Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 2/2019

01-02-2019 | Gastrointestinal

Pre-operative ADC predicts early recurrence of HCC after curative resection

Authors: Sunyoung Lee, Seong Hyun Kim, Jeong Ah Hwang, Ji Eun Lee, Sang Yun Ha

Published in: European Radiology | Issue 2/2019

Login to get access

Abstract

Objectives

To assess a correlation between the preoperative diffusion-weighted imaging (DWI) and early recurrence (<2 years) and to determine the best DWI parameters as the risk factor of early recurrence after surgery in single hepatocellular carcinoma (HCC).

Methods

The study included 114 patients with surgically resected single HCC (≤5 cm) who underwent preoperative magnetic resonance imaging (MRI) with DWI. Radiologists evaluated the diffusion restriction of the tumours using qualitative assessment and the mean and minimum apparent diffusion coefficient values (ADCmean and ADCmin) of the tumours using quantitative measurement. Clinical and laboratory findings and DWI parameters as a risk factor for early recurrence were identified by using Cox proportional hazards model.

Results

No significant difference was observed in early recurrence rates of HCCs between those with and those without diffusion restriction (p = 0.484). Early recurrence rates of HCCs with ADCmean and ADCmin values lower than the optimal cut-offs (1.023 and 0.773 × 10-3 mm2/s, respectively) were significantly higher compared with those with values higher than the optimal cut-offs (p = 0.001 and p < 0.001, respectively). In the multivariable analysis, tumour size [hazard ratio (HR) per centimetre, 2.011; 95% CI, 1.304-3.102; p = 0.002] and ADCmin ≤0.773 × 10-3 mm2/s (HR, 13.339; 95% CI, 4.422-40.240; p < 0.001) were independent risk factors for early HCC recurrence.

Conclusions

DWI is a promising imaging tool for early recurrence of HCC. Among qualitative and quantitative assessments of DWI, ADCmin is a significant risk factor for early recurrence after surgery in single HCC.

Key Points

• The performance of minimum apparent diffusion coefficient (ADCmin) is significantly better than that of mean apparent diffusion coefficient (ADCmean) for identifying early recurrence.
• ADCmin is a significantly independent risk factor of early HCC recurrence after surgery.
• ADCmin correlates with early recurrence after curative resection of single HCC, reflecting histopathological features of the tumours including histological grade and microvascular invasion.
Literature
1.
Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226:71–78CrossRef
2.
Parikh T, Drew SJ, Lee VS et al (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822CrossRef
3.
Taouli B, Koh DM (2010) Diffusion-weighted MR imaging of the liver. Radiology 254:47–66CrossRef
4.
Mitchell DG, Bruix J, Sherman M, Sirlin CB (2015) LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology 61:1056–1065CrossRef
5.
Cha DI, Jang KM, Kim SH, Kang TW, Song KD (2017) Liver Imaging Reporting and Data System on CT and gadoxetic acid-enhanced MRI with diffusion-weighted imaging. Eur Radiol 27:4394–4405CrossRef
6.
Muhi A, Ichikawa T, Motosugi U et al (2009) High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 30:1005–1011CrossRef
7.
Heo SH, Jeong YY, Shin SS et al (2010) Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor. Korean J Radiol 11:295–303CrossRef
8.
Nishie A, Tajima T, Asayama Y et al (2011) Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol 80:e29–e33CrossRef
9.
An C, Park MS, Jeon HM et al (2012) Prediction of the histopathological grade of hepatocellular carcinoma using qualitative diffusion-weighted, dynamic. and hepatobiliary phase MRI. Eur Radiol 22:1701–1708
10.
Nakanishi M, Chuma M, Hige S et al (2012) Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Ann Surg Oncol 19:1302–1309CrossRef
11.
Okamura S, Sumie S, Tonan T et al (2016) Diffusion-weighted magnetic resonance imaging predicts malignant potential in small hepatocellular carcinoma. Dig Liver Dis 48:945–952CrossRef
12.
Suh YJ, Kim MJ, Choi JY, Park MS, Kim KW (2012) Preoperative prediction of the microvascular invasion of hepatocellular carcinoma with diffusion-weighted imaging. Liver Transpl 18:1171–1178CrossRef
13.
Zhao J, Li X, Zhang K et al (2017) Prediction of microvascular invasion of hepatocellular carcinoma with preoperative diffusion-weighted imaging: A comparison of mean and minimum apparent diffusion coefficient values. Medicine (Baltimore) 96:e7754CrossRef
14.
15.
Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358–380CrossRef
16.
Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 89:500–507CrossRef
17.
Imamura H, Matsuyama Y, Tanaka E et al (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207CrossRef
18.
Portolani N, Coniglio A, Ghidoni S et al (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235CrossRef
19.
Cucchetti A, Piscaglia F, Caturelli E et al (2009) Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol 16:413–422CrossRef
20.
Padhani AR, Liu G, Koh DM et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125CrossRef
21.
Choi JY, Lee JM, Sirlin CB (2014) CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 273:30–50CrossRef
22.
Edmondson HA, Steiner PE (1954) Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 7:462–503CrossRef
23.
Thoeny HC, De Keyzer F, Vandecaveye V et al (2005) Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology 237:492–499CrossRef
24.
Deng J, Rhee TK, Sato KT et al (2006) In vivo diffusion-weighted imaging of liver tumor necrosis in the VX2 rabbit model at 1. 5 Tesla. Invest Radiol 41:410–414CrossRef
25.
Chen CY, Li CW, Kuo YT et al (2006) Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants—initial experience. Radiology 239:448–456CrossRef
26.
Nasu K, Kuroki Y, Tsukamoto T, Nakajima H, Mori K, Minami M (2009) Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient. and histopathologic grade. AJR Am J Roentgenol 193:438–444CrossRef
27.
Nakashima O, Kojiro M (2001) Recurrence of hepatocellular carcinoma: multicentric occurrence or intrahepatic metastasis? A viewpoint in terms of pathology. J Hepatobiliary Pancreat Surg 8:404–409CrossRef
Metadata
Title
Pre-operative ADC predicts early recurrence of HCC after curative resection
Authors
Sunyoung Lee
Seong Hyun Kim
Jeong Ah Hwang
Ji Eun Lee
Sang Yun Ha
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5642-5

Other articles of this Issue 2/2019

European Radiology 2/2019 Go to the issue

Correction

Correction to: National survey on dose data analysis in computed tomography

Neuro

Detection of suspected brain infarctions on CT can be significantly improved with temporal subtraction images

Oncology

Prognostic model based on magnetic resonance imaging, whole-tumour apparent diffusion coefficient values and HPV genotyping for stage IB-IV cervical cancer patients following chemoradiotherapy

Chest

Observer variability for Lung-RADS categorisation of lung cancer screening CTs: impact on patient management

Gastrointestinal

Diffusion and perfusion MRI quantification in ileal Crohn’s disease

Ultrasound

Shear wave elastography for liver fibrosis in chronic hepatitis B: Adapting the cut-offs to alanine aminotransferase levels improves accuracy