Role of baseline volumetric functional MRI in predicting histopathologic grade and patients’ survival in hepatocellular carcinoma

Sanaz Ameli, Mohammadreza Shaghaghi, Mounes Aliyari Ghasabeh, Pallavi Pandey, Bita Hazhirkarzar, Maryam Ghadimi, Roya Rezvani Habibabadi, Pegah Khoshpouri, Ankur Pandey, Robert A. Anders, Ihab R. Kamel

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objectives: We aimed to evaluate the role of volumetric ADC (vADC) and volumetric venous enhancement (vVE) in predicting the grade of tumor differentiation in hepatocellular carcinoma (HCC). Methods: The study population included 136 HCC patients (188 lesions) who had baseline MR imaging and histopathological report. Measurements of vVE and vADC were performed on baseline MRI. Tumors were histologically classified into low-grade and high-grade groups. The parameters between the two groups were compared using Mann-Whitney U and chi-square tests for continuous and categorical parameters, respectively. Area under receiver operating characteristic (AUROC) was calculated to investigate the accuracy of vADC and vVE. Logistic regression and multivariable Cox regression were used to unveil the potential parameters associated with high-grade HCC and patient’s survival, respectively. Results: Lesions with higher vADC values and a higher absolute vADC skewness were more likely to be high grade on histopathology assessment (p = 0.001 and p = 0.0291, respectively). Also, vVE showed a trend to be higher in low-grade lesions (p = 0.079). Adjusted multivariable model including vADC, vVE, and vADC skewness could strongly predict HCC degree of differentiation (AUROC = 83%). Additionally, a higher Child-Pugh score (HR = 2.39 [p = 0.02] for score 2 and HR = 3.47 [p = 0.001] for score 3), vADC skewness (HR = 1.52, p = 0.02; per increments in skewness), and tumor volume (HR = 1.1, p = 0.001; per 100 cm3 increments) showed the highest association with patients’ survival. Conclusions: vADC and vVE have the potential to accurately predict HCC differentiation. Additionally, some imaging features in combination with patients’ clinical characteristics can predict patient survival. Key Points: • Volumetric functional MRI metrics can be considered as non-invasive measures for determining tumor histopathology in HCC. • Estimating patient survival based on clinical and imaging parameters can be used for modifying management approach and preventing unnecessary adverse events.

Original languageEnglish (US)
Pages (from-to)3748-3758
Number of pages11
JournalEuropean radiology
Issue number7
StatePublished - Jul 1 2020


  • Hepatocellular carcinoma
  • Magnetic resonance imaging
  • Survival analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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