Abstract:

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） enhanced MRI combined with diffusion weighted imaging （DWI） in evaluating vessels encroachment tumor clusters （VETCs） in patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted and 116 patients with HCC admitted to the Second Hospital of Qinhuangdao from January 2023 to December 2024 were selected for the study. All patients underwent Gd-EOB-DTPA-enhanced MRI and DWI examinations within 7 d before surgery. Based on postoperative pathological results， the patients were divided into VETC positive group （n=35） and VETC negative group （n=81）. Imaging features and apparent diffusion coefficient （ADC） values of the two groups were compared. Multivariate logistic regression was utilized to analyze the influencing factors of VETC in patients with HCC， and the receiver operator characteristic （ROC） curve was plotted to analyze the value of each parameters in evaluating VETC in patients with HCC. Results The incidence rates of rough tumor margins， peritumoral enhancement in arterial phase， and hepatobiliary specific peritumoral hypointensity in the VETC positive group [51.43% （18/35）， 42.86% （15/35）， 54.29% （19/35）] were higher than those in the VETC negative group [25.93% （21/81）， 16.05% （13/81）， 18.52% （15/81）]， with statistically significant differences （χ²=7.12， P=0.008； χ²=9.59， P=0.002； χ²=15.09， P<0.001）. The ADC value of the VETC positive group [（1.05±0.30）×10^-3 mm²/s] was lower than that of the VETC negative group [（1.28±0.44）×10^-3 mm²/s] （t=2.82， P=0.006）. Multivariate logistic regression analysis showed that peritumoral enhancement in arterial phase （OR=1.40， 95%CI： 1.12-1.74， P=0.003）， hepatobiliary specific peritumoral hepatobiliary （OR=1.43， 95%CI： 1.13-1.81， P=0.003）， and decreased ADC value （OR=1.49， 95%CI： 1.20-1.86， P<0.001） were independent risk factors for VETC in patients with HCC. ROC curve analysis showed that the values of the area under the curve （AUC） of peritumoral enhancement in arterial phase， hepatobiliary specific peritumoral hypointensity， decreased ADC value， and the combined detection of the three for predicting VETC in HCC patients were 0.695， 0.684， 0.725， and 0.855， respectively. The AUC of the combined detection of the three for predicting VETC in HCC patients was higher than that of the individual detection （Z=2.08， P=0.038； Z=2.86， P=0.004； Z=2.97， P=0.003）. Conclusions Gd-EOB-DTPA enhanced MRI combined with DWI is of high value in evaluating VETC in patients with HCC， and can help to guide individualized treatment plan and evaluate the prognosis.

Key words: Carcinoma， hepatocyte, Vessels encapsulating tumor clusters positive, Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, MRI, Diffusion-weighted imaging