Prediction microvascular invasion of hepatocellular carcinoma based on tumour margin enhancing pattern in multiphase computed tomography images

Purpose: The presence of microvascular invasion of hepatocellular carcinoma has a significantly decreased outcome following hepatectomy or liver transplantation. Currently, it is still based on histological examination. Identification of microvascular invasion by using pre-operative imaging is important for the decision-making of surgeons and interventional radiologists. Aim of the study was to predict the microvascular invasion of hepatocellular carcinoma based on tumour margin enhancement of pre-operative multiphase computed tomography (CT) images. Material and methods: Fifty-three patients with hepatocellular carcinoma, who underwent pre-operative multiphase CT scans, were included in this study. Tumour margin enhancing patterns were analysed in the late arterial phase, portovenous phase, and delay phase. The CT features including peritumoral enhancement, arterial rim-enhancement, presence of daughter nodules, complete capsule enhancement in portovenous/delay phase, and nodular capsule enhancement in portovenous/delay phase were reviewed with calculations for sensitivity and specificity. Univariate analysis and multivariate analysis were used to identify predictive features for microvascular invasion (MVI). Results: In the late arterial phase, peritumoral enhancement or the presence of daughter nodules were not predictors for MVI. Nodular capsule enhancement in the portovenous phase and delay phase were independent predictors for MVI with odds ratios of 29.25 and 33.09, respectively. The sensitivity and specificity for incomplete/nodular capsule enhancement in the portovenous phase were 69.23% and 96.86%, respectively. The sensitivity and specificity for incomplete/nodular capsule enhancement in the delay phase were 71.79% and 96.86%, respectively. Conclusion: Nodular capsule enhancement in the portovenous phase or delay phase was a good predictor for MVI.