Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in gross morphological classification of hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHENG Siman ¹ ,  CHEN Chuang ¹ , CHEN Xiaoyu ² , LIU Hongyang ² , ZHU Lun ³ , LI Hong ³ , DING Zhilong ¹ , XU Zhen ¹ , WANG Zheng ¹ , PAN Zhi ¹

1. Department of Hepatobiliary Surgery, Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu 223002, P. R. China;
2. Department of Radiology, Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu 223002, P. R. China;
3. Department of Pathology, Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu 223002, P. R. China;

Corresponding author：

CHEN Chuang, Email: chuang1030@126.com

Keywords：

hepatocellular carcinoma; gross morphological classification; gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid; magnetic resonance imaging

DOI：

10.7507/1007-9424.202303064

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Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) in gross morphological classification of hepatocellular carcinoma (HCC). Methods The clinicopathologic data of patients with HCC who received surgical treatment in the Affiliated Huai’an Hospital of Xuzhou Medical University from January 2017 to December 2022 were retrospectively gathered. The Gd-EOB-DTPA-MRI was performed before operation. Two radiologists independently assessed the gross morphological classification of HCC according to the imaging performance. The tumors were cut into sections in a coronal plane and were taken pictures for recording pathological features after operation. The tumors were assigned into 4 types according to the references and clinical experiences: single nodular type (SN), single nodular with extranodular growth type (SN-EG), confluent multi-nodular type (CMN), and infiltration type (IF). Matching degree of morphological classification was analyzed between by the Gd-EOB-DTPA-MRI and resected specimen. The pathological features of 4 types of HCC were also analyzed. Results A total of 87 patients with HCC were included. The gross morphological classification by the Gd-EOB-DTPA-MRI was 28 (32.2%) patients with SN, 28 (32.2%) patients with SN-EG, 21 (24.1%) patients with CMN, 10 (11.5%) patients with IF, which by the resected specimen was 33 (37.9%) patients with SN, 24 (27.6%) patients with SN-EG, 21 (24.1%) patients with CMN, and 9 (10.4%) patients with IF in the 87 patients with HCC. The Kappa’s coefficient of agreement between the results of Gd-EOB-DTPA-MRI and postoperative resection specimens was 0.776 (P=0.199). There were statistical differences in the tumor diameter and microvascular invasion (MVI) among the 4 types of gross morphology classification (F=2.937, P=0.038; χ²=16.852, P=0.001), the MVI rate was highest and tumor diameter was biggest in the patients with IF among the 4 types of gross morphology classification (P<0.05). Conclusions From the results of this study, the gross morphological classification of HCC is closely related to the tumor diameter and MVI. Results of Gd-EOB-DTPA-MRI and postoperative resection specimens in assessing the gross morphological classification are good agreement. Therefore, an accurate preoperative planning and better therapy strategy for the patients with HCC can be provided according to gross morphological classification by preoperative Gd-EOB-DTPA-MRI.

Citation： SHENG Siman, CHEN Chuang, CHEN Xiaoyu, LIU Hongyang, ZHU Lun, LI Hong, DING Zhilong, XU Zhen, WANG Zheng, PAN Zhi. Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in gross morphological classification of hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 814-819. doi: 10.7507/1007-9424.202303064 Copy

