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To determine the value of preoperative Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in comparison with extracellular contrast agent MRI and CT in the selection of surgical candidates among patients with hepatocellular carcinoma (HCC), particularly in terms of oncological outcomes after hepatectomy.
This retrospective study included 542 consecutive patients who underwent radical hepatectomy for HCC. One group underwent preoperative Gd-EOB-DTPA-enhanced MRI, one group underwent contrast-enhanced CT, and one group underwent extracellular contrast agent MRI. We compared oncologic outcomes including recurrence free survival and overall survival between the three groups. Subgroup analyses were also performed to provide more specific candidates or beneficiaries for preoperative EOB-MRI.
A total of 244 patients had tumor recurrence, with 55 in the EOB-MRI group, 106 in the Routine-MRI group, and 83 in the CT group (p = 0.010). The numbers with early recurrence (<2 years) in each group were 40 (27.03%), 78 (35.78%), and 62 (35.22%), respectively (p = 0.018). The 1, 2, and 3-year recurrence-free survival (RFS) percentages were 82.4%, 73.0%, and 68.2% in the EOB-MRI group, 70.2%, 64.3%, and 56.9% in the Routine-MRI group, and 76.8%, 64.83%, and 58.9% in the CT group (p = 0.010). The 1, 2, and 3-year overall survival percentages were 89.19%, 83.11%, and 80.41% in the EOB-MRI group, 79.82%, 73.86%, and 67.44% in the Routine-MRI group, and 86.55%, 76.14%, and 69.32% in the CT group (p = 0.016). Subgroup analysis showed significant differences in RFS in patients with solitary tumor <3 cm.
Preoperative EOB-MRI is superior to contrast-enhanced CT or extracellular contrast agent MRI for selecting surgical candidates at low risk of recurrence following hepatic resection for HCC.
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