Abstract
Objectives
To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis.
Methods
Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48–74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA.
Results
After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0–318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10–20 mm in 27, 20–50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54–84), even in 17/29 nodules with 10–20 mm diameter (58.6%, CI: 39–76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22–47) (p= 0.0007). MVI did not correlate with history of previous HCC.
Conclusions
HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients.
Key Points
• In HCV cirrhosis, hepatocellular carcinoma develops soon after direct-acting antiviral therapy.
• HCC presents imaging features of microvascular invasion, predictive of more aggressive progression.
• Cirrhotic patients need aggressive and close monitoring after direct-acting antiviral therapy.
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Abbreviations
- BCLC:
-
Barcelona clinic liver cancer
- CI:
-
Confidence interval
- CT:
-
Computed tomography
- DAA:
-
Direct-acting antiviral
- HBV:
-
Hepatitis B virus
- HCC:
-
Hepatocellular carcinoma
- HCV:
-
Hepatitis C virus
- MRI:
-
Magnetic resonance imaging
- MVI:
-
Microvascular invasion
- NSTM:
-
Non-smooth tumour margins
- OR:
-
Odds ratio
- PEI:
-
Percutaneous ethanol injection
- PTE:
-
Peritumoral enhancement
- RFA:
-
Radiofrequency ablation
- SVR:
-
Sustained virological response
- TACE:
-
Transarterial chemoembolisation
- TTPVI:
-
Two-trait predictor of venous invasion
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The scientific guarantor of this publication is Stefano Brillanti, M.D., Department of Medical and Surgical Sciences, University of Bologna, Italy.
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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.
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No complex statistical methods were necessary for this paper.
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Institutional Review Board approval was obtained.
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Written informed consent was obtained from all subjects (patients) in this study.
Methodology
• retrospective
• case-control study
• performed at one institution
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Renzulli, M., Buonfiglioli, F., Conti, F. et al. Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis. Eur Radiol 28, 506–513 (2018). https://doi.org/10.1007/s00330-017-5033-3
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DOI: https://doi.org/10.1007/s00330-017-5033-3