MRI features of hepatocellular carcinoma expressing progenitor cell markers

Abstract Background & Aims To determine whether magnetic resonance ( MR ) imaging features differ between hepatocellular carcinomas ( HCC s) with and without expression of progenitor cell markers, such as cytokeratin ( CK ) 19 and epithelial cell adhesion molecule ( EpCAM ). Methods Sixty‐three patients with 71 HCC s who underwent surgery after preoperative gadoxetic acid‐enhanced MR imaging were evaluated. HCC s expressing progenitor cell markers were defined as showing CK 19 or EpCAM expression. MR imaging features, including the fat component, arterial enhancement (global vs. peripheral), dynamic enhancement (washout vs. progressive or persistent), nodule‐in‐nodule appearance and MR gross morphology (expanding vs. non‐expanding), were compared between HCC s with and without progenitor cell markers expression. Lesion‐to‐liver signal intensity ratio ( SIR ) and apparent diffusion coefficient values were compared using an independent samples t ‐test. Early recurrence rates were also compared. Results HCC s expressing progenitor cell markers were more commonly of the non‐expanding type ( P = 0.016), more frequently had a progressive or persistent dynamic enhancement pattern ( P = 0.008) and less frequently demonstrated a nodule‐in‐nodule appearance ( P = 0.009). HCC s expressing progenitor cell markers had significantly higher SIR s on diffusion‐weighted images ( DWI s) ( b = 50 and 800, P < 0.001; b = 400, P = 0.001) and a significantly lower SIR on hepatobiliary phase images ( P = 0.024). The early recurrence rate was significantly higher in patients with prior HCC s that expressed progenitor cell markers ( P = 0.045). Conclusions HCC s expressing progenitor cell markers can be characterized according to their non‐expanding MR gross morphology, persistent or progressive dynamic enhancement patterns, higher SIR s on DWI s, lower SIR s on hepatobiliary phase images and less frequent nodule‐in‐nodule appearance.