Hepatocellular Carcinoma
Mi-Suk Park1

1Diagnostic Radiology, Severance hospital/Yonsei University, Seoul, Korea, Republic of

Synopsis

Several studies reveal a large number of MRI phenotypes related to the biologic behavior of hepatocellular carcinoma (HCC). Hemodynamic change-related, peri-tumoral change-related, hepatocyte-related, and diffusion-related phenotypes. In this talk, I will touch on various MRI features of HCC and their implications for the diagnosis and prognosis as imaging biomarkers.

Introduction: Until now it is widely accepted that tumor size, multifocality, and vascular invasion are the most important prognostic factors of HCC. These variables are incorporated into various staging systems, and imaging plays a major role in the assessment of these variables. Therefore, the established roles of imaging include not only screening and surveillance of at-risk patients, but also diagnosis, staging, and prognostication of HCC. For these purposes, MRI is advantageous because of its high soft tissue contrast, capacity for multiple parameters, and use of various contrast agents. Furthermore, in addition to the severity of liver disease and tumor characteristics, several other features related to survival have emerged from a large number of studies. Therefore, some MR imaging features may have prognostic, as well as the diagnostic values. Hemodynamic change-related phenotypes: Angiogenesis in HCC is characterized by the presence of unpaired arteries and sinusoidal capillarization. In parallel with these changes, the portal tracts progressively diminish. Physiologically, the diminution in portal tracts causes a gradual reduction in arterial and portal venous flow to the nodule, while the formation of unpaired neo-arteries increases arterial flow. The balance is such that in the early phases of hepatocarcinogenesis, there is a net decrease in intranodular arterial flow and preservation of portal venous flow, while in the later phases, portal flow declines and eventually becomes absent while net arterial flow increases. Thus, the overt HCC usually have elevated arterial flow with reduced or absent portal flow, which makes the diagnostic hallmark of HCC, “arterial enhancement and washout”. Some HCCs showing peripheral, progressive/persistent enhancement patterns express progenitor cell markers and have tendency of early recurrence rate. Peri-tumoral change-related phenotypes: Tumor capsule is one of the characteristics of nodular progressed HCC, either true fibrous capsule or pseudocapsule. Some studies suggest that host mesenchymal cells, not tumor cells elaborate extracellular matrix component of these structures, possibly in response to compression of liver parenchyma by expansile tumor as well as host-tumor interactions. It has been reported that HCCs with intact capsules are associated with a better prognosis, probably due to the barrier effect which inhibit HCC dissemination. Corona enhancement, a transient rim enhancement around a hypervascular HCC in the late arterial phase or early portal venous phase, is another characteristic feature of HCC. It can be differentiated from capsular enhancement, which is usually seen in the equilibrium phase not in the arterial phase. The area of corona enhancement is considered as the initial drainage pathway of the tumor, because local recurrence is usually observed in this area. Distortion of corona enhancement is one of the findings predicting microvessel invasion. Hepatocyte-specific contrast agent-related phenotypes: Hepatocyte-specific contrast agents are taken up by functioning hepatocytes and excreted into the biliary system. OATP8 is known to be responsible for it. The expression of OATP is gradually decreases beginning from DN to progressed HCC. Because the reduction of OATP occurs prior to the increase of arterial flow, early HCC, which is usually hypovascular, is frequently found on hepatobiliary phase of gadoxetic acid-enhanced MRI. In addition to the early detection, the signal intensity of the tumor in the hepatocyte phase inversely correlates with histologic grades. Therefore, the signal intensity of the tumor in the hepatocyte phase could be a prognostic factor5 to 12% of HCCs show hyperintensity on hepatocyte phase, and most of them are well- or moderately differentiated HCCs, indicating favorable prognosis. Diffusion-related phenotypes There are several studies that suggests ADC values are correlated with the histologic grade of HCC, since high-grade tumor usually have densely-packed cells and a high N/C ratio, resulting in restricted diffusion. DWI has been used to monitor response assessment after treatment. Conclusion: MRI can be used for predicting tumor biology as an imaging biomarker in patients with HCC.

Acknowledgements

Jin-Young Choi, MD

References

No reference found.


Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)