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IVIM improves preoperative assessment of microvascular invasion in HCC

  • Oncology
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Abstract

Purpose

To prospectively evaluate the potential role of intravoxel incoherent motion (IVIM) and conventional radiologic features for preoperative prediction of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).

Methods

Institutional review board approval and written informed consent were obtained for this study. A cohort comprising 115 patients with 135 newly diagnosed HCCs between January 2016 and April 2017 were evaluated. Two radiologists independently reviewed the radiologic features and the apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion component fraction (f) were also measured. Interobserver agreement was checked and univariate and multivariate logistic regressions were used for screening the risk factors. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance.

Results

Features significantly related to MVI of HCC at univariate analysis were reduced ADC (odds ratio, 0.341; 95% CI, 0.211–0.552; p < 0.001), D (odds ratio, 0.141; 95% CI, 0.067–0.299; p < 0.001), and irregular circumferential enhancement (odds ratio, 9.908; 95% CI, 3.776–25.996; p < 0.001). At multivariate analysis, only D value (odds ratio, 0.096; 95% CI, 0.025–0.364; p < 0.001) was the independent risk factor for MVI of HCC. The mean D value for MVI of HCC showed an area under ROC curves of 0.815 (95% CI, 0.740–0.877).

Conclusion

IVIM model–derived D value is superior to ADC measured with mono-exponential model for evaluating the MVI of HCC. Among MR imaging features, tumor margin, enhancement pattern, tumor capsule, and peritumoral enhancement were not predictive for MVI.

Key Points

• Diffusion MRI is useful for non-invasively evaluating the microvascular invasion of hepatocellular carcinoma.

• IVIM model is advantageous over mono-exponential model for assessing the microvascular invasion of hepatocellular carcinoma.

• Decreased D value was the independent risk factor for predicting MVI of HCC.

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Abbreviations

18F-FDG:

18F-fluorodeoxyglucose

ADC:

Apparent diffusion coefficient

AUC:

Area under curve

CI:

Confidence interval

CT:

Computed tomography

D :

True diffusion coefficient

D* :

Pseudodiffusion coefficient

DWI:

Diffusion-weighted imaging

f :

Pseudodiffusion component fraction

HCC:

Hepatocellular carcinoma

ICC:

Intra-class correlation coefficient

IVIM:

Intravoxel incoherent motion

LAVA:

Liver acceleration volume acquisition

MRI:

Magnetic resonance imaging

MVI:

Microvascular invasion

OR:

Odds ratio

PET:

Positron emission tomography

ROC:

Receiver operating characteristics

ROI:

Region of interest

WTV:

Whole tumor volume

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Funding

This study was funded by Research Grant of National Nature Science Foundation of China and Science (Grant number 81471658) and Technology Support Program of Sichuan Province (Grant number 2017SZ0003) and Science and Technology Support Program of Sichuan Province (Grant number 2017SZ0185).

Author information

Author notes

  1. Yi Wei and Zixing Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Yi Wei, Zixing Huang, Hehan Tang, Liping Deng, Yuan Yuan & Bin Song

  2. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China

    Jiaxing Li

  3. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China

    Dongbo Wu

  4. GE Healthcare China, Beijing, China

    Xiaocheng Wei

Authors
  1. Yi Wei
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  2. Zixing Huang
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  5. Yuan Yuan
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Correspondence to Bin Song.

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Guarantor

The scientific guarantor of this publication is Bin Song.

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

One of the authors (Yi Wei) has significant statistical expertise.

Informed consent

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

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Institutional Review Board approval was obtained.

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• prospective

• diagnostic study

• performed at one institution

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Wei, Y., Huang, Z., Tang, H. et al. IVIM improves preoperative assessment of microvascular invasion in HCC. Eur Radiol 29, 5403–5414 (2019). https://doi.org/10.1007/s00330-019-06088-w

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