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Evaluating the severity of microvascular invasion in hepatocellular carcinoma, by probing the combination of enhancement modes and growth patterns through magnetic resonance imaging

Yanzhuo Li

Yanzhuo Li

Department of Radiology, Minhang Hospital, Fudan UniversityShanghai, People’s Republic of China
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Li, Yanzhuo
, 
Sijie Li

Sijie Li

Department of Radiology, Changhai Hospital, Naval Medical UniversityShanghai, People’s Republic of China
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Li, Sijie
, 
Yan Lei

Yan Lei

Department of Radiology, Minhang Hospital, Fudan UniversityShanghai, People’s Republic of China
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Lei, Yan
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Lianlian Liu

Lianlian Liu

Department of Radiology, Minhang Hospital, Fudan UniversityShanghai, People’s Republic of China
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Liu, Lianlian
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Bin Song

Bin Song

Department of Radiology, Minhang Hospital, Fudan UniversityShanghai, People’s Republic of China
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Song, Bin
  
Apr 11, 2025
Evaluating the severity of microvascular invasion in hepatocellular carcinoma, by probing the combination of enhancement modes and growth patterns through magnetic resonance imaging's Cover Image
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Article Category: research article
Published Online: Apr 11, 2025
Page range: 183 - 192
Received: Oct 12, 2025
Accepted: Jan 27, 2025
DOI: https://doi.org/10.2478/raon-2025-0021
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© 2025 Yanzhuo Li et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

A 34-year-old male with a clearly bounded solitary HCC and M0 status, (A-D) exhibits persistent enhancement in AP, PVP, DP, and a smooth tumor margin (red arrow). A 52-year-old male with HCC and M1 grade, which illustrates a typical no/mini enhancement (red arrow) (E-G). Vague margin is visible at the superior edge of the tumor (black arrowhead) (H). A 65-year-old male who had HCC with M2 status was detected. The mass has a Max/Min-R of 1.59 and heterogeneous moderate hyperintensity on T2WI (I), which displays no or minimal enhancement (red arrow) on AP, PVP, and DP(J-L). The lesion appears as extranodular nodule (black arrowhead) (L).
A 34-year-old male with a clearly bounded solitary HCC and M0 status, (A-D) exhibits persistent enhancement in AP, PVP, DP, and a smooth tumor margin (red arrow). A 52-year-old male with HCC and M1 grade, which illustrates a typical no/mini enhancement (red arrow) (E-G). Vague margin is visible at the superior edge of the tumor (black arrowhead) (H). A 65-year-old male who had HCC with M2 status was detected. The mass has a Max/Min-R of 1.59 and heterogeneous moderate hyperintensity on T2WI (I), which displays no or minimal enhancement (red arrow) on AP, PVP, and DP(J-L). The lesion appears as extranodular nodule (black arrowhead) (L).

Figure 2.

(A,B) The MVI nomogram was built by incorporating four variables, and among the MVI-positive cases, three variables were used to establish another nomogram for predicting M2 grade. (C,D) Calibration curves of the nomogram in predicting MVI and its M2 grade. X-axis, nomogram-predicted probability of MVI or M2; Y-axis, observed MVI or M2. (E,F) Nomogram model (blue line) outperforms all (red line) and none (horizontal green line) across all reasonable threshold probabilities in predicting MVI and its M2 grade. (G,H) The ROC curves demonstrate the discriminatory ability of the two nomograms of MVI positive and its M2 grade.
(A,B) The MVI nomogram was built by incorporating four variables, and among the MVI-positive cases, three variables were used to establish another nomogram for predicting M2 grade. (C,D) Calibration curves of the nomogram in predicting MVI and its M2 grade. X-axis, nomogram-predicted probability of MVI or M2; Y-axis, observed MVI or M2. (E,F) Nomogram model (blue line) outperforms all (red line) and none (horizontal green line) across all reasonable threshold probabilities in predicting MVI and its M2 grade. (G,H) The ROC curves demonstrate the discriminatory ability of the two nomograms of MVI positive and its M2 grade.

