Clinical and Pathological Attributes of Hepatocellular Carcinoma Showing Lack of Restricted Diffusion on Magnetic Resonance Imaging

Authors

  • Dearada Wancharoenrung Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States and Department of Diagnostic Radiology, Faculty of Medicine, Vajira Hospital, Nawamindradhiraj University, Dusit, Bangkok 10300, Thailand.
  • Kamonwon Cattapan Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States and Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Thitinan Chulroek Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States and Department of Diagnostic Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Pathum Wan, Bangkok 10330, Thailand.
  • Hamed Kordbacheh Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
  • Martina Cecconi Department of Diagnostic Radiology, AOB Azienda Ospedaliera Brotzu, Piazzale Ricchi, Cagliari Sardinia 09134, Italy.
  • Mukesh Harisinghani Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.

DOI:

https://doi.org/10.31584/jhsmr.2021802

Keywords:

diffuse weighted imaging, hepatocellular carcinoma, histological grading, liver, non-restricted diffusion

Abstract

Objective: To correlate non-restricted diffusion magnetic resonance imaging (MRI) patterns of hepatocellular carcinoma (HCC), with histopathology and clinical outcome.

Material and Methods: We retrospectively evaluated pre-treatment MRIs showing non-restricted diffusion HCC lesions (≥1-centimeter), excluding lesions with poor quality/non-available diffusion weighted imaging (DWI). Three radiologists evaluated 37 lesions in 27 patients, for: T1-weighted (T1W)/T2-weighted (T2W) characteristics, arterial enhancement, washout on portal venous/delayed phase, capsular enhancement, intralesional fat component and presence of cirrhosis. Histopathological reports were categorized as: well/moderate/poorly differentiated. Kaplan-Meier survival analysis was calculated for clinical outcome.

Results: From a total of 37 lesions, 24 lesions had available pathological grading, which revealed well and moderately differentiated equally (12 lesions each). None of the non-restricted diffusion HCCs were poorly differentiated. Thirty-five of the 37 lesions (94.6%) showed arterial enhancement with washout; 34 lesions (91.9%) were T2W hypo-/isointense, 33 lesions (89.2%) were T1W iso-/hyperintense, 19 lesions (51.4%) showed capsular enhancement and 8 lesions (21.6%) had intralesional fat. These findings in the well and moderately differentiated groups were not significantly different (p-value 0.178-1.000). Overall mean-survival was 6.972 years (95% confidence interval (CI); 5.3-8.6). The 1-year, overall survival rate was 83.6% and for 3-years was 67.9%. Mean survival of well and moderately differentiated groups were 6.88 and 7.23 years (95% CI 5.7-8.0 and 4.4-10.1), respectively (p-value=0.319).

Conclusion: DWI may help to predict histological grading of HCC and clinical outcome. We found that non-restricted diffusion HCCs were histologically well or moderately differentiated, with no significant difference of imaging findings and survival rates between the two groups. No poorly differentiated lesions were seen in our non-restricted HCC cohort.

References

Mittal S, El-Serag HB. Epidemiology of HCC: consider the population. J Clin Gastroenterol 2013;47:S2–6.

Ghouri YA, Mian I, Rowe JH. Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis. J Carcinog [serial on the Internet]. 2017 May [cited 2018 Feb 5];16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490340/

Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ, et al. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol 2017; 15:767.

Willatt J, Ruma JA, Azar SF, Dasika NL, Syed F. Imaging of hepatocellular carcinoma and image guided therapies - how we do it. Cancer Imaging 2017;17:9.

Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, et al. 2017 version of LI-RADS for CT and MR imaging: an update. RadioGraphics 2017;37:1994–2017.

Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS Policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 2013;266: 376–82.

Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatol Baltim Md 2018;67:358–80.

Taouli B, Koh DM. Diffusion-weighted MR Imaging of the Liver. Radiology 2009;254:47–66.

Hicks RM, Yee J, Ohliger MA, Weinstein S, Kao J, Ikram NS, et al. Comparison of diffusion-weighted imaging and T2- weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma. Magn Reson Imaging 2016;34:915–21.

Xu PJ, Yan FH, Wang JH, Shan Y, Ji Y, Chen CZ. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 2010;34: 506–12.

Nasu K, Kuroki Y, Tsukamoto T, Nakajima H, Mori K, Minami M. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. Am J Roentgenol 2009;193:438–44.

Park MS, Kim S, Patel J, Hajdu CH, G. Do RK, Mannelli L, et al. Hepatocellular carcinoma: detection with diffusionweighted versus contrast-enhanced magnetic resonance imaging in pretransplant patients. Hepatology 2012;56:140–8.

Muhi A, Ichikawa T, Motosugi U, Sano K, Matsuda M, Kitamura T, et al. High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 2009;30:1005–11.

