MRI versus 64-row MDCT for diagnosis of hepatocellular carcinoma

AIM： To compare the diagnostic capability of multidetector computed tomography （MDCT） and magnetic resonance imaging （MRI） for the detection of hepatocellular carcinoma （HCC） tumour nodules and their effect on patient management. METHODS： A total of 28 patients （25 male, 3 female, mean age 67 ± 10.8 years） with biopsy-proven HCC were investigated with 64-row MDCT （slice 3 mm native, arterial and portal-venous phase, 120 mL Iomeprol, 4 mL/s, delay by bolus trigger） and MRI （Tlfs fl2d TE/ TR 2.72/129 ms, T2tse TE/TR 102/4000 ms, 5-phase dynamic contrast-enhanced Tlfs fl3d TE/TR 1.56/4.6, Gadolinium-DTPA, slice 4 mm）. Consensus reading of both modalities was used as reference. Tumour nodules were analyzed with respect to number, size, and location. RESULTS： In total, 162 tumour nodules were detected by consensus reading. MRI detected significantly more tumour nodules （159 vs 123, P 〈 0.001） compared to MDCT, with the best sensitivity for early arterial phase MRI. False-negative CT findings included nodules ≤ 5 mm （n = 5）, ≤ 10 mm （n = 17）, ≤ 15 mm （n= 12）,≤20mm（n=4）,andlnodule〉20mm.MRI missed 2 nodules ≤ 10 mm and 1 nodule ≤ 15 mm. On MRI, nodule diameters were greater than on CT （29.2 ≤25.1 mm, range 5-140 mm vs 24.1 ± 22.7 mm, range 4-129 mm, P 〈 0.005）. In 2 patients, MDCT showed only unilobar tumour spread, whereas MRI revealed additional nodules in the contralateral lobe. Detection of these nodules could have changed the therapeutic strategy. CONCLUSION： Contrast-enhanced MRI is superior to 64-row MDCT for the detection of HCC nodules. Patients should be allocated to interventional or operative treatment according to a dedicated MRI-protocol.

Liver transplantation and BCLC classification:Limitations impede optimum treatment

Background:The Barcelona Clinic Liver Cancer(BCLC)system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma.This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.Methods:The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.Results:BCLC staging was as follows:0,n=5;A,n=77;B,n=41;C,n=53;and D,n=22.Accordingly,liver transplantation was performed in the majority of patients against BCLC recommendations.Surgery(n=16),radiofrequency ablation(n=15)and transarterial chemoembolization(n=151)preceded liver transplantation in 182 patients.Sixteen patients were transplanted without pretreatment.The 1-,5-and 10-year survival rates were 83.8%,62.4%and 45.9%,and 1-,5-,and 10-year recurrence rates were 7.7%,22.7%and 26.7%.The BCLC classification did neither impact survival(P=0.796)nor recurrence(P=0.693).In the Cox analysis,RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.Conclusions:Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome.Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.

Hepatocellular carcinoma recurrence after acute liver allograft rejection treatment: A multicenter European experience

Background:During the last decades,several risk factors for the recurrence of hepatocellular carcinoma(HCC)after liver transplantation(LT)have been investigated.However,the impact of two important drivers of oncogenesis,namely the immunosuppression and the treatment of acute cellular rejection(ACR)have been marginally addressed.This study aimed at investigating the impact of ACR treatment on the incidence of tumor recurrence in a large European HCC-LT population.Methods:Seven hundred and eighty-one adult patients transplanted between February 1,1985 and June 30,2016 were retrospectively analyzed.After propensity score match,116 patients treated for ACR using steroid boluses were compared with 115 patients who did not present any ACR or a histologic but clinical irrelevant ACR.Results:Steroid boluses treated patients had a 18-fold higher overall incidence of HCC recurrence than those non-treated patients(16.4%vs.0.9%;P<0.0001).At multivariate Cox regression analysis,steroid boluses used to treat ACR were an independent risk factor for HCC recurrence(HR=14.2;95%CI:1.8–110.4;P=0.010).Conclusions:The decision to treat ACR as well as to reinforce immunosuppression load should be cautiously taken in view of the presented results.Prospective studies are needed to further elucidate the clinical impact of immunosuppression on HCC recurrence after transplantation.

Microvascular invasion of hepatocellular carcinoma predicts microvascular invasion of its recurrence: potential implications for salvage liver transplantation?

Background:Microvascular invasion(MVI)can only be assessed on a full surgical specimen.We aimed at evaluating,whether the histology of the primary tumor is predictive of MVI in a hepatocellular carcinoma(HCC)recurrence.Methods:Patients,who underwent liver resection or orthotopic liver transplantation(OLT)for recurrent HCC from January 2001 until June 2018 were eligible for this retrospective analysis.Resected specimens were evaluated for HCC subtype/morphology,vessels encapsulating tumor clusters(VETC)-pattern and MVI.Dichotomous parameters were analyzed using χ^(2)-test andϕ-values,with P values<0.05 being considered significant.Results:Of 230 HCC recurrences,37(16.1%)underwent repeated liver resection(n=22)or OLT(n=15).Of these,67.6%initially exceeded the Milan criteria.MVI correlated Milan criteria(P=0.005),tumor size(P=0.015)and VETC-pattern(P=0.034)in the primary specimen.The recurrences shared many features of the primary HCC such as tumor grade(P=0.002),VETC-pattern(P=0.035),and MVI(P=0.046).In recurrences,however,only the concordance with the Milan criteria correlated with MVI(P=0.018).No patient without MVI in the primary HCC revealed MVI on early recurrence(<2 years)(P=0.035).Conclusions:HCC recurrences share many biological features of the primary tumor.Moreover,early recurrences of MVI-negative HCC never revealed MVI.This finding offers novel concepts,e.g.,patient selection for salvage OLT.