Gong Qishu, Zhang Yusen, Wu Tianchong, Du Zhiyong, Zhang Yue
Department of Hepatobiliary Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
Quant Imaging Med Surg. 2023 Jul 1;13(7):4633-4640. doi: 10.21037/qims-22-940. Epub 2023 May 18.
Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a novel subtype of HCC, one of eight distinct subtypes, that accounts for 5% of all cases of HCC and is associated with a worse prognosis. Preoperative diagnosis of MTM-HCCs using imaging findings can facilitate patient treatment decision-making. The purpose of this study was to describe computed tomography (CT) and magnetic resonance imaging (MRI) findings of MTM-HCCs and compare these findings with histopathological features.
This retrospective case-control study was performed at Shenzhen People's Hospital. The cohort included 17 patients with surgically confirmed MTM-HCCs and 232 patients with surgically confirmed non-MTM-HCCs who were enrolled by searching the pathological database from January 2018 to June 2022. CT and MRI findings were retrospectively analyzed and compared with pathological features. Student's -test or Mann-Whitney U test for continuous variables and χ test or Fisher's exact test for categorical variables were implemented to compare imaging manifestations between MTM-HCCs and non-MTM-HCCs, as appropriate.
Seventeen tumors with a mean diameter of 8.58±2.83 cm were identified in the 17 patients. In addition to the typical findings of hepatocellular carcinomas (HCCs), such as arterial phase hyperenhancement (APHE), wash out, restricted diffusion, capsule and non-uptake at the hepatobiliary phase (HBP), the most common findings in MTM-HCCs were necrosis in 11 patients (64.7%, 11/17), followed by intratumoral arteries in 6 patients (35.3%, 6/17), peritumoral arterial transitive enhancement in 3 patients (17.6%, 3/17) and peritumoral hypointensive areas at the HBP in 3 of 8 patients (37.5%, 3/8) who received gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) enhancement. The tumor size of non-MTM-HCCs was 5.26±1.94 cm, which was smaller than the 8.58±2.83 cm of MTM-HCCs (P<0.001). The frequency of necrosis and intratumoral arteries was significantly higher in MTM-HCCs than in non-MTM-HCCs (necrosis: 64.7% 34.6%, P=0.012; intratumoral arteries: 47.1% 19.7%, P=0.008).
MTM-HCCs tend to be large in size with intratumoral artery and intratumoral necrosis, which are characteristics that may distinguish them from non-MTM-HCCs.
巨小梁-块状肝细胞癌（MTM-HCC）是肝细胞癌的一种新型亚型，是八种不同亚型之一，占所有肝细胞癌病例的5%，且预后较差。利用影像学表现对MTM-HCC进行术前诊断有助于患者的治疗决策。本研究的目的是描述MTM-HCC的计算机断层扫描（CT）和磁共振成像（MRI）表现，并将这些表现与组织病理学特征进行比较。
本回顾性病例对照研究在深圳市人民医院进行。该队列包括17例经手术确诊的MTM-HCC患者和232例经手术确诊的非MTM-HCC患者，这些患者是通过检索2018年1月至2022年6月的病理数据库纳入的。对CT和MRI表现进行回顾性分析，并与病理特征进行比较。根据情况，采用学生t检验或Mann-Whitney U检验分析连续变量，采用χ检验或Fisher精确检验分析分类变量，以比较MTM-HCC和非MTM-HCC之间的影像学表现。
17例患者共发现17个肿瘤，平均直径为8.58±2.83cm。除肝细胞癌（HCC）的典型表现，如动脉期高增强（APHE）、廓清、扩散受限、包膜及肝胆期（HBP）无摄取外，MTM-HCC最常见的表现为11例患者出现坏死（64.7%，11/17），其次为6例患者出现瘤内动脉（35.3%，6/17），3例患者出现瘤周动脉过渡性强化（17.6%，3/17），8例接受钆塞酸二钠（Gd-EOB-DTPA）增强的患者中有3例在HBP出现瘤周低强化区（37.5%，3/8）。非MTM-HCC的肿瘤大小为5.26±1.94cm，小于MTM-HCC的8.58±2.83cm（P<0.001）。MTM-HCC中坏死和瘤内动脉的发生率显著高于非MTM-HCC（坏死：6
