Hepatocellular Carcinoma: In Vivo Evaluation of Water Percentage as a Prognostic Biomarker Using Magnetic Resonance Imaging 3D-VIBE Multiecho Dixon.

INTRODUCTION: It is urgent to find an effective method to diagnose and prognose early hepatocellular carcinoma (HCC). The purpose of this study was to investigate the correlation between HCC histological degree and water percentage (WP) obtained from magnetic resonance imaging 3D-VIBE multiecho Dixon, and to evaluate the feasibility of WP in the postoperative prediction of early HCC recurrence.

METHODS AND MATERIALS: From June 2016 to July 2017, 76 patients with diagnostic HCC all underwent 3D-VIBE Multiecho Dixon and ultrahigh b value diffusion-weighted imaging (DWI) examination. Freehand regions of interests were placed to measure the WP and apparent diffusion coefficient (ADC) value. The Edmondson-Steiner (E-S) grades proved by histopathological results were acquired from all patients. Comparisons between mean WP and ADC with E-S grades I-IV were performed using Kruskal-Wallis test and one-way ANOVA. Least Significant Difference t-test (LSD-t test) was applied to compare particular pairs of mean ADC value between every two E-S groups. Correlations between WP, ADC, and E-S grades were assessed by Spearman's rank correlation test. The Mann-Whitney U test was utilized to compare the difference of mean WP between recurrence and nonrecurrence group. The receiver operating characteristic (ROC) curves were calculated to estimate the diagnostic effect of 3D-VIBE Multiecho Dixon and ultrahigh b value DWI to HCC. Kaplan-Meier method was used to evaluate the recurrence free survival (RFS) after surgical resection.

RESULTS: Mean WP values among groups E-S I to IV were 91.8%, 95.2%, 96.4%, and 97.7%, respectively. A positive correlation was exhibited between the WP and histopathological E-S grades (r = 0.480, p < 0.01). The ADC values based on E-S grades were 0.93, 0.82, 0.74, and 0.62 × 10-3 mm2 /s, respectively. Significant differences were found between every two E-S groups (p < 0.01), and a negative correlation between ADC and E-S grades (r = -0.784, p = 0.000) was observed. Mean value of WP was 97.2% in recurrence group and 94.6% in nonrecurrence group (p < 0.01). The optimal cutoff value was 95.7%. The maximal area under the ROC curve was 0.747 ± 0.06 for WP, 0.631 ± 0.07 for ADC, and 0.753 ± 0.06 for the combination of WP and ADC. Mean RFS was 18.1 months in the lower WP and 10.7 months in higher WP group (p < 0.01).

CONCLUSIONS: WP can be used as a potential biomarker for the diagnosis and prognosis of HCC. A lower value of WP may imply a better outcome in patients after surgical resection.