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Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis.

Methods

Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48–74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA.

Results

After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0–318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10–20 mm in 27, 20–50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54–84), even in 17/29 nodules with 10–20 mm diameter (58.6%, CI: 39–76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22–47) (p= 0.0007). MVI did not correlate with history of previous HCC.

Conclusions

HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients.

Key Points

• In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy.

• HCC presents imaging features of microvascular invasion, predictive of more aggressive progression.

• Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.

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Abbreviations

BCLC:

Barcelona clinic liver cancer

CI:

Confidence interval

CT:

Computed tomography

DAA:

Direct-acting antiviral

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

MRI:

Magnetic resonance imaging

MVI:

Microvascular invasion

NSTM:

Non-smooth tumour margins

OR:

Odds ratio

PEI:

Percutaneous ethanol injection

PTE:

Peritumoral enhancement

RFA:

Radiofrequency ablation

SVR:

Sustained virological response

TACE:

Transarterial chemoembolisation

TTPVI:

Two-trait predictor of venous invasion

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic Medicine and Prevention, Sant’Orsola-Malpighi Hospital, Bologna, Italy

    Matteo Renzulli, Stefano Brocchi & Rita Golfieri

  2. Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy

    Federica Buonfiglioli, Fabio Conti, Gabriella Verucchi, Pietro Andreone & Stefano Brillanti

  3. Department of Digestive Diseases, Sant’Orsola-Malpighi Hospital, Bologna, Italy

    Ilaria Serio

  4. Division of Internal Medicine, Ospedale di Faenza, Faenza, Italy

    Francesco Giuseppe Foschi

  5. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

    Paolo Caraceni & Giuseppe Mazzella

  6. U.O. di Gastroenterologia, Via Massarenti 9, 40138, Bologna, Italy

    Stefano Brillanti

Authors
  1. Matteo Renzulli
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  2. Federica Buonfiglioli
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  3. Fabio Conti
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  4. Stefano Brocchi
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  5. Ilaria Serio
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  6. Francesco Giuseppe Foschi
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  7. Paolo Caraceni
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  8. Giuseppe Mazzella
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  9. Gabriella Verucchi
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  10. Rita Golfieri
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  11. Pietro Andreone
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  12. Stefano Brillanti
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Corresponding author

Correspondence to Stefano Brillanti.

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Guarantor

The scientific guarantor of this publication is Stefano Brillanti, M.D., Department of Medical and Surgical Sciences, University of Bologna, Italy.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Methodology

• retrospective

• case-control study

• performed at one institution

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Renzulli, M., Buonfiglioli, F., Conti, F. et al. Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis. Eur Radiol 28, 506–513 (2018). https://doi.org/10.1007/s00330-017-5033-3

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  • DOI: https://doi.org/10.1007/s00330-017-5033-3

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