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2.	McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology, 2021, 73 Suppl 1(Suppl 1): 4-13.
3.	Venook AP, Papandreou C, Furuse J, et al. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist, 2010, 15 Suppl 4: 5-13.
4.	Kwon SK, Yun SS, Kim HJ, et al. The risk factors of early recurrence after hepatectomy in hepatocellular carcinoma. Ann Surg Treat Res, 2014, 86(6): 283-288.
5.	Shirabe K, Aishima S, Taketomi A, et al. Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related liver transplantation. Br J Surg, 2011, 98(2): 261-267.
6.	Lee Y, Park H, Lee H, et al. The clinicopathological and prognostic significance of the gross classification of hepatocellular carcinoma. J Pathol Transl Med, 2018, 52(2): 85-92.
7.	Liao H, Xiong T, Peng J, et al. Classification and prognosis prediction from histopathological images of hepatocellular carcinoma by a fully automated pipeline based on machine learning. Ann Surg Oncol, 2020, 27(7): 2359-2369.
8.	周斌, 徐光, 戴社教, 等. 原发性肝癌介入治疗后疗效影响因素的分析. 实用放射学杂志, 2007, 23(2): 220-222.
9.	陈柯, 田云鸿, 刘小红. 预测肝癌术后早期与晚期的复发因素研究. 西部医学, 2015, 27(7): 1008-1010.
10.	江柳, 唐光健. 肝胆特异性磁共振对比剂Gd-EOB-DTPA的临床研究进展. 国际医学放射学杂志, 2011, 34(6): 564-568.
11.	He J, Shi J, Fu X, et al. The clinicopathologic and prognostic significance of gross classification on solitary hepatocellular carcinoma after hepatectomy. Medicine (Baltimore), 2015, 94(32): e1331. doi: 10.1097/MD.0000000000001331.
12.	Kanai T, Hirohashi S, Upton MP, et al. Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer, 1987, 60(4): 810-819.
13.	Kudo M, Kitano M, Sakurai T, et al. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the Liver Cancer Study Group of Japan. Dig Dis, 2015, 33(6): 765-770.
14.	Ichikawa T, Saito K, Yoshioka N, et al. Detection and characterization of focal liver lesions: a Japanese phase Ⅲ, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol, 2010, 45(3): 133-141.
15.	于长江, 朱绍成. 磁共振影像生物标志物预测肝细胞癌术后复发风险的研究进展. 磁共振成像, 2022, 13(5): 154-157.
16.	李小庆, 周智鹏, 何松青, 等. 磁共振成像对比剂Gd-EOB-DTPA动态增强对肝脏局灶性病变的临床价值. 中华肝胆外科杂志, 2013, 19(11): 815-820.
17.	罗琳, 单鸿, 王劲. 钆塞酸二钠在肝硬化性结节及小肝癌评估中的应用进展. 中华肝胆外科杂志, 2013, 19(12): 955-960.
18.	Murakami T, Sofue K, Hori M. Diagnosis of hepatocellular carcinoma using Gd-EOB-DTPA MR imaging. Magn Reson Med Sci, 2022, 21(1): 168-181.
19.	Wang WT, Zhu S, Ding Y, et al. T1 mapping on gadoxetic acid-enhanced MR imaging predicts recurrence of hepatocellular carcinoma after hepatectomy. Eur J Radiol, 2018, 103: 25-31.
20.	Kudo M. Early hepatocellular carcinoma: definition and diagnosis. Liver Cancer, 2013, 2(2): 69-72.
21.	Kitao A, Zen Y, Matsui O, et al. Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR imaging—correlation with molecular transporters and histopathologic features. Radiology, 2010, 256(3): 817-826.
22.	Chong YS, Kim YK, Lee MW, et al. Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol, 2012, 67(8): 766-773.
23.	李晨霞, 刘海甜, 李香, 等. 钆塞酸二钠增强MRI在评估肝功能中的参数选择研究. 中华实用诊断与治疗杂志, 2019, 33(12): 1212-1216.
24.	刘桂勤, 沈加林. 肝硬化影像学诊断新进展. 中华实用诊断与治疗杂志, 2014, 28(2): 112-114.
25.	饶圣祥, 曾蒙苏. 肝特异性对比剂Gd-EOB-DTPA增强磁共振成像评价肝功能的研究进展. 世界华人消化杂志, 2016, 24(28): 3940-3945.
26.	Ueno S, Kubo F, Sakoda M, et al. Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg, 2008, 15(5): 493-500.
27.	郑丽荣, 沈俊颐, 陈卫霞, 等. CT增强扫描预测肝细胞癌微血管侵犯、根治性切除术后早期复发. 中国普外基础与临床杂志, 2016, 23(11): 1400-1406.
28.	伏旭, 何健, 史炯, 等. 肝细胞癌大体形态分型的临床意义. 中华消化外科杂志, 2015, 14(2): 120-126.

