IVIM improves preoperative assessment of microvascular invasion in HCC
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To prospectively evaluate the potential role of intravoxel incoherent motion (IVIM) and conventional radiologic features for preoperative prediction of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).
Institutional review board approval and written informed consent were obtained for this study. A cohort comprising 115 patients with 135 newly diagnosed HCCs between January 2016 and April 2017 were evaluated. Two radiologists independently reviewed the radiologic features and the apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion component fraction (f) were also measured. Interobserver agreement was checked and univariate and multivariate logistic regressions were used for screening the risk factors. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance.
Features significantly related to MVI of HCC at univariate analysis were reduced ADC (odds ratio, 0.341; 95% CI, 0.211–0.552; p < 0.001), D (odds ratio, 0.141; 95% CI, 0.067–0.299; p < 0.001), and irregular circumferential enhancement (odds ratio, 9.908; 95% CI, 3.776–25.996; p < 0.001). At multivariate analysis, only D value (odds ratio, 0.096; 95% CI, 0.025–0.364; p < 0.001) was the independent risk factor for MVI of HCC. The mean D value for MVI of HCC showed an area under ROC curves of 0.815 (95% CI, 0.740–0.877).
IVIM model–derived D value is superior to ADC measured with mono-exponential model for evaluating the MVI of HCC. Among MR imaging features, tumor margin, enhancement pattern, tumor capsule, and peritumoral enhancement were not predictive for MVI.
• Diffusion MRI is useful for non-invasively evaluating the microvascular invasion of hepatocellular carcinoma.
• IVIM model is advantageous over mono-exponential model for assessing the microvascular invasion of hepatocellular carcinoma.
• Decreased D value was the independent risk factor for predicting MVI of HCC.
KeywordsMagnetic resonance imaging Hepatocellular carcinoma Diagnostic imaging
Apparent diffusion coefficient
Area under curve
True diffusion coefficient
Pseudodiffusion component fraction
Intra-class correlation coefficient
Intravoxel incoherent motion
Liver acceleration volume acquisition
Magnetic resonance imaging
Positron emission tomography
Receiver operating characteristics
Region of interest
Whole tumor volume
This study was funded by Research Grant of National Nature Science Foundation of China and Science (Grant number 81471658) and Technology Support Program of Sichuan Province (Grant number 2017SZ0003) and Science and Technology Support Program of Sichuan Province (Grant number 2017SZ0185).
Compliance with ethical standards
The scientific guarantor of this publication is Bin Song.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors (Yi Wei) has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
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