MR Elastography-Based Shear Strain Mapping for Assessment of Microvascular Invasion in Hepatocellular Carcinoma

Mengsi Li, Ziying Yin, Bing Hu, Ning Guo, Linqi Zhang, Lina Zhang, Jie Zhu, Wenying Chen, Meng Yin, Jun Chen, Richard L Ehman, Jin Wang, Mengsi Li, Ziying Yin, Bing Hu, Ning Guo, Linqi Zhang, Lina Zhang, Jie Zhu, Wenying Chen, Meng Yin, Jun Chen, Richard L Ehman, Jin Wang

Abstract

Objectives: To evaluate the potential of MR elastography (MRE)-based shear strain mapping to noninvasively predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC).

Methods: Fifty-nine histopathology-proven HCC patients with conventional 60-Hz MRE examinations (+/-MVI, n = 34/25) were enrolled retrospectively between December 2016 and October 2019, with one subgroup comprising 29/59 patients (+/-MVI, n = 16/13) who also underwent 40- and 30-Hz MRE examinations. Octahedral shear strain (OSS) maps were calculated, and the percentage of peritumoral interface length with low shear strain (i.e., a low-shear-strain length, pLSL, %) was recorded. For OSS-pLSL, differences between the MVI (+) and MVI (-) groups and diagnostic performance at different MRE frequencies were analyzed using the Mann-Whitney test and area under the receiver operating characteristic curve (AUC), respectively.

Results: The peritumor OSS-pLSL was significantly higher in the MVI (+) group than in the MVI (-) group at the three frequencies (all p < 0.01). The AUC of peritumor OSS-pLSL for predicting MVI was good/excellent in all frequency groups (60-Hz: 0.73 (n = 59)/0.80 (n = 29); 40-Hz: 0.84; 30-Hz: 0.90). On further analysis of the 29 cases with all frequencies, the AUCs were not significantly different. As the frequency decreased from 60-Hz, the specificity of OSS increased at 40-Hz (53.8-61.5%) and further increased at 30-Hz (53.8-76.9%), and the sensitivity remained high at lower frequencies (100.0-93.8%) (all p > 0.05).

Conclusions: MRE-based shear strain mapping is a promising technique for noninvasively predicting the presence of MVI in patients with HCC, and the most recommended frequency for OSS is 30-Hz.

Key points: • MR elastography (MRE)-based shear strain mapping has the potential to predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma preoperatively. • The low interface shear strain identified at tumor-liver boundaries was highly correlated with the presence of MVI.

Keywords: Elasticity imaging techniques; Hepatocellular carcinoma; Magnetic resonance; Tissue adhesions.

Conflict of interest statement

Conflict of Interest:

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

© 2022. The Author(s), under exclusive licence to European Society of Radiology.

Figures

Fig. 1
Fig. 1
(a) Tumor ROI and peritumoral liver parenchyma ROI overlayed on the MRE magnitude image. (b) The actual tumor–liver parenchyma contact length (green line, 62.37 mm). (c) The OSS map with high-shear-strain interface (yellow arrow) and low-shear-strain interface (white arrows). (d) The actual length of the low-shear-strain tumor–liver parenchyma interface (white line, 8.57 mm). ROI= Region of interest; MRE=Magnetic resonance elastography; OSS= Octahedral shear strain.
Fig. 2
Fig. 2
Flow chat shows inclusion and exclusion criteria for the study. MRE=Magnetic resonance elastography; HCC=Hepatocellular carcinoma; MVI=Microvascular invasion.
Fig. 3
Fig. 3
Box plot of the peritumor OSS-pLSL at different frequencies (60-Hz, n=59; 40-Hz, n=29; 30-Hz, n=29) in MVI (+) and MVI (−) groups. Note: ***: p

Fig. 4

A 53-year-old female without MVI…

Fig. 4

A 53-year-old female without MVI at pathology. The MRE magnitude image showed a…

Fig. 4
A 53-year-old female without MVI at pathology. The MRE magnitude image showed a large HCC with heterogeneous high signal. The 0% of OSS-pLSL in OSS maps at 60-Hz, 40-Hz, or 30-Hz indicates a sharp mechanical boundary between the tumor and the liver parenchyma. OSS-pLSL was evaluated only at the tumor–liver parenchyma interface. The positions of the start and end of the tumor–liver parenchyma interface were marked by the white arrows. MVI=Microvascular invasion; MRE=Magnetic resonance elastography; OSS=Octahedral shear strain; pLSL= Percentage of low-shear-strain length; HCC=Hepatocellular carcinoma; AP=Arterial phase; PVP=Portal venous phase.

Fig. 5

A 55-year-old male with MVI…

Fig. 5

A 55-year-old male with MVI at pathology. The tumor–liver parenchyma mechanical integration was…

Fig. 5
A 55-year-old male with MVI at pathology. The tumor–liver parenchyma mechanical integration was observed in OSS maps at different frequencies with 100% OSS-pLSL. OSS-pLSL was evaluated only at the tumor–liver parenchyma interface. The positions of the start and end of the tumor–liver parenchyma interface were marked by the white arrows. MVI= Microvascular invasion; OSS=Octahedral shear strain; pLSL=Percentage of low-shear-strain length; AP=Arterial phase; PVP=Portal venous phase.

Fig. 6

The ROC analysis about the…

Fig. 6

The ROC analysis about the performance of peritumor OSS-pLSL (n=29) for diagnosing MVI…

Fig. 6
The ROC analysis about the performance of peritumor OSS-pLSL (n=29) for diagnosing MVI at different frequencies. OSS=Octahedral shear strain; pLSL=Percentage of low-shear-strain length; MVI=Microvascular invasion.
Fig. 4
Fig. 4
A 53-year-old female without MVI at pathology. The MRE magnitude image showed a large HCC with heterogeneous high signal. The 0% of OSS-pLSL in OSS maps at 60-Hz, 40-Hz, or 30-Hz indicates a sharp mechanical boundary between the tumor and the liver parenchyma. OSS-pLSL was evaluated only at the tumor–liver parenchyma interface. The positions of the start and end of the tumor–liver parenchyma interface were marked by the white arrows. MVI=Microvascular invasion; MRE=Magnetic resonance elastography; OSS=Octahedral shear strain; pLSL= Percentage of low-shear-strain length; HCC=Hepatocellular carcinoma; AP=Arterial phase; PVP=Portal venous phase.
Fig. 5
Fig. 5
A 55-year-old male with MVI at pathology. The tumor–liver parenchyma mechanical integration was observed in OSS maps at different frequencies with 100% OSS-pLSL. OSS-pLSL was evaluated only at the tumor–liver parenchyma interface. The positions of the start and end of the tumor–liver parenchyma interface were marked by the white arrows. MVI= Microvascular invasion; OSS=Octahedral shear strain; pLSL=Percentage of low-shear-strain length; AP=Arterial phase; PVP=Portal venous phase.
Fig. 6
Fig. 6
The ROC analysis about the performance of peritumor OSS-pLSL (n=29) for diagnosing MVI at different frequencies. OSS=Octahedral shear strain; pLSL=Percentage of low-shear-strain length; MVI=Microvascular invasion.

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