MRI imaging features for predicting macrotrabecular-massive subtype hepatocellular carcinoma: a systematic review and meta-analysis

Purpose

To identify significant MRI features associated with macrotrabecular-massive hepatocellular carcinoma (MTM-HCC), and to assess the distribution of Liver Imaging Radiology and Data System (LI-RADS, LR) category assignments.

Methods

PubMed and EMBASE were searched up to March 28, 2023. Random-effects model was constructed to calculate pooled diagnostic odds ratios (DORs) and 95% confidence intervals (CIs) for each MRI feature for differentiating MTM-HCC from NMTM-HCC. The pooled proportions of LI-RADS category assignments in MTM-HCC and NMTM-HCC were compared using z-test.

Results

Ten studies included 1978 patients with 2031 HCCs (426 (20.9%) MTM-HCC and 1605 (79.1%) NMTM-HCC). Six MRI features showed significant association with MTM-HCC: tumor in vein (TIV) (DOR = 2.4 [95% CI, 1.6–3.5]), rim arterial phase hyperenhancement (DOR =2.6 [95% CI, 1.4–5.0]), corona enhancement (DOR = 2.6 [95% CI, 1.4–4.5]), intratumoral arteries (DOR = 2.6 [95% CI, 1.1–6.3]), peritumoral hypointensity on hepatobiliary phase (DOR = 2.2 [95% CI, 1.5–3.3]), and necrosis (DOR = 4.2 [95% CI, 2.0–8.5]). The pooled proportions of LI-RADS categories in MTM-HCC were LR-3, 0% [95% CI, 0–2%]; LR-4, 11% [95% CI, 6–16%]; LR-5, 63% [95% CI, 55–71%]; LR-M, 12% [95% CI, 6–19%]; and LR-TIV, 13% [95% CI, 6–22%]. In NMTM-HCC, the pooled proportions of LI-RADS categories were LR-3, 1% [95% CI, 0–2%]; LR-4, 8% [95% CI, 3–15%]; LR-5, 77% [95% CI, 71–82%]; LR-M, 5% [95% CI, 3–7%]; and LR-TIV, 6% [95% CI, 2–11%]. MTM-HCC had significantly lower proportion of LR-5 and higher proportion of LR-M and LR-TIV categories.

Conclusions

Six MRI features showed significant association with MTM-HCC. Additionally, compared to NMTM-HCC, MTM-HCC are more likely to be categorized LR-M and LR-TIV and less likely to be categorized LR-5.

Clinical relevance statement

Several MR imaging features can suggest macrotrabecular-massive hepatocellular carcinoma subtype, which can assist in guiding treatment plans and identifying potential candidates for clinical trials of new treatment strategies.

Key Points

• Macrotrabecular-massive hepatocellular carcinoma is a subtype of HCC characterized by its aggressive nature and unfavorable prognosis.

• Tumor in vein, rim arterial phase hyperenhancement, corona enhancement, intratumoral arteries, peritumoral hypointensity on hepatobiliary phase, and necrosis on MRI are indicative of macrotrabecular-massive hepatocellular carcinoma.

• Various MRI characteristics can be utilized for the diagnosis of the macrotrabecular-massive hepatocellular carcinoma subtype. This can prove beneficial in guiding treatment decisions and identifying potential candidates for clinical trials involving novel treatment approaches.