Filiz Çelebi1, Aysegül Görmez2, Ahmet Serkan Ilgun3, Yaman Tokat4, Numan Cem Balcı5. 1. Yeditepe University Hospital Department of Radiology, Istanbul, Turkey. 2. Yeditepe University Hospital Department of Radiology, Istanbul, Turkey. Electronic address: gundogdu.aysegul@gmail.com. 3. Demiroglu Science University, Department of Surgery, Turkey. 4. Acıbadem Fulya Hastanesi, Department of Surgery, Turkey. 5. Cleveland Clinic Abu Dhabi Lerner School of Medicine, Department of Radiology, Professor of Radiology, United Arab Emirates.
Abstract
RATIONALE AND OBJECTIVES: Investigating the association between maximum standardized uptake value (SUVmax), peritumoral and intratumoral apparent diffusion coefficient (ADC) values and whether these parameters are useful in predicting the preoperative microvascular invasion (MVI) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-four patients [8 women and 36 men, median age of 62 (21-76)] with single HCCs (≥2 cm) who underwent preoperative 18F-FDG PET/MRI were retrospectively evaluated. The peritumoral and intratumoral ADC values were evaluated on diffusion-weighted images using Image J an open software and the intratumoral SUVmax values were measured on fusion 18F-FDG PET/MRI images. Univariate and multivariate logistic regression analyses were performed to determine the most influential factor predicting MVI. Interobserver agreement was checked using the intraclass correlation coefficient (ICC). RESULTS: Univariate analysis showed that the histologic grade, tumor size, maximum peritumoral ADC (PTband ADCmax), mean peritumoral ADC (PTband ADCmean), mean intratumoral ADC (IT ADCmean), and maximum SUV (SUVmax) correlated with MVI (p < 0.05). On multivariate analysis, the SUVmax was the only independent risk factor for the MVI of HCC [OR, 1.68; 95% CI (1.04-2.70); p = 0.032)]. An AUC value of 0.896, 95% CI, 0.786-1.0) had a sensitivity of 75% and specificity of 97% using the best cut-off SUVmax 5.85 to differentiate MVI-positive HCCs from MVI-negative. The PPV, NPV, and accuracy were 92.3%, 87%, and 89%, respectively. The ICC values were 0.95-0.99, a nearly perfect level of agreement. CONCLUSION: 18F-FDG PET/MRI is a useful noninvasive imaging tool for predicting the MVI of HCC.
RATIONALE AND OBJECTIVES: Investigating the association between maximum standardized uptake value (SUVmax), peritumoral and intratumoral apparent diffusion coefficient (ADC) values and whether these parameters are useful in predicting the preoperative microvascular invasion (MVI) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-four patients [8 women and 36 men, median age of 62 (21-76)] with single HCCs (≥2 cm) who underwent preoperative 18F-FDG PET/MRI were retrospectively evaluated. The peritumoral and intratumoral ADC values were evaluated on diffusion-weighted images using Image J an open software and the intratumoral SUVmax values were measured on fusion 18F-FDG PET/MRI images. Univariate and multivariate logistic regression analyses were performed to determine the most influential factor predicting MVI. Interobserver agreement was checked using the intraclass correlation coefficient (ICC). RESULTS: Univariate analysis showed that the histologic grade, tumor size, maximum peritumoral ADC (PTband ADCmax), mean peritumoral ADC (PTband ADCmean), mean intratumoral ADC (IT ADCmean), and maximum SUV (SUVmax) correlated with MVI (p < 0.05). On multivariate analysis, the SUVmax was the only independent risk factor for the MVI of HCC [OR, 1.68; 95% CI (1.04-2.70); p = 0.032)]. An AUC value of 0.896, 95% CI, 0.786-1.0) had a sensitivity of 75% and specificity of 97% using the best cut-off SUVmax 5.85 to differentiate MVI-positive HCCs from MVI-negative. The PPV, NPV, and accuracy were 92.3%, 87%, and 89%, respectively. The ICC values were 0.95-0.99, a nearly perfect level of agreement. CONCLUSION: 18F-FDG PET/MRI is a useful noninvasive imaging tool for predicting the MVI of HCC.