Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging
Wentao Wang, Chun Yang, Kai Zhu, Li Yang, Ying Ding, Rongkui Luo, Shuo Zhu, Caizhong Chen, Wei Sun, Mengsu Zeng, Shengxiang Rao
Abstract
Small recurrent hepatocellular carcinoma (HCC) can show atypical imaging patterns, and a specific diagnostic algorithm for HCC is lacking. This study aimed to better characterize postoperative recurrent HCCs <20 mm in size with gadoxetic acid–enhanced magnetic resonance imaging (MRI). We evaluated 373 newly developed nodules after hepatectomy in 204 HCC patients with chronic hepatitis B virus infection. The diagnostic performance of Liver Imaging Reporting and Data System (LI‐RADS) version 2018 was calculated with gadoxetic acid–enhanced MRI to characterize recurrent HCC. Modified diagnostic algorithms were proposed by combining significant imaging biomarkers related to subcentimeter and 10‐19 mm recurrence, and the algorithms were then compared with the LI‐RADS system. A total of 256 recurrent HCCs (108 recurrent HCCs <10 mm in size; 148 recurrent HCCs 10‐19 mm in size) were confirmed via histology or follow‐up imaging. Nonrim arterial phase hyperenhancement (APHE) and 3 LI‐RADS ancillary features (AFs; hepatobiliary phase hypointensity, mild‐moderate T 2 hyperintensity, and restricted diffusion) were significantly related to recurrent HCCs <20 mm in size according to a multivariate analysis. For subcentimeter recurrence, combining at least 2 of the 3 AFs only achieved better specificity (sensitivity, 83.3%; specificity, 87.7%) than the LR‐4 category (sensitivity, 88.9%, P = 0.21; specificity, 70.8%, P = 0.006). For 10‐19 mm recurrences, combining nonrim APHE and at least 1 of the 3 AFs achieved only a significantly enhanced sensitivity of 85.1% but a lower specificity of 86.5% compared with the LR‐5 category (sensitivity: 63.5%, P < 0.001; specificity: 94.2%, P = 0.13). In conclusion, the diagnostic algorithms for subcentimeter and 10‐19 mm recurrent HCCs should be stratified. Combining at least 2 AFs demonstrated comparable sensitivity with significantly enhanced specificity compared with the LR‐4 category for characterizing subcentimeter recurrence.