Objective: We explored the impact of our “Imaging Technology Research Methods” course on cultivation of Comprehensive Research Competence among medical imaging technology undergraduates. Methods: Medical imaging technology undergraduates working in the Department of Radiology, West China Hospital, were sorted into experimental and control groups based on their participation in the “imaging technology research methods” course. Differences in comprehensive research competence (research thinking, research ability, competency transfer, research related professional competence, and research output) were compared between the two groups. Subgroups in each group comprising students who did or did not pursue postgraduate studies after graduation were also assessed for differences in comprehensive research competence variables. Results: The control and experimental groups respectively comprised 23 and 27 participants. In whole group comparisons, the experimental group significantly outperformed the control group in comprehensive research competence (research thinking, research ability, competency transfer, professional competence-research-related dimension, and research output). Subgroup analysis revealed that among students pursuing postgraduate studies after graduation, the experimental group achieved significantly higher scores across all evaluated dimensions. Among students who did not pursue postgraduate studies, no statistically significant difference in research output was observed between the two subgroups. Conclusion: The “Imaging Technology Research Methods” course serves as a core pathway that fosters research competency among undergraduates, particularly for those pursuing postgraduate education.

Background:Although simultaneous multislice (SMS) acceleration shortens abdominal diffusion-weighted imaging (DWI) scans, its effect on quantitative hepatocellular carcinoma (HCC) measurements is unclear. This study aimed to evaluate SMS acceleration effects on DWI-derived quantitative measurements in HCC and the upper abdominal solid organs. Methods:This prospective cross-sectional study initially enrolled 205 patients with clinically suspected HCC. Free-breathing conventional (CON) and SMS-accelerated monoexponential DWI, diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) were performed. Two radiologists independently measured the apparent diffusion coefficient (ADC) for monoexponential DWI, mean kurtosis, and mean diffusivity for DKI, as well as the pure diffusion coefficient and perfusion fraction (f) for IVIM, in HCC and the upper abdominal solid organs. Paired t-tests or Wilcoxon signed-rank tests were used to compare the quantitative diffusion parameters between CON and SMS-accelerated sequences. Results:A total of 113 patients comprising 129 HCCs were included in the study. The ADC values from SMS-DWI were significantly lower than those from CON-DWI in HCC (P=0.003). Moreover, the f values from SMS-IVIM were significantly lower than those from CON-IVIM in HCC (P<0.001), liver parenchyma (P=0.005), right kidney (P=0.002), and left kidney (P=0.005). Other quantitative diffusion parameters did not differ significantly between CON and SMS-accelerated sequences (all P values >0.008). Conclusions:Compared with CON sequences, SMS acceleration did not affect most quantitative parameters in HCC or the upper abdominal organs. However, the monoexponential DWI-derived ADC value and IVIM-derived f value on SMS-accelerated sequences should be interpreted with caution.

ObjectivesTo explore whether T1 mapping parameters and the functional liver imaging score (FLIS) based on Gd-EOB-DTPA MRI could evaluate liver regeneration after hepatectomy for HCC patient.MethodsThis retrospective study finally included 60 HCC patients (48 men and 12 women, with a median age of 53 years). T1 relaxation time of liver before gadoxetic acid injection (T1pre) and during the hepatobiliary phase (T1HBP), reduction rate (Δ%) and FLIS were calculated, their correlations with liver fibrosis stage, hepatic steatosis, and liver regeneration, quantified as regeneration index (RI), were assessed by Kendall’s tau-b correlation test or Spearman’s correlation test. Multivariate linear regression analyses were used to explore the indicator of RI.ResultsT1pre, T1HBP, Δ%, and FLIS manifested significant correlation with fibrosis stage (r = 0.434, P =0.001; r = 0.546, P < 0.001; r = -0.356, P =0.005; r = -0.653, P <0.001, respectively). T1pre showed significant correction with steatosis grade (r = 0.415, P =0.001). Fibrosis stage and steatosis grade were associated with RI (r = -0.436, P<0.001; r = -0.338, P =0.008). Accordingly, T1pre, T1HBP and FLIS were the significant predictors (P<0.05) of RI in multivariate analysis. Similarly, in the patients undergoing minor hepatectomy (n=35), T1HBP, Δ% and FLIS were related to RI (P<0.05) in multivariate analysis. Nevertheless, in the patients undergoing major hepatectomy (n=25), no T1 mapping parameter and FLIS was the independent predictor of RI.ConclusionsT1 mapping parameters and FLIS were the potential noninvasive indicators of liver regeneration, except for HCC patients undergoing major hepatectomy.Clinical relevance statementThe value of T1 mapping and FLIS with Gd-EOB-DTPA MRI for accurate preoperative evaluation of liver regeneration is critical to prevent liver failure and improve prognosis of HCC patients.

