Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

Figure 1 Typical cases of early recurrence of hepatocellular carcinoma after resection. A-D: A 45-year-old male with pathologically proven hepatocellular carcinoma (HCC) [China liver cancer (CNLC) stage IIIa] suffering from recurrence 3 months after surgery. Axial T1-weighted imaging showed hyperintensity signal in the tumor indicating intratumoral hemorrhage (A, arrow). Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) showed large vessel invasion with filling defect in the portal vein (b, arrow) and non-enhanced necrotic area (B, dashed arrow). The tumor showed irregular or nodular like shape with incomplete capsule and peritumoral hypointensity (C, arrows) in the hepatobiliary phase. The pathological result was moderately differentiated HCC with microvascular invasion (D); E-H: A 60-year-old male with moderately differentiated HCC experienced recurrence 6 months after surgery (CNLC stage IIIa). Gd-EOB-DTPA-enhanced MRI showed peritumoral enhancement manifesting patchy enhancing areas around the tumor in the arterial and venous phase (E and F, arrows). The tumor was inhomogeneously nonrim arterial phase hyperenhancement and nonperipheral washout in the portal venous phase with non-enhanced necrotic area (G, arrow). Peritumoral hypointensity was seen in the hepatobiliary phase (F, arrows). The pathological result was moderately differentiated HCC with microvascular invasion (H).