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Gadoxetic acid-enhanced MRI of macrotrabecular-massive hepatocellular carcinoma and its prognostic implications

 Rhee, Hyung jin  ;  Cho, Eun-Suk  ;  Nahm, Ji Hae  ;  Jang, Mi  ;  Chung, Yong Eun  ;  Baek, Song-Ee  ;  Lee, Sunyoung  ;  Kim, Myeong-Jin  ;  Park, Mi-Suk  ;  Han, Dai Hoon  ;  Choi, Jin-Young  ;  Park, Young Nyun 
 JOURNAL OF HEPATOLOGY, Vol.74(1) : 109-121, 2021-01 
Journal Title
Issue Date
Hepatocellular carcinoma ; MRI ; Gadoxetic acid ; Biopsy ; Prognosis
Background & Aims: Despite the clinical and genetic significance of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC), its characteristics on imaging have not been described. This study aimed to characterise MTM-HCC on gadoxetic acid-enhanced MRI and to evaluate the diagnostic accuracy and prognostic value of these imaging characteristics. Methods: We enrolled 3 independent cohorts from 2 tertiary care centres. The 3 cohorts consisted of a total of 476 patients who underwent gadoxetic acid-enhanced MRI and surgical resection for treatment-naive single HCCs. Independent review of histopathology and MRI by 2 reviewers was performed for each cohort, and inter-reader agreement was evaluated. Based on the result of MRI review in the training cohort (cohort 1), we developed 2 diagnostic criteria for MTM-HCC and evaluated their prognostic significance. The diagnostic performance and prognostic significance were validated in 2 validation cohorts (cohorts 2 and 3). Results: We developed 2 diagnostic MRI criteria (MRIC) for MTM-HCC: MRIC-1, >= 20% arterial phase hypovascular component; MRIC-2, >= 50% hypovascular component and 2 or more ancillary findings (intratumoural artery, arterial phase peritumoural enhancement, and non-smooth tumour margin). MRIC-1 showed high sensitivity and negative predictive value (88% and 95% in the training cohort, and 88% and 97% in the pooled validation cohorts, respectively), whereas MRIC-2 demonstrated moderate sensitivity and high specificity (47% and 94% in the training cohort, and 46% and 96% in the pooled validation cohorts, respectively). MRIC-2 was an independent poor prognostic factor for overall survival in both training and pooled validation cohorts. Conclusions: Using gadoxetic acid-enhanced MRI findings, including an arterial phase hypovascular component, we could stratify the probability of MTM-HCC and non-invasively obtain prognostic information. Lay summary: Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a histopathologic subtype of HCC characterised by aggressive biological behaviour and poor prognosis. We developed imaging criteria based on liver MRI that could be used for the non-invasive diagnosis of MTM-HCC. HCCs showing imaging findings of MTM-HCC were associated with poor outcomes after hepatic resection. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Nahm, Ji Hae(남지해) ORCID logo https://orcid.org/0000-0003-0902-866X
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Baek, Song Ee(백송이) ORCID logo https://orcid.org/0000-0001-8146-2570
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
Rhee, Hyungjin(이형진) ORCID logo https://orcid.org/0000-0001-7759-4458
Jang, Mi(장미) ORCID logo https://orcid.org/0000-0002-0153-9847
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Cho, Eun Suk(조은석)
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
Han, Dai Hoon(한대훈) ORCID logo https://orcid.org/0000-0003-2787-7876
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