1. Gilles H, Garbutt T, Landrum J. Hepatocellular carcinoma. Crit Care Nurs Clin North Am, 2022, 34(3): 289-301.
2. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology, 2021, 73 Suppl 1(Suppl 1): 4-13.
3. Venook AP, Papandreou C, Furuse J, et al. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist, 2010, 15 Suppl 4: 5-13.
4. Kwon SK, Yun SS, Kim HJ, et al. The risk factors of early recurrence after hepatectomy in hepatocellular carcinoma. Ann Surg Treat Res, 2014, 86(6): 283-288.
5. Shirabe K, Aishima S, Taketomi A, et al. Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related liver transplantation. Br J Surg, 2011, 98(2): 261-267.
6. Lee Y, Park H, Lee H, et al. The clinicopathological and prognostic significance of the gross classification of hepatocellular carcinoma. J Pathol Transl Med, 2018, 52(2): 85-92.
7. Liao H, Xiong T, Peng J, et al. Classification and prognosis prediction from histopathological images of hepatocellular carcinoma by a fully automated pipeline based on machine learning. Ann Surg Oncol, 2020, 27(7): 2359-2369.
8. 周斌, 徐光, 戴社教, 等. 原发性肝癌介入治疗后疗效影响因素的分析. 实用放射学杂志, 2007, 23(2): 220-222.
9. 陈柯, 田云鸿, 刘小红. 预测肝癌术后早期与晚期的复发因素研究. 西部医学, 2015, 27(7): 1008-1010.
10. 江柳, 唐光健. 肝胆特异性磁共振对比剂Gd-EOB-DTPA的临床研究进展. 国际医学放射学杂志, 2011, 34(6): 564-568.
11. He J, Shi J, Fu X, et al. The clinicopathologic and prognostic significance of gross classification on solitary hepatocellular carcinoma after hepatectomy. Medicine (Baltimore), 2015, 94(32): e1331. doi: 10.1097/MD.0000000000001331.
12. Kanai T, Hirohashi S, Upton MP, et al. Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer, 1987, 60(4): 810-819.
13. Kudo M, Kitano M, Sakurai T, et al. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the Liver Cancer Study Group of Japan. Dig Dis, 2015, 33(6): 765-770.
14. Ichikawa T, Saito K, Yoshioka N, et al. Detection and characterization of focal liver lesions: a Japanese phase Ⅲ, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol, 2010, 45(3): 133-141.
15. 于长江, 朱绍成. 磁共振影像生物标志物预测肝细胞癌术后复发风险的研究进展. 磁共振成像, 2022, 13(5): 154-157.
16. 李小庆, 周智鹏, 何松青, 等. 磁共振成像对比剂Gd-EOB-DTPA动态增强对肝脏局灶性病变的临床价值. 中华肝胆外科杂志, 2013, 19(11): 815-820.
17. 罗琳, 单鸿, 王劲. 钆塞酸二钠在肝硬化性结节及小肝癌评估中的应用进展. 中华肝胆外科杂志, 2013, 19(12): 955-960.
18. Murakami T, Sofue K, Hori M. Diagnosis of hepatocellular carcinoma using Gd-EOB-DTPA MR imaging. Magn Reson Med Sci, 2022, 21(1): 168-181.
19. Wang WT, Zhu S, Ding Y, et al. T1 mapping on gadoxetic acid-enhanced MR imaging predicts recurrence of hepatocellular carcinoma after hepatectomy. Eur J Radiol, 2018, 103: 25-31.
20. Kudo M. Early hepatocellular carcinoma: definition and diagnosis. Liver Cancer, 2013, 2(2): 69-72.
21. Kitao A, Zen Y, Matsui O, et al. Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR imaging—correlation with molecular transporters and histopathologic features. Radiology, 2010, 256(3): 817-826.
22. Chong YS, Kim YK, Lee MW, et al. Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol, 2012, 67(8): 766-773.
23. 李晨霞, 刘海甜, 李香, 等. 钆塞酸二钠增强MRI在评估肝功能中的参数选择研究. 中华实用诊断与治疗杂志, 2019, 33(12): 1212-1216.
24. 刘桂勤, 沈加林. 肝硬化影像学诊断新进展. 中华实用诊断与治疗杂志, 2014, 28(2): 112-114.
25. 饶圣祥, 曾蒙苏. 肝特异性对比剂Gd-EOB-DTPA增强磁共振成像评价肝功能的研究进展. 世界华人消化杂志, 2016, 24(28): 3940-3945.
26. Ueno S, Kubo F, Sakoda M, et al. Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg, 2008, 15(5): 493-500.
27. 郑丽荣, 沈俊颐, 陈卫霞, 等. CT增强扫描预测肝细胞癌微血管侵犯、根治性切除术后早期复发. 中国普外基础与临床杂志, 2016, 23(11): 1400-1406.
28. 伏旭, 何健, 史炯, 等. 肝细胞癌大体形态分型的临床意义. 中华消化外科杂志, 2015, 14(2): 120-126.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in gross morphological classification of hepatocellular carcinoma

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