRI yielded a 90.2% accuracy to categorize the Milan criteria when compared with the explanted liver. Peritumoral hypointensity on HBP was significantly associated with a worse tumor grade (p = 0.010) and MVI (p < 0.001). The 5-year DFS rate in patients with "beyond the Milan criteria" but the absence of peritumoral hypointensity on HBP was not different from that in patients "within the Milan criteria" (92.2% vs. 92.9%, p = 0.438).
Pre-transplant gadoxetic acid-enhanced MRI may assist in the HCC recurrence risk prediction.
• Lesions beyond the Milan criteria and peritumoral hypointensity on hepatobiliary phase (HBP) were independent predictors of HCC recurrence. • Peritumoral hypointensity on HBP significantly associated with a worse tumor grade and microvascular invasion.
探讨钆塞酸增强磁共振成像（MRI）在预测原发性肝癌（HCC）患者肝移植术后肿瘤分期和复发中的价值。
本多中心回顾性研究纳入了 122 例因未治疗的 HCC 接受活体供肝肝移植（LDLT）且在移植前接受过钆塞酸增强 MRI 检查的患者。评估无病生存率（DFS）。在对供肝进行的病理检查中，分析米兰标准、肿瘤分级和微血管侵犯（MVI）。
1、3、5、7 年的 DFS 率分别为 93.3%、90.7%、88.9%和 86.1%。多变量分析显示，HCC 复发的独立预测因素是“超出米兰标准”（风险比[HR]，3.54；95%置信区间[CI]，1.13-11.12；p=0.030）和肝胆期（HBP）的瘤周低信号（HR，18.30；95%CI，4.33-77.34；p<0.001）。与供肝相比，移植前 MRI 对米兰标准的分类准确率为 90.2%。HBP 上的瘤周低信号与较差的肿瘤分级（p=0.010）和 MVI（p<0.001）显著相关。“超出米兰标准”但 HBP 上无瘤周低信号的患者与“在米兰标准内”的患者的 5 年 DFS 率无差异（92.2% vs. 92.9%，p=0.438）。
移植前钆塞酸增强 MRI 可能有助于预测 HCC 复发风险。
“超出米兰标准”和 HBP 上的瘤周低信号是 HCC 复发的独立预测因素。
HBP 上的瘤周低信号与肿瘤分级和微血管侵犯显著相关。
