Prediction of microvascular invasion of hepatocellular carcinoma using gadoxetic acid-enhanced MR and 18F-FDG PET/CT

To identify the gadoxetic acid-enhanced MR and the F-18-fludeoxyglucose (FDG) PET/CT findings associated with microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients who are undergoing liver transplantation (LT). Fifty-one patients with 78 HCCs underwent LT. Preoperative MRI and F-18-FDG PET/CT findings were retrospectively analyzed and the association of the imaging findings with MVI was assessed. Univariate analysis revealed that hypointensity seen on T1WI (OR = 4.329, p = 0.011), peritumoral enhancement (OR = 7.000, p = 0.008), inhomogeneity on arterial phase (OR = 4.321, p = 0.011), delayed phase (OR = 4.519, p = 0.009) or hepatobiliary phase (OR = 3.564, p = 0.032), and the large tumor size (> 5 cm) (OR = 12.091, p = 0.001) showed statistically significant associations with MVI. The ratio of tumor maximum standardized uptake value (SUV) to normal liver mean SUV (T-SUVmax/L-SUVmean) (2.05 +/- A 1.43 vs. 1.08 +/- A 0.37) revealed significantly higher value in the MVI-positive group. Multivariate analysis revealed that peritumoral enhancement and a T-SUVmax/L-SUVmean of 1.2 or greater had a statistically significant association with MVI, with odds ratios of 10.648 (p = 0.016) and 14.218 (p = 0.001), respectively. Preoperative imaging findings such as peritumoral enhancement seen on gadoxetic acid-enhanced MR and a T-SUVmax/L-SUVmean of 1.2 or more on F-18-FDG PET/CT, may suggest the presence of MVI in HCC patients.