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Microvascular invasion in hepatocellular carcinoma : anatomic-radiological correlation
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Resumo(s)
O Carcinoma Hepatocelular (CHC) é a terceira principal causa de morte relacionada com o cancro no mundo. A invasão microvascular (IVM) é um fator prognóstico essencial nos doentes com CHC e representa uma ferramenta valiosa para a previsão de recorrência e a seleção adequada de tratamento.
Neste estudo, retrospetivo analisou-se a importância do desempenho diagnóstico da Ressonância Magnética (RM) na avaliação pré-operatória e previsão de IVM, comparando os resultados RM e histológicos em doentes com CHC utilizando diversos softwares especializados.
A amostra foi constituída por incluídos 22 doentes que foram tratados cirurgicamente para CHC no Hospital de Santa Maria, entre abril de 2017 e março de 2022, realizando previamente uma RM abdominal, com contraste extracelular ou hépato-específico.
Em relação aos dados demográficos, as variáveis estudadas não demonstraram distribuição normal. Quanto à fiabilidade interobservador, todas as lesões medidas na fase portal, hépato-especifica, bem como todos o ROIs medidos neste estudo, nas sequências T1 em fase e fora de fase, e na sequência T2 mostraram uma consistência excecional (coeficiente >0,950). Na análise da relevância das características de RM preditores de IVM, as medições efetuadas na fase portal, hépato-específica, Washout e a hipervascularidade das lesões demonstraram terem relevância na predição de IVM (p
<0.05). Foi observada na maioria das variáveis uma fiabilidade intraobservador excelente (coeficiente >0.900). Não foi possível demonstrar o papel preditor das variáveis significativas na IVM (p = 0,080).
Alguns resultados observados neste estudo estão de acordo com a literatura, como as medições das lesões na fase portal, hépato-específico e na análise do Washout e da hipervascularidade das lesões de CHC. Estes achados sugerem que as características de RM apresentam potencial menos invasivo para predizer IVM no doentes com diagnóstico de CHC.
Hepatocellular Carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Microvascular invasion (MVI) is a key prognostic factor in patients with HCC and represents a valuable tool for predicting recurrence and appropriate treatment selection. This retrospective study analyzed the importance of Magnetic Resonance Imaging (MRI) diagnostic performance in preoperative evaluation and prediction of MVI by comparing MRI and histological findings in HCC patients using several specialized software. The sample consisted of included 22 patients who were surgically treated for HCC at Santa Maria Hospital in Lisbon between April 2017 and March 2022, previously performing an abdominal MRI, with extracellular or hepatocyte-specific contrast. Regarding demographic data, the studied variables did not show normal distribution. Regarding interobserver reliability, all lesions measured in the portal, hepatobiliary phase, as well as all ROIs measured in this study, on T1 in-phase and out-of-phase sequences, and T2 sequence showed exceptional consistency (coefficient >0,950). In the analysis of the relevance of MRI features predictors of MVI, measurements performed in portal phase, hepatospecific, Washout and hypervascularity of lesions were shown to have relevance in predicting MVI (p <0.05). Excellent intraobserver reliability (coefficient >0,900) was observed for most variables. The predictive role of significant variables of MVI could not be demonstrated (p = 0,080). Some results observed in this study are in agreement with the literature, such as the measurements of lesions in the portal and hepatobiliary phase and the analysis of Washout and hypervascularity of HCC lesions. These findings suggest that MRI features have potential as less invasive method to predict MVI in patients with HCC.
Hepatocellular Carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Microvascular invasion (MVI) is a key prognostic factor in patients with HCC and represents a valuable tool for predicting recurrence and appropriate treatment selection. This retrospective study analyzed the importance of Magnetic Resonance Imaging (MRI) diagnostic performance in preoperative evaluation and prediction of MVI by comparing MRI and histological findings in HCC patients using several specialized software. The sample consisted of included 22 patients who were surgically treated for HCC at Santa Maria Hospital in Lisbon between April 2017 and March 2022, previously performing an abdominal MRI, with extracellular or hepatocyte-specific contrast. Regarding demographic data, the studied variables did not show normal distribution. Regarding interobserver reliability, all lesions measured in the portal, hepatobiliary phase, as well as all ROIs measured in this study, on T1 in-phase and out-of-phase sequences, and T2 sequence showed exceptional consistency (coefficient >0,950). In the analysis of the relevance of MRI features predictors of MVI, measurements performed in portal phase, hepatospecific, Washout and hypervascularity of lesions were shown to have relevance in predicting MVI (p <0.05). Excellent intraobserver reliability (coefficient >0,900) was observed for most variables. The predictive role of significant variables of MVI could not be demonstrated (p = 0,080). Some results observed in this study are in agreement with the literature, such as the measurements of lesions in the portal and hepatobiliary phase and the analysis of Washout and hypervascularity of HCC lesions. These findings suggest that MRI features have potential as less invasive method to predict MVI in patients with HCC.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Carcinoma hepatocelular Invasão microvascular Ressonância magnética Imagiologia