title: Can Current Preoperative Imaging Be Used to Detect Microvascular Invasion of Hepatocellular Carcinoma?
abstract: OBJECTIVE
  To determine the accuracy of imaging features, such as tumor dimension, multinodularity, nonsmooth tumor margins, peritumoral enhancement, and radiogenomic algorithm based on the association between imaging features (internal arteries and hypoattenuating halos) and gene expression that the authors called two-trait predictor of venous invasion (TTPVI), in the prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC).
  
  
  METHODS
  This single-center retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. One hundred twenty-five patients (median age, 63 years; interquartile range, 53-71 years) with a diagnosis of HCC and indications for hepatic resection were included. Two observers independently reviewed radiologic images to evaluate the following features for MVI: maximum diameter, number of lesions, tumor margins, TTPVI, and peritumoral enhancement. Interobserver agreement was checked, and diagnostic accuracy of radiologic features was investigated.
  
  
  RESULTS
  The total number of HCC nodules was 140. Large tumor size, nonsmooth tumor margins, TTPVI, and peritumoral enhancement were significantly related to the presence of MVI (P < .05 in all cases and for both observers). Multinodularity was not significantly related (P = .158). Moreover, the diagnostic accuracy of the three "worrisome" radiologic features (nonsmooth tumor margins, peritumoral enhancement, and TTPVI) was associated with tumor size: The negative predictive value of the absence of worrisome features decreased from 0.84 for observer 1 and 0.91 for observer 2 for tumors smaller than 2 cm to 0.56 and 0.71, respectively, for tumors larger than 5 cm, whereas the presence of all three worrisome features returned to a positive predictive value of 0.95 for observer 1 and 0.96 for observer 2 independent of tumor size, with no significant interobserver differences (P > .10).
  
  
  CONCLUSIONS
  "Worrisome" imaging features, such as tumor dimension, nonsmooth tumor margins, peritumoral enhancement, and TTPVI, have high accuracy in the prediction of MVI in HCC.
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Renzulli
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Brocchi
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mazzotti
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mosconi
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Sportoletti
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandi
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: From the Radiology Unit, Department of Diagnostic Medicine and Prevention (M.R., S.B., C.M., C.S., R.G.), Department of Medical and Surgical Sciences (A.C., F.M., A.D.P.), and Department of Specialized, Experimental and Diagnostic Medicine (G.B.), S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
mesh_terms: D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis*; D009389:Neovascularization, Pathologic / Q000175:diagnosis*; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media