Journal of Hepatocellular Carcinoma (Sep 2023)
The Feasibility of Using Tri-Exponential Intra-Voxel Incoherent Motion DWI for Identifying the Microvascular Invasion in Hepatocellular Carcinoma
Abstract
Yunfei Zhang,1,2,* Ruofan Sheng,1,2,* Chun Yang,2 Yongming Dai,3 Mengsu Zeng1,2 1Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, People’s Republic of China; 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 3School of Biomedical Engineering, ShanghaiTech University, Shanghai, 200032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yongming Dai, School of Biomedical Engineering, ShanghaiTech University, Shanghai, 200032, People’s Republic of China, Tel +86 13917166155, Email [email protected] Mengsu Zeng, Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-021-64041990, Email [email protected]: To assess the effectiveness of tri-exponential Intra-Voxel Incoherent Motion (tri-IVIM) MRI in preoperatively identifying microvascular invasion (MVI) in hepatocellular carcinoma (HCC).Patients and Methods: In this prospective study, 67 patients with HCC were included. Metrics from bi-exponential IVIM (bi-IVIM) and tri-IVIM were calculated. Subgroup comparisons were analyzed using the independent Student’s t-test or Mann–Whitney U-test. Logistic regression was performed to explore clinical risk factors. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis.Results: MVI-positive HCCs exhibited significantly lower true diffusion coefficient (Dt) from bi-IVIM, as well as fast-diffusion coefficients (Df) and slow-diffusion coefficients (Ds) from tri-IVIM, compared to MVI-negative HCCs (p < 0.05). Tumor size and alpha-fetoprotein (AFP) were identified as risk factors. The combination of tri-IVIM-derived metrics (Ds and Df) yielded higher diagnostic accuracy (AUC = 0.808) compared to bi-IVIM (AUC = 0.741). A predictive model based on a nomogram was constructed using Ds, Df, tumor size, and AFP, resulting in the highest diagnostic accuracy (AUC = 0.859). Decision curve analysis indicated that the constructed model, provided the highest net benefit by accurately stratifying the risk of MVI, followed by tri-IVIM and bi-IVIM.Conclusion: Tri-IVIM can provide information on perfusion and diffusion for evaluating MVI in HCC. Additionally, tri-IVIM outperformed bi-IVIM in identifying MVI-positive HCC. By integrating clinical risk factors and metrics from tri-IVIM, a predictive nomogram exhibited the highest diagnostic accuracy, potentially aiding in the noninvasive and preoperative assessment of MVI.Keywords: tri-exponential intra-voxel incoherent motion, diffusion weighted imaging, hepatocellular carcinoma, microvascular invasion