The diagnostic performance of nomogram models for MVI-positive and M2 grade in HCC

Model AUC (95%CI) Accuracy (%) Sensitivity (%) Specificity (%) PPV NPV
MVI-positive 0.855(0.833–0.937) 84.0 88.9 81.1 74.2 92.2
M2 grade 0.805(0.703–0.908) 79.0 74.2 82.0 71.9 83.7

Univariate and multivariate logistic regression analysis for predicting M2 grade

Variable Univariable analysis Multivariable analysis
Odds ratio (95 % CI) P-value Odds ratio (95 % CI) P-value
Clinical features
Age (≥ 58 years) 1.68 (0.68–4.14) 0.262
Sex (male) 1.27 (0.35–4.69) 0.703
HBeAg(+) 0.32 (0.09–1.05) 0.060
AFP lg10 1.86 (0.75–4.63) 0.183
PIVKA-II lg10 1.09 (0.64–1.88) 0.745
Pathological data
Satellite nodule 0.46 (0.18–1.16) 0.098
MRI findings
Tumor Max-D (≥ 4.3cm) 1.39 (0.56–3.42) 0.480
Tumor Min-D (≥ 3.7cm) 1.07 (0.44–2.61) 0.888
Max/Min-R (≥ 1.22) 3.53 (1.38–9.04) 0.009* 2.91 (1.07–7.92) 0.036*
Irregular tumor shape 1.32 (0.52–3.32) 0.560
Non-smooth tumor margin 3.43 (1.33–8.82) 0.011*
Confluent multinodule growth 3.29 (1.19–9.08) 0.021* 3.92 (1.25–12.25) 0.019*
Washin/washout enhanced mode 0.34 (0.13–0.88) 0.026* 0.31 (0.11–0.92) 0.035*
Beak sign 1.18 (0.48–2.91) 0.721
Arterial Rim-enhancement 2.15 (0.73–6.34) 0.167
Peritumoral enhancement on AP 1.99 (0.79–5.01) 0.143
Peritumoral hypointensity on HBP 1.77 (0.63–4.92) 0.227

Univariate and multivariate logistic regression analysis for predicting MVI-positive HCCs

Variable Univariable analysis Multivariable analysis
Odds ratio (95 % CI) P-value Odds ratio (95 % CI) P-value
Clinical features
Age (≥ 57 years) 1.11 (0.64–1.94) 0.702
Sex (male) 1.28 (0.60–2.72) 0.525
Etiology (hepatitis B virus) 1.02 (0.54–1.93) 0.960
AFP (≥ 20ng/mL) 1.98 (1.12–3.49) 0.018*
PIVKA-II lg10 1.18 (0.84–1.66) 0.342
Pathological data
Edmondson-Steiner (III-IV) 2.35 (1.05–5.26) 0.037*
Satellite nodule 2.53 (1.43–4.48) 0.001*
MRI findings
Tumor Max-D (≥ 3.9cm) 2.14 (1.22–3.77) 0.008*
Tumor Min-D (≥ 3.1cm) 2.04 (1.16–3.59) 0.014*
Irregular tumor shape 4.59 (2.54–8.33) <0.001*
Non-smooth tumor margin 2.93 (1.63–5.27) <0.001*
Solitary nodule growth 0.18 (0.10–0.34) <0.001* 0.25 (0.12–0.52) < 0.001*
No/mini enhanced mode 2.76 (1.31–5.85) 0.008* 3.24 (1.19–8.88) 0.022*
Beak sign 4.07 (2.25–7.38) <0.001*
Arterial Rim-enhancement 2.07 (0.97–4.42) 0.060
Peritumoral enhancement on AP 5.23 (2.56–10.66) <0.001* 5.19 (2.15–12.53) < 0.001*
Peritumoral hypointensity on HBP 11.26 (5.84–21.68) <0.001* 10.74 (5.07–22.75) < 0.001*
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