Preoperative prediction of microvascular invasion in hepatocellular carcinoma using ultrasound features including elasticity

ARTICLE HIGHLIGHTS

Research background

Hepatocellular carcinoma (HCC), as the third leading cause of cancer-related deaths worldwide and the second leading cause in China, represents a major health concern throughout the world, especially in China. Microvascular invasion (MVI) is a very important predictor of poor prognosis in patients with HCC after surgical resection or liver transplantation. Accurate preoperative prediction of MVI in HCC would offer valuable insights to guide therapeutic strategy. Preoperative imaging including contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging, and contrast-enhanced ultrasound may help in the diagnosis of MVI.

Research motivation

Shear wave elastography (SWE) has the advantage of the absence of contrast agent allergy and is generally less expensive and less time-consuming than other methods, making it a more practical option for many medical facilities. Our previous study showed promising results using SWE with maximal elasticity (Emax) as the parameter to differentiate malignant focal liver lesions from benign lesions and to differentiate among different pathological types of malignant focal liver lesions. However, only a few studies have focused on the value of SWE in the prediction of MVI.

Research objectives

We aimed to explore the value of conventional ultrasound features and SWE in the preoperative prediction of MVI in HCC.

Research methods

In this study, we enrolled patients with a postoperative pathological diagnosis of HCC and a definite diagnosis of MVI. Conventional ultrasound features and SWE features such as Emax of HCCs and Emax of the periphery of HCCs were acquired before surgery. These features were compared between MVI-positive HCCs and MVI-negative HCC and between mild MVI HCCs and severe MVI HCCs.

Research results

There were a total of 86 MVI-negative HCCs and 102 MVI-positive HCCs in this study, including 54 with mild MVI and 48 with severe MVI. Maximal tumor diameters, surrounding liver tissue, color Doppler flow, Emax of HCCs, and Emax of the periphery of HCCs were significantly different between MVI-positive HCCs and MVI-negative HCCs. In addition, Emax of the periphery of HCCs was significantly different between mild MVI HCCs and severe MVI HCCs. Higher Emax of the periphery of HCCs (> 2.340 m/s, area under the curve as 0.598) and larger maximal diameters (> 61.95 mm, area under the curve as 0.663) were independent risk factors for MVI, with odds ratios of 2.820 and 1.021, respectively.

Research conclusions

HCC size and stiffness of the periphery of HCCs are useful ultrasound criteria for predicting positive MVI. Thus, preoperative ultrasound and SWE could provide useful information for the prediction of MVI in HCCs.

Research perspectives

In this study, we demonstrated the value of conventional ultrasound features and SWE in the preoperative prediction of MVI in HCC. Prospective studies to explore the value of multimodal ultrasound imaging including conventional ultrasound, ultrasound elastography, superb microvascular imaging, and contrast-enhanced ultrasound in the preoperative prediction of MVI in HCC would be beneficial.