Nishie A, Tajima T, Asayama Y, Ishigami K, Kakihara D, Nakayama T, et al. Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol 2011;80:e29-33.

Heo SH, Jeong YY, Shin SS, Kim JW, Lim HS, Lee JH, et al. 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 2010;11:295–303.

Nakanishi M, Chuma M, Hige S, Omatsu T, Yokoo H, Nakanishi K, et al. Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Ann Surg Oncol 2012;19:1302–9.

Tang Y, Wang H, Ma L, Zhang X, Yu G, Li J, et al. Diffusionweighted imaging of hepatocellular carcinomas: a retrospective analysis of correlation between apparent diffusion coefficients and histological grade. Abdom Radiol N Y 2016; 41:1539–45.

Shenoy-Bhangle A, Baliyan V, Kordbacheh H, Guimaraes AR, Kambadakone A. Diffusion weighted magnetic resonance imaging of liver: principles, clinical applications and recent updates. World J Hepatol 2017;9:1081–91.

Guo W, Zhao S, Yang Y, Shao G. Histological grade of hepatocellular carcinoma predicted by quantitative diffusionweighted imaging. Int J Clin Exp Med 2015;8:4164–9.

Saito K, Moriyasu F, Sugimoto K, Nishio R, Saguchi T, Akata S, et al. Histological grade of differentiation of hepatocellular carcinoma: comparison of the efficacy of diffusion-weighted MRI with T2-weighted imaging and angiography-assisted CT. J Med Imaging Radiat Oncol 2012;56:261–9.

Kim YK, Kim CS, Han YM, Lee YH. Detection of liver malignancy with gadoxetic acid-enhanced MRI: Is addition of diffusionweighted MRI beneficial. Clin Radiol 2011;66:489–96.

Gluskin JS, Chegai F, Monti S, Squillaci E, Mannelli L. Hepatocellular Carcinoma and Diffusion-Weighted MRI: Detection and Evaluation of Treatment Response. J Cancer 2016;7:1565–70.

Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA, et al. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. AJR Am J Roentgenol 2007; 189:799–806.

Luciani A, Vignaud A, Cavet M, Tran Van Nhieu J, Mallat A, Ruel L, et al. Liver cirrhosis: intravoxel incoherent motion MR imaging—pilot study. Radiology 2008;249:891–9.

Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed. Philadelphia: Saunders/Elsevier; 2014.

Kadoya M, Matsui O, Takashima T, Nonomura A. Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings. Radiology 1992;183:819–25.

Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2014;273:30–50.

Muramatsu Y, Nawano S, Takayasu K, Moriyama N, Yamada T, Yamasaki S, et al. Early hepatocellular carcinoma: MR imaging. Radiology 1991;181:209–13.

Hussain SM, Zondervan PE, IJzermans JNM, Schalm SW, de Man RA, Krestin GP. Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation. RadioGraphics 2002;22:1023–36.

Shah S, Shukla A, Paunipagar B. Radiological features of hepatocellular carcinoma. J Clin Exp Hepatol 2014;4:S63–6.

Ebara M, Fukuda H, Kojima Y, Morimoto N, Yoshikawa M, Sugiura N, et al. Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal content of the tumor and surrounding hepatic parenchyma. Radiology 1999;210:81–8.

Khatri G, Merrick L, Miller FH. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 2010;18:421–50.

Niendorf E, Spilseth B, Wang X, Taylor A. Contrast enhanced MRI in the diagnosis of HCC. Diagnostics 2015;5:383–98.

Zech CJ, Reiser MF, Herrmann KA. Imaging of hepatocellular carcinoma by computed tomography and magnetic resonance imaging: state of the art. Dig Dis 2009;27:114–24.

Enomoto S, Tamai H, Shingaki N, Mori Y, Moribata K, Shiraki T, et al. Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis. Hepatol Int 2011;5:730–7.

Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014;272:635–54.

Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 2000; 33:282–9.

Costa AF, Thipphavong S, Arnason T, Stueck AE, Clarke SE. Fat-containing liver lesions on imaging: detection and differential diagnosis. Am J Roentgenol 2017;210:68–77.

Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 2009;27:1485– 91.

Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:417–22.

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Published

2022-03-15

How to Cite

1.
Wancharoenrung D, Cattapan K, Chulroek T, Kordbacheh H, Cecconi M, Harisinghani M. Clinical and Pathological Attributes of Hepatocellular Carcinoma Showing Lack of Restricted Diffusion on Magnetic Resonance Imaging. J Health Sci Med Res [Internet]. 2022 Mar. 15 [cited 2024 Apr. 27];39(6):447-58. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/255301

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VOL 39, NO. 6(2021): Nov-Dec

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Original Article

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