Objective: The aim of this study was to assess the potential role of fractal analysis derived from Gd-EOB-DTPA-enhanced MRI in predicting vessels that encapsulate tumor clusters (VETC) in patients with hepatocellular carcinoma (HCC). Methods: This retrospective study included 505 patients with HCC who underwent Gd-EOB-DTPA-enhanced MRI before surgical resection at two medical centers (training set: 253 patients, internal test set: 108 patients, external test set: 144 patients). The fractal dimension (FD) and lacunarity were extracted from the hepatobiliary phase of the tumor using box-counting algorithms. Additionally, conventional imaging features were evaluated. Univariate and multivariate logistic regression analyses were conducted in the training set to identify independent predictors for VETC, and a nomogram was created to visualize the final predictive model. The performance of these models was tested in the internal and external test sets. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method along with the log-rank test. Results: VETC-positive HCC exhibited higher FD and lacunarity than VETC-negative HCC (p <0 .001). The FD-lacunarity model achieved an area under receiver operating characteristics curve (AUC) of 0.78 (95% confidence interval [CI]: 0.70-0.87) in the internal test set and 0.79 (95%CI:0.70-0.86) in the external test set. Multivariate logistic regression analysis identified serum alpha-fetoprotein, tumor size, intratumor artery, FD, and lacunarity as independent predictors for VETC, which were used for constructing the hybrid model. A clinical model was established using AFP, tumor size, and intratumor artery alone. The diagnostic performance of the hybrid model was significantly surpassed that of the clinical-radiological model when fractal parameters were incorporated, with AUCs increasing from 0.72 to 0.80 in the internal test set and from 0.65 to 0.84 in the external test set (all p < 0.05). Patients predicted by the hybrid model to have VETC-positive HCC exhibited significantly shorter RFS and OS compared to those predicted to have VETC-negative HCC (p < 0.05). Conclusion: Fractal analysis based on Gd-EOB-DTPA-enhanced MRI enabled the quantitative characterization of VETC status by fractal dimension and lacunarity. The hybrid model may assist in estimating VETC and stratifying prognosis in patients with HCC.

This study aimed to evaluate the value of simultaneous multislice diffusion kurtosis imaging (SMS-DKI) for predicting early recurrence (within 2 years) in hepatocellular carcinoma (HCC) and to develop a predictive model. This prospective study included 67 HCC patients who underwent SMS-DKI on a 3-T MRI between June 2021 and January 2023. Diffusion parameters, including the apparent diffusion coefficient (ADC), SMS-mean kurtosis (SMS-MK), and SMS-mean diffusivity (SMS-MD), along with radiological features, were analyzed. Logistic regression models were used to predict early recurrence, internally validated using 10-fold cross-validation, and assessed using AUC, calibration curves, and decision curve analysis (DCA). Among 67 patients (58 males; mean age, 53.5 ± 9.9 years), 30 (44.8

This study aimed to assess the potential role of 3-dimensional (3D) fractal dimension (FD) derived from contrast-enhanced CT images in predicting microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC). This retrospective study included 655 patients with surgically confirmed HCC from two medical centers (training set: 406 patients; internal test set: 170 patients; external test set: 79 patients). Box-counting algorithms were used to compute 3D FD values from portal venous phase images. Univariable and multivariable logistic regression analyses identified independent predictors. The model’s area under the curve (AUC) was calculated. Recurrence-free survival (RFS) and overall survival (OS) were evaluated using the Kaplan–Meier method. Patients with MVI-positive HCC demonstrated significantly higher FD values compared to those with MVI-negative HCC (p < 0.01). The FD achieved AUCs of 0.786 (95

OBJECTIVES:This study aimed to evaluate the diagnostic performance of simultaneous multislice (SMS) acquisition combined with monoexponential, intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) models for predicting microvascular invasion (MVI) and histologic grade in hepatocellular carcinoma (HCC). MATERIALS AND METHODS:A prospective study was conducted with 77 HCC patients. Diffusion-weighted imaging (DWI), IVIM, and DKI were performed on a 3T MRI using both SMS and conventional sequences. The values of diffusion parameters (ADC, D, D*, f, MD, and MK) were compared among SMS and conventional sequences, between MVI-positive and MVI-negative groups, and between high-grade and low-grade HCC groups. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of diffusion parameters in predicting MVI and histologic grade. Inter-reader consistency was evaluated using intraclass correlation coefficients (ICC). RESULTS:Among the 77 patients, 29.9% were MVI-positive and 35.1% had high-grade HCC. SMS reduced scanning time by up to 44.44%. Most diffusion parameters were similar between SMS and conventional sequences, except for slightly lower ADC and f in SMS. MVI-positive and high-grade HCC cases showed lower ADC, D, D*, and MD values and higher MK values. The ICC ranged from 0.702 to 0.879. SMS-MK demonstrated the highest diagnostic performance with an AUC of 0.92 for MVI and 0.86 for histologic grade. CONCLUSIONS:SMS acquisition, integrated with IVIM and DKI, is a feasible imaging method for preoperative evaluation of MVI and histologic grade in HCC, offering a faster alternative to conventional methods without compromising diagnostic performance.

