Tao Yuhao, Song Mingyue, Zhang Hanjun, He Haoran, Du Mingzhan, Guo Lingchuan, Hu Chunhong, Zhang Weiguo
Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Eur Radiol. 2025 Sep 12. doi: 10.1007/s00330-025-11994-3.
To explore the gadoxetic acid-enhanced MR imaging features and prognosis of large well-differentiated hepatocellular carcinoma (LWDHCC) (≥ 3 cm) in patients with HBV.
One hundred and eighty-two patients with HBV-related HCC (≥ 3 cm) who underwent gadoxetic acid-enhanced MR scanning and surgical resection were included in this retrospective study, 31 were defined as LWDHCC and 151 as typical HCC. Clinicopathologic characteristics and gadoxetic acid-enhanced MR imaging features were evaluated. The Kaplan-Meier method and Cox proportional hazards model were used to analyze recurrence-free survival (RFS), overall survival (OS).
LWDHCCs had a lower incidence of microvascular invasion (29% vs 56%, p = 0.021), and none of them were classified as macrotrabecular-massive or steatohepatitic subtype. LWDHCCs showed transitional-phase (TP) washout more frequently (32% vs 17%, p = 0.004) or did not washout (26% vs 11%, p = 0.004). Lesion-to-liver signal intensity ratio during the portal phase of LWDHCC was significantly higher (1.04 ± 0.21 vs 0.85 ± 0.26, p < 0.001). TP hyperintensity (odds ratio, 3.186; p = 0.010) and mosaic architecture (odds ratio, 0.215; p = 0.004) were independent imaging predictors associated with LWDHCC. Portal vein tumor thrombosis (PVTT) (hazard ratio [HR] 0.265, p = 0.024) was an independent predictor of poorer RFS, while PVTT (HR 0.396, p = 0.023) and mosaic architecture (HR 0.286, p = 0.002) were linked to poorer OS.
TP hyperintensity and mosaic architecture were associated with LWDHCC. PVTT and mosaic architecture were significantly associated with RFS and OS in patients with HBV-related HCC (≥ 3 cm).
Question Gadoxetic acid-enhanced MR imaging features and prognosis of large and well-differentiated HBV-related HCC are unknown. Findings Transitional phase hyperintensity and mosaic architecture were associated with large well-differentiated HCC, portal vein tumor thrombus, and mosaic architecture were associated with prognosis. Clinical relevance The study provides clinicians with a more robust diagnostic and prognostic framework for managing patients with HCC ≥ 3.0 cm, and is helpful to understand the pathogenesis of large well-differentiated HCC, which may not necessarily be multi-step carcinogenesis.
探讨钆塞酸二钠增强磁共振成像（MR）特征及乙型肝炎病毒（HBV）相关的大的高分化肝细胞癌（LWDHCC，≥3 cm）患者的预后。
本回顾性研究纳入182例接受钆塞酸二钠增强MR扫描及手术切除的HBV相关肝癌（≥3 cm）患者，其中31例为LWDHCC，151例为典型肝癌。评估临床病理特征及钆塞酸二钠增强MR成像特征。采用Kaplan-Meier法和Cox比例风险模型分析无复发生存期（RFS）、总生存期（OS）。
LWDHCC微血管侵犯发生率较低（29% 对56%，p = 0.021），且均未分类为大梁-实体型或脂肪性肝炎亚型。LWDHCC更频繁出现过渡期（TP）廓清（32% 对17%，p = 0.004）或无廓清（26% 对11%，p = 0.004）。LWDHCC门静脉期病灶与肝脏信号强度比显著更高（1.04±0.21对0.85±0.26，p < 0.001）。TP高信号（比值比，3.186；p = 0.010）和马赛克样结构（比值比，0.215；p = 0.004）是与LWDHCC相关的独立影像预测因素。门静脉癌栓（PVTT）（风险比[HR] 0.265，p = 0.024）是RFS较差的独立预测因素，而PVTT（HR 0.396，p = 0.023）和马赛克样结构（HR 0.286，p = 0.002）与OS较差相关。
TP高信号和马赛克样结构与LWDHCC相关。PVTT和马赛克样结构与HBV相关肝癌（≥3 cm）患者的RFS和OS显著相关。
问题 钆塞酸二钠增强MR成像特征及大的、高分化的HBV相关肝癌的预后尚不清楚。发现 过渡期高信号和马赛克样结构与大的高分化肝癌相关，门静脉癌栓和马赛克样结构与预后相关。临床意义 本研究为临床医生管理≥3.0 cm肝癌患者提供了更可靠的诊断和预后框架，有助于理解大的高分化肝癌的发病机制，其不一定是多步骤癌变。
