title: Histological differentiation grade and microvascular invasion of hepatocellular carcinoma predicted by dynamic contrast-enhanced MRI.
abstract: OBJECTIVE
  To explore the potential use of magnetic resonance imaging (MRI) in predicting the outcome for patients with hepatocellular carcinoma (HCC), imaging characteristics were correlated with pathological findings and clinical outcome.
  
  
  METHODS
  With permission from the Ethical Board, clinical data and tissues of resected HCC patients were collected, including the preoperative MRI. The role of MRI characteristics on recurrence and survival were evaluated with univariate and multivariate analyses.
  
  
  RESULTS
  Between January 2000 and December 2008, 87 patients with 104 HCCs were operated on. Microvascular invasion was present in 55 lesions (53%). HCC was characterized as well differentiated in 15 lesions (14%), as moderate in 50 lesions (48%), and as poorly differentiated in 34 lesions (33%). Due to preoperative treatment in five lesions (5%) no vital tumor was left. In 85 lesions (88%) washout of contrast was noted. Of the 87 patients, 28 (32%) with 37 lesions developed HCC recurrence; these patients had microvascular invasion significantly more often and a moderate or poorly differentiated tumor (P < 0.001 and P = 0.025, respectively). MRI more often showed washout when HCC was moderately or poorly differentiated (P < 0.001) or microvascular invasion was present (P = 0.032).
  
  
  CONCLUSIONS
  Differentiation grade and microvascular invasion are significantly associated with the presence of washout demonstrated on dynamic contrast-enhanced MRI.
authors.affiliation: Department of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Centre, 's Gravendijkwal 230, Rotterdam, the Netherlands. c.witjes@erasmusmc.nl
authors.forename: Caroline D M
authors.initials: CD
authors.lastname: Witjes
authors.forename: François E J A
authors.initials: FE
authors.lastname: Willemssen
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Sacha J
authors.initials: SJ
authors.lastname: van der Veer
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007223:Infant; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media