Evaluation and Prognostication of Gd‐EOB‐DTPA MRI and CT in Patients With Macrotrabecular‐Massive Hepatocellular Carcinoma

Background Macrotrabecular‐massive hepatocellular carcinoma (MTM‐HCC) is highly aggressive. Comparing the diagnosis ability of CT and gadoxetate disodium (Gd‐EOB‐DTPA) MRI for MTM‐HCC are lacking. Purpose To compare the performance of Gd‐EOB‐DTPA MRI and CT for differentiating MTM‐HCC from non‐MTM‐HCC, and determine the prognostic indicator. Study Type Retrospective. Subjects Post‐surgery HCC patients, divided into the training (N = 272) and external validation (N = 44) cohorts. Field Strength/Sequence 3.0 T, T1‐weighted imaging, in‐opp phase, and T1‐weighted volumetric interpolated breath‐hold examination/liver acquisition with volume acceleration; enhanced CT. Assessment Three radiologists evaluated clinical characteristics (sex, age, liver disease, liver function, blood routine, alpha‐fetoprotein [AFP] and prothrombin time international normalization ratio [PT‐INR]) and imaging features (tumor length, intratumor fat, hemorrhage, arterial phase peritumoral enhancement, intratumor necrosis or ischemia, capsule, and peritumoral hepatobiliary phase [HBP] hypointensity). Compared the performance of CT and MRI for diagnosing MTM‐HCC. Follow‐up occurred every 3–6 months, and nomogram demonstrated the probability of MTM‐HCC. Statistical Tests Fisher test, t ‐test or Wilcoxon rank‐sum test, area under the curve (AUC), 95% confidence interval (CI), multivariable logistic regression, Kaplan–Meier curve, and Cox proportional hazards. Significance level: P < 0.05. Results Gd‐EOB‐DTPA MRI (AUC: 0.793; 95% CI, 0.740–0.839) outperformed CT (AUC: 0.747; 95% CI, 0.691–0.797) in the training cohort. The nomogram, incorporating AFP, PT‐INR, and MRI features (non‐intratumor fat, incomplete capsule, intratumor necrosis or ischemia, and peritumoral HBP hypointensity) demonstrated powerful performance for diagnosing MTM‐HCC with an AUC of 0.826 (95% CI, 0.631–1.000) in the external validation cohort. Median follow‐up was 347 days (interquartile range [IQR], 606 days) for the training cohort and 222 days (IQR, 441 days) for external validation cohort. Intratumor necrosis or ischemia was an independent indicator for poor prognosis. Data Conclusion Gd‐EOB‐DTPA MRI might assist in preoperative diagnosis of MTM‐HCC, and intratumor necrosis or ischemia was associated with poor prognosis. Evidence Level 4 Technical Efficacy Stage 2