The presence of a satellite nodule or peritumoral hypointensity in the hepatobiliary phase during preoperative hepatobiliary magnetic resonance imaging correlated with a high rate of recurrence among patients both within and outside Milan criteria who underwent liver transplantation for hepatocellular carcinoma, according to recently published data.
“These high-risk radiologic findings were not only helpful in patients transplanted outside the Milan criteria, but also for patients transplanted within the Milan criteria,” Ah Yeong Kim, MD, from the Sungkyunkwan University School of Medicine, South Korea, and colleagues wrote. “Our data indicate that hepatobiliary MRI can be a useful tool in further refinement of current LT selection criteria, and that it should be a valuable component of pre-LT evaluation tool in our clinical practice.”
To assess preoperative gadoxetic acid-enhanced MRI and diffusion-weighted imaging as a predictive method for tumor recurrence, Kim and colleagues 100 patients who underwent living donor liver transplantation for HCC. The researchers conducted MRI within 3 months prior to liver transplantation.
During a mean follow-up of 49.6 months, 33 patients experienced HCC recurrence. Additionally, the researchers observed extrahepatic tumor recurrence in the lung (n = 20), lymph node (n = 10), bone (n = 10), adrenal gland (n = 5), peritoneal seeding (n = 4) and brain (n = 3). Mean time between liver transplantation and recurrence was 15.8 months.
Fifty-five patients showed microvascular metastasis (HR = 5.74; 95% CI, 2.21-14.9) and 28 patients showed intrahepatic metastasis (HR = 3.68; 95% CI, 1.85-7.33), both of which significantly correlated with recurrence-free survival.
Multivariate analysis showed that the presence of a satellite nodule (HR = 3.07; 95% CI, 1.14-8.25) and peritumoral hypointensity in the hepatobiliary phase (HR = 4.53; 95% CI, 1.53-13.44) independently correlated with recurrence-free survival.
Finally, the researchers defined the presence of high-risk radiologic findings as at least one of two MRI-found features: the presence of a satellite nodule or peritumoral hypointensity in the hepatobiliary phase. Patients with these findings were overall significantly more like to have recurrence (HR = 8.22; 95% CI, 4.07-16.58) and more likely to have recurrence regardless of whether they were within Milan criteria (HR = 8.55; 95% CI, 2.87-25.43) or outside Milan criteria (HR = 4.77; 95% CI, 1.74-13.06). – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.