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Optimal imaging criteria and modality to determine Milan criteria for the prediction of post-transplant HCC recurrence after locoregional treatment

 Nieun Seo  ;  Dong Jin Joo  ;  Mi-Suk Park  ;  Seung-Seob Kim  ;  Hye Jung Shin  ;  Yong Eun Chung  ;  Jin-Young Choi  ;  Myoung Soo Kim  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.33(1) : 501-511, 2023-01 
Journal Title
Issue Date
Carcinoma, Hepatocellular* / diagnostic imaging Carcinoma, Hepatocellular* / therapy ; Humans ; Liver Neoplasms* / diagnostic imaging ; Liver Neoplasms* / therapy ; Liver Transplantation* ; Response Evaluation Criteria in Solid Tumors ; Retrospective Studies
Hepatocellular carcinoma ; LI-RADS ; Milan criteria ; Recurrence ; mRECIST
Objectives: We aimed to investigate the optimal radiologic method to determine Milan criteria (MC) for the prediction of recurrence in patients who underwent locoregional treatment (LRT) for hepatocellular carcinoma (HCC) and subsequent liver transplantation (LT).

Methods: This retrospective study included 121 HCC patients who underwent LRT and had both liver dynamic CT and MRI. They were classified with MC using four cross combinations of two imaging modalities (CT and MRI) and two diagnostic criteria (modified Response Evaluation Criteria in Solid Tumors [mRECIST] and Liver Imaging Reporting and Data System treatment response algorithm [LI-RADS TRA]). Competing risk regression was performed to analyze the time to recurrence after LT. The predictive abilities of the four methods for recurrence were evaluated using the time-dependent area under the curve (AUC).

Results: Competing risk regression analyses found that beyond MC determined by MRI with mRECIST was independently associated with recurrence (hazard ratio, 6.926; p = 0.001). With mRECIST, MRI showed significantly higher AUCs than CT at 3 years and 5 years after LT (0.597 vs. 0.756, p = 0.012 at 3 years; and 0.588 vs. 0.733, p = 0.024 at 5 years). Using the pathologic reference standard, MRI with LI-RADS TRA showed higher sensitivity (61.5%) than CT with LI-RADS TRA (30.8%, p < 0.001) or MRI with mRECIST (38.5%, p < 0.001).

Conclusions: MRI with mRECIST was the optimal radiologic method to determine MC for the prediction of post-LT recurrence in HCC patients with prior LRT.

Key points: • MRI with modified RECIST (mRECIST) is the optimal preoperative method to determine Milan criteria for the prediction of post-transplant HCC recurrence in patients with prior locoregional treatment. • With mRECIST, MRI was better than CT for the prediction of post-transplant recurrence.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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