Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Radiology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China.
J Magn Reson Imaging. 2023 Jun;57(6):1893-1905. doi: 10.1002/jmri.28488. Epub 2022 Oct 19.
Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has potential to improve treatment decisions.
To develop and validate a nomogram based on gadoxetate disodium-enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection.
Retrospective.
A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147).
FIELD STRENGTH/SEQUENCE: A3.0 T/turbo spin-echo T2-weighted, spin-echo echo-planar diffusion-weighted, and 3D T1-weighted gradient-echo sequences.
A set of previously reported VETC- and/or prognosis-correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression-based nomogram was then constructed using the significant factors for VETC pattern. The nomogram-estimated VETC stratification was assessed for its association with recurrence.
Fisher exact test, t-test or Mann-Whitney test, logistic regression analyses, Harrell's concordance index (C-index), nomogram, Kaplan-Meier curves and log-rank tests. P value < 0.05 was considered statistically significant.
Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring-like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C-index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram-estimated high-risk VETC group and low-risk VETC group were found (2-year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively).
The nomogram integrating gadoxetate disodium-enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC.
4 TECHNICAL EFFICACY: Stage 2.
包裹肿瘤簇的血管（VETC）模式是一种与肝细胞癌（HCC）不良预后相关的新型微血管模式。术前对 VETC 的评估有可能改善治疗决策。
建立并验证基于钆塞酸二钠增强 MRI 的 HCC 中 VETC 预测模型，并评估其预测值与肝切除术后复发的相关性。
回顾性。
来自三个中心的共 320 例 HCC 患者和组织病理学 VETC 模式评估（发展队列：验证队列=173:147）。
场强/序列：3.0T/turbo 自旋回波 T2 加权、自旋回波回波平面扩散加权和 3D T1 梯度回波序列。
评估了一组先前报道的与 VETC 和/或预后相关的定性和定量成像特征。根据组织病理学 VETC 状态比较临床和影像学变量，以探讨提示 VETC 模式的因素。然后使用 VETC 模式的显著因素构建基于回归的列线图。评估列线图预测的 VETC 分层与复发的相关性。
Fisher 确切检验、t 检验或 Mann-Whitney 检验、逻辑回归分析、Harrell 一致性指数（C 指数）、列线图、Kaplan-Meier 曲线和对数秩检验。P 值<0.05 被认为具有统计学意义。
156 例患者存在病理学 VETC 模式（发展队列：验证队列=83:73）。肿瘤大小、存在分隔或不规则环状结构的异质性增强、坏死是预测 VETC 模式的显著因素。包含这些指标的列线图具有良好的判别能力，发展队列和验证队列的 C 指数分别为 0.870 和 0.862。在列线图预测的高危 VETC 组和低危 VETC 组之间发现了复发率的显著差异（发展队列和验证队列的 2 年复发率分别为 50.7% vs. 30.3%和 49.6% vs. 31.8%）。
该列线图整合了钆塞酸二钠增强 MRI 特征，与 HCC 患者的 VETC 模式术前相关，并与术后复发相关。
4 级技术功效：2 级。
