3D MR Elastography of Hepatocellular Carcinomas as a Potential Biomarker for Predicting Tumor Recurrence

Abstract

BACKGROUND: Preoperative prediction of tumor recurrence is important in the management of patients with hepatocellular carcinoma (HCC). PURPOSE: To investigate whether tumor stiffness derived by magnetic resonance elastography (MRE) could predict early recurrence of HCC after hepatic resection. STUDY TYPE: Retrospective. POPULATION: In all, 99 patients with pathologically confirmed HCCs after surgical resection. FIELD STRENGTH/SEQUENCE: 3.0T; preoperative MRE with 60-Hz mechanical vibrations using an active acoustic driver. ASSESSMENT: Regions of interest (ROIs) were manually drawn in the tumors to measure mean tumor stiffness. Surgical specimens were reviewed for histological grade, capsule, vascular invasion, and surgical margins. The early recurrence of HCC was defined as that occurring within 2 years after resection. STATISTICAL TESTS: Cox proportional hazard models were used to evaluate risk factors associated with the time to early recurrence. RESULTS: HCCs with recurrence had higher tumor stiffness, higher rate of advanced T stage, vascular invasion, lower rate of capsule formation, larger tumor size, higher aspartate aminotransferase (AST), and hepatitis B virus (HBV)-DNA level and aspartate aminotransferase / alanine aminotransferase ratio (P = 0.031, 0.007, 0.01, <0.001, 0.015, 0.034, 0.01, and 0.014, respectively) than HCCs without recurrence. Vascular invasion (hazard ratio [HR] = 2.922; 95% confidence interval [CI]: [1.079, 7.914], P = 0.035) and mean tumor stiffness (HR = 1.163; 95% CI: [1.055, 1.282], P = 0.002) were risk factors associated with early recurrence. Each 1-kPa increase in tumor stiffness was associated with a 16.3% increase in the risk for tumor recurrence. DATA CONCLUSION: The mean stiffness of HCCs may be a useful, noninvasive, quantitative biomarker for the prediction of early HCC recurrence after hepatic resection. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:719-730.