ArticleEuropean radiology2026
Large well-differentiated hepatocellular carcinoma in patients with HBV: gadoxetic acid-enhanced MR imaging features and prognosis.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
objectiveTo explore the gadoxetic acid-enhanced MR imaging features and prognosis of large well-differentiated hepatocellular carcinoma (LWDHCC) (≥ 3 cm) in patients with HBV. MATERIALS AND
methodsOne hundred and eighty-two patients with HBV-related HCC (≥ 3 cm) who underwent gadoxetic acid-enhanced MR scanning and surgical resection were included in this retrospective study, 31 were defined as LWDHCC and 151 as typical HCC. Clinicopathologic characteristics and gadoxetic acid-enhanced MR imaging features were evaluated. The Kaplan-Meier method and Cox proportional hazards model were used to analyze recurrence-free survival (RFS), overall survival (OS).
resultsLWDHCCs had a lower incidence of microvascular invasion (29% vs 56%, p = 0.021), and none of them were classified as macrotrabecular-massive or steatohepatitic subtype. LWDHCCs showed transitional-phase (TP) washout more frequently (32% vs 17%, p = 0.004) or did not washout (26% vs 11%, p = 0.004). Lesion-to-liver signal intensity ratio during the portal phase of LWDHCC was significantly higher (1.04 ± 0.21 vs 0.85 ± 0.26, p < 0.001). TP hyperintensity (odds ratio, 3.186; p = 0.010) and mosaic architecture (odds ratio, 0.215; p = 0.004) were independent imaging predictors associated with LWDHCC. Portal vein tumor thrombosis (PVTT) (hazard ratio [HR] 0.265, p = 0.024) was an independent predictor of poorer RFS, while PVTT (HR 0.396, p = 0.023) and mosaic architecture (HR 0.286, p = 0.002) were linked to poorer OS.
conclusionTP hyperintensity and mosaic architecture were associated with LWDHCC. PVTT and mosaic architecture were significantly associated with RFS and OS in patients with HBV-related HCC (≥ 3 cm). KEY POINTS: Question Gadoxetic acid-enhanced MR imaging features and prognosis of large and well-differentiated HBV-related HCC are unknown. Findings Transitional phase hyperintensity and mosaic architecture were associated with large well-differentiated HCC, portal vein tumor thrombus, and mosaic architecture were associated with prognosis. Clinical relevance The study provides clinicians with a more robust diagnostic and prognostic framework for managing patients with HCC ≥ 3.0 cm, and is helpful to understand the pathogenesis of large well-differentiated HCC, which may not necessarily be multi-step carcinogenesis.
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