Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea.
Eur Radiol. 2021 Oct;31(10):7760-7770. doi: 10.1007/s00330-021-07897-8. Epub 2021 Apr 15.
To identify independent imaging and histopathologic factors that affect washout appearance of hepatocellular carcinoma (HCC) in CT images.
This retrospective study included 264 patients who had undergone surgical resection for treatment-naïve single HCC between January 2014 and December 2015 and had available preoperative multiphasic CT images. Two reviewers evaluated the CT imaging features of HCC using LI-RADS v2018. The "washout" was visually assessed in portal venous or equilibrium phases. Depending on the presence of washout appearance of HCC, all patients were divided into "washout" (n = 228) and "no washout" (n = 36) groups. Multivariable logistic regression analysis was used to identify factors associated with the absence of washout appearance of HCC.
A total of 264 HCCs (median size, 2.6 cm) were analyzed. Histologically proven hepatic steatosis (macrovesicular steatosis ≥ 5%) (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.05-6.74; p = 0.040), tumor capsule on histopathology (OR, 0.17; 95% CI, 0.06-0.50; p = 0.001), and mosaic appearance on CT image (OR, 0.34; 95% CI, 0.14-0.85; p = 0.021) were independent factors associated with the absence of washout appearance of HCC. In 189 patients with available unenhanced CT images, CT-diagnosed hepatic steatosis was also an independent factor for the absence of washout appearance of HCC (OR, 9.26; 95% CI, 3.06-28.02; p < 0.001).
Washout appearance of HCC in CT images could be obscured in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis, and could be enhanced with tumor capsule on histopathology and mosaic appearance on CT image.
• Hepatic steatosis is an independent factor related to the absence of washout appearance of hepatocellular carcinoma in CT images, in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis. • Both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis have higher odds of absence of washout appearance of hepatocellular carcinoma compared to non-steatotic liver. • Tumor capsule on histopathology and mosaic appearance on CT image are independent factors that enhance the probability that washout appearance of hepatocellular carcinoma is visible.
确定影响肝细胞癌（HCC）在 CT 图像中洗脱外观的独立影像学和组织病理学因素。
本回顾性研究纳入了 2014 年 1 月至 2015 年 12 月期间接受治疗初治单发 HCC 手术切除且术前有可用多期 CT 图像的 264 例患者。两位审阅者使用 LI-RADS v2018 评估 HCC 的 CT 影像学特征。在门静脉或平衡期观察 HCC 的“洗脱”。根据 HCC 洗脱外观的存在情况，所有患者分为“洗脱”（n=228）和“无洗脱”（n=36）组。采用多变量逻辑回归分析确定与 HCC 无洗脱外观相关的因素。
共分析了 264 个 HCC（中位大小 2.6cm）。组织学证实的肝脂肪变性（大泡性脂肪变性≥5%）（比值比[OR]，2.65；95%置信区间[CI]，1.05-6.74；p=0.040）、组织病理学上的肿瘤包膜（OR，0.17；95%CI，0.06-0.50；p=0.001）和 CT 图像上的马赛克外观（OR，0.34；95%CI，0.14-0.85；p=0.021）是与 HCC 无洗脱外观相关的独立因素。在 189 例有可用平扫 CT 图像的患者中，CT 诊断的肝脂肪变性也是 HCC 无洗脱外观的独立因素（OR，9.26；95%CI，3.06-28.02；p<0.001）。
CT 图像中 HCC 的洗脱外观可能在组织学证实的肝脂肪变性和 CT 诊断的肝脂肪变性中都被掩盖，并且可以通过组织病理学上的肿瘤包膜和 CT 图像上的马赛克外观增强。
肝脂肪变性是 CT 图像中 HCC 洗脱外观缺失的独立相关因素，既与组织学证实的肝脂肪变性有关，也与 CT 诊断的肝脂肪变性有关。
与非脂肪变性肝脏相比，组织学证实的肝脂肪变性和 CT 诊断的肝脂肪变性均更有可能出现 HCC 洗脱外观缺失。
组织病理学上的肿瘤包膜和 CT 图像上的马赛克外观是增强 HCC 洗脱外观可见性的独立因素。
