Objective This study aimed to evaluate the value of simultaneous multislice diffusion kurtosis imaging (SMS-DKI) for predicting early recurrence (within 2 years) in hepatocellular carcinoma (HCC) and to develop a predictive model. Materials and methods This prospective study included 67 HCC patients who underwent SMS-DKI on a 3-T MRI between June 2021 and January 2023. Diffusion parameters, including the apparent diffusion coefficient (ADC), SMS-mean kurtosis (SMS-MK), and SMS-mean diffusivity (SMS-MD), along with radiological features, were analyzed. Logistic regression models were used to predict early recurrence, internally validated using 10-fold cross-validation, and assessed using AUC, calibration curves, and decision curve analysis (DCA). Results Among 67 patients (58 males; mean age, 53.5 ± 9.9 years), 30 (44.8%) experienced early recurrence. The early recurrence had significantly lower ADC (1.12 vs 1.22 × 10−3 mm2/s) and SMS-MD (1.45 vs 1.70 × 10−3 mm2/s), and higher SMS-MK (0.91 vs 0.75). SMS-MK showed the highest AUC (0.90, 95% CI: 0.80–0.96). Multivariate analysis identified SMS-MK (OR = 3.43 [1.31–8.89]), tumor size (OR = 4.22 [1.58–7.76]), non-smooth tumor margin (OR = 2.68 [1.58–7.96]), and complete capsule (OR = 0.22 [0.02–0.79]) as independent predictors of early recurrence. Based on these four parameters, the final model achieved an AUC of 0.94 (95% CI: 0.88–1.00). Calibration curves and DCA confirmed clinical utility. Conclusion SMS-DKI enhances early recurrence prediction in HCC. The predictive model, incorporating SMS-MK, tumor size, and key radiological features, demonstrated good prognostic value. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Can SMS-DKI predict HCC early recurrence within 2 years post-surgery? <Emphasis Type="BoldItalic">Findings</Emphasis> Higher SMS-MK, larger tumor size, non-smooth margins, and incomplete capsule predict HCC early recurrence (model AUC = 0.94). <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Integrating preoperative SMS-DKI biomarkers (SMS-MK) with tumor size and capsule status stratifies early HCC recurrence risk, guiding surgical planning and postoperative management. Graphical Abstract

Preoperative prediction of early recurrence in hepatocellular carcinoma using simultaneous multislice diffusion kurtosis imaging

期刊论文
发表日期：

2025年5月6日

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Yingyi Wu,
Zheng Ye,
Ting Yang,
Shan Yao,
Jie Chen,
Ting Yin,
Bin Song

摘要

Objective

This study aimed to evaluate the value of simultaneous multislice diffusion kurtosis imaging (SMS-DKI) for predicting early recurrence (within 2 years) in hepatocellular carcinoma (HCC) and to develop a predictive model.

Materials and methods

This prospective study included 67 HCC patients who underwent SMS-DKI on a 3-T MRI between June 2021 and January 2023. Diffusion parameters, including the apparent diffusion coefficient (ADC), SMS-mean kurtosis (SMS-MK), and SMS-mean diffusivity (SMS-MD), along with radiological features, were analyzed. Logistic regression models were used to predict early recurrence, internally validated using 10-fold cross-validation, and assessed using AUC, calibration curves, and decision curve analysis (DCA).

Results

Among 67 patients (58 males; mean age, 53.5 ± 9.9 years), 30 (44.8%) experienced early recurrence. The early recurrence had significantly lower ADC (1.12 vs 1.22 × 10⁻³ mm²/s) and SMS-MD (1.45 vs 1.70 × 10⁻³ mm²/s), and higher SMS-MK (0.91 vs 0.75). SMS-MK showed the highest AUC (0.90, 95% CI: 0.80–0.96). Multivariate analysis identified SMS-MK (OR = 3.43 [1.31–8.89]), tumor size (OR = 4.22 [1.58–7.76]), non-smooth tumor margin (OR = 2.68 [1.58–7.96]), and complete capsule (OR = 0.22 [0.02–0.79]) as independent predictors of early recurrence. Based on these four parameters, the final model achieved an AUC of 0.94 (95% CI: 0.88–1.00). Calibration curves and DCA confirmed clinical utility.

Conclusion

SMS-DKI enhances early recurrence prediction in HCC. The predictive model, incorporating SMS-MK, tumor size, and key radiological features, demonstrated good prognostic value.

Key Points

Question Can SMS-DKI predict HCC early recurrence within 2 years post-surgery?

Findings Higher SMS-MK, larger tumor size, non-smooth margins, and incomplete capsule predict HCC early recurrence (model AUC = 0.94).

Clinical relevance Integrating preoperative SMS-DKI biomarkers (SMS-MK) with tumor size and capsule status stratifies early HCC recurrence risk, guiding surgical planning and postoperative management.

Graphical Abstract