Prediction early recurrence of hepatocellular carcinoma after hepatectomy using gadoxetic acid-enhanced MRI and IVIM

Objectives: This study aims to develop and validate a predictive nomogram for early recurrence in hepatocellular carcinoma (HCC), utilizing gadoxetic acid-enhanced MRI and intravoxel incoherent motion (IVIM) imaging to improve preoperative assessment and decision-making. Materials and methods: From March 2018 and June 2022, a total of 245 patients with pathologically confirmed HCC, who underwent preoperative gadoxetic acid-enhanced MRI and IVIM, were retrospectively enrolled from two hospitals. These patients were divided into a training cohort (n = 160) and a validation cohort (n = 85). All patients were followed until death or the last follow-up date, with a minimum follow-up period of two years. Clinical indicators and pathologic information were compared between train cohort and validation cohort. Radiological features and diffusion parameters were compared between recurrence and non-recurrence groups using the chi-square test, Mann-Whitney U test and independent sample t test in training cohort. Univariate and multivariate analyses were performed to identify significant clinical-radiological variables associated with early recurrence in the training cohort. Based on these findings, a predictive nomogram integrating risk factors and diffusion parameters was developed. The predictive performance of the nomogram was evaluated in both the training and validation cohorts. Results: No statistically significant difference in clinical and pathologic characteristics were observed between the training and validation cohorts. In training cohort, significant differences were identified between the recurrence and non-recurrence groups in tumor size, nodule-in-nodule architecture, mosaic architecture, non-smooth tumor margin, intratumor necrosis, satellite nodule, and peritumoral hypo-intensity in the hepatobiliary phase (HBP). The results of multivariate analysis identified tumor size (HR, 1.435; 95 % CI, 0.702-2.026; p G 0.05), mosaic architecture (HR, 0.790; 95 % CI, 0.421-1.480; p G 0.05), non-smooth tumor margin (HR, 1.775; 95 % CI, 0.941-3.273; p G 0.05), intratumor necrosis (HR, 1.414; 95 % CI, 0.807-2.476; p G 0.05), satellite nodule (HR, 0.648; 95 % CI, 0.352-1.191; p G 0.01), peritumoral hypo-intensity on HBP (HR, 2.786; 95 % CI, 1.141-6.802; p G 0.001) and D (HR, 0.658; 95 % CI,0.487-0.889; p G 0.01) were the independent risk factor for recurrence. The nomogram exhibited excellent predictive performance with C-index of 0.913 and 0.875 in the training cohort and validation cohort, respectively. Also, based on the nomogram score, the patients were classified according to risk factor and the Kaplan-Meier curve analysis also showed that the nomogram had a good predictive efficacy. Conclusion: The nomogram, integrating radiological risk factors and diffusion parameters, offers a reliable tool for preoperative prediction of early recurrence in HCC patients.