BACKGROUND:In clinical practice, hepatocellular carcinoma (HCC) is widely diagnosed by using MRI, however, whether the imaging features are affected by hepatic steatosis (HS) is still unknown. PURPOSE:To investigate and compare the differences in HCC related imaging features between with- and without-HS groups, and to further determine whether HS affects the diagnosis accuracy of Liver Imaging Reporting and Data System (LI-RADS) v2018 of HCC in MRI. STUDY TYPE:Prospective. SUBJECTS:One hundred and seventy-one patients (mean age, 52 ± 11 years; range, 26-83 years) including 137 men and 34 women. FIELD STRENGTH/SEQUENCE:3.0 T, gradient echo (GRE). ASSESSMENT:Subjects were classified as HS and non-HS groups according to MRI-proton density fat-fraction (PDFF). HS was defined as MRI-PDFF >5.6%. Three radiologists accessed HCC features and assigned LI-RADS categories in MRI independently based on LI-RADS v2018. Frequencies of HCC major features and LR categorization assignment between the two groups as well as interobserver agreement between the two radiologists were assessed. STATISTICAL TESTS:Unpaired t-test, Chi-square test, Fisher's exact test, kappa statistic, intraclass correlation coefficient (ICC). A two-sided P value <0.05 was considered as statistically significant. RESULTS:Major features including arterial hyperenhancement (APHE), enhancing "capsule" and nonperipheral "washout" observed between HS and non-HS groups were not significantly different (78.95% vs.78.62%, P = 0.866; 57.89% vs.52.98%, P = 0.483; and 75% vs.81.46%, P = 0.257, respectively), and the assessment of observation size showed a borderline difference (P = 0.059). No significant difference in LR-5 assignment between the two groups (69.74% vs. 72.85% for reader 1, P = 0.641; 71.05% vs. 72.19% for reader 2, P = 0.877). Interobserver agreement between the two radiologists showed almost perfect in LR-5 assignment (κ = 0.869) and size observation (ICC = 0.997). DATA CONCLUSION:The diagnosis of HCC based on LI-RADS v2018 in MRI is of comparable performance regardless of HS, in which there is no significant difference in either the major imaging features or LR categorization. LEVEL OF EVIDENCE:2 Technical Efficacy Stage: 2.

Background: Simultaneous multislice (SMS) technology improves acquisition efficiency of diffusion- weighted imaging (DWI). This study aimed to evaluate the performance of SMS-DWI in image quality and apparent diffusion coefficient (ADC) measurements for focal liver lesions (FLLs) as compared with that of conventional DWI (CON-DWI). Methods: The institutional ethics committee of West China Hospital, Sichuan University approved this single-center, prospective study conducted from February 2021 to March 2022. Free-breathing SMS-DWI and CON-DWI examinations were acquired on a 3-T scanner with b-values of 50, 400, and 800 s/mm(2). Qualitative image quality and quantitative measurements of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC were compared between SMS-DWI and CON-DWI. The ADC values for FLLs were further compared between SMS-DWI and CON-DWI in different patient subgroups. The intra- and interreader agreements were assessed. Significance was set at P<0.05. Results: This study included 116 patients (96 males, 20 females; mean age 52.0 +/- 10.7 years) with 119 FLLs. No significant differences were observed between SMS-DWI and CON-DWI regarding overall image quality in any b-value DWIs, and there were also no differences observed between SMS-DWI and CON- DWI (b=800 s/mm(2)) for either SNR or CNR (both P values >0.05). ADC values obtained from CON-DWI were higher than those from SMS-DWI in all FLLs [(1.31 +/- 0.47)x10(-3) vs. (1.26 +/- 0.46)x10(-3) mm(2)/s; P=0.004], and similar findings were observed across the different patient subgroups. The consistency analysis showed intrareader intraclass correlation coefficient (ICC) values of 0.792-0.944 and interreader ICC values of 0.758-0.861 for quantitative measurements (SNR, CNR, and ADC) and kappa values of 0.609-0.878 for qualitative image quality. Conclusions: SMS-DWI achieved a 37% reduction in scan time compared to CON-DWI while maintaining comparable overall image quality. Notably, the ADC values for FLLs were observed to be quantitatively lower with SMS-DWI.

Background Simultaneous multi‐slice diffusion‐weighted imaging (SMS‐DWI) can shorten acquisition time in abdominal imaging. Purpose To investigate the agreement and reproducibility of apparent diffusion coefficient (ADC) from abdominal SMS‐DWI acquired with different vendors and different breathing schemes. Study Type Prospective. Subjects Twenty volunteers and 10 patients. Field Strength/Sequence 3.0 T, SMS‐DWI with a diffusion‐weighted echo‐planar imaging sequence. Assessment SMS‐DWI was acquired using breath‐hold and free‐breathing techniques in scanners from two vendors, yielding four scans in each participant. Average ADC values were measured in the liver, pancreas, spleen, and both kidneys. Non‐normalized ADC and ADCs normalized to the spleen were compared between vendors and breathing schemes. Statistical Tests Paired t ‐test or Wilcoxon signed rank test; intraclass correlation coefficient (ICC); Bland–Altman method; coefficient of variation (CV) analysis; significance level: P < 0.05. Results Non‐normalized ADCs from the four SMS‐DWI scans did not differ significantly in the spleen ( P = 0.262, 0.330, 0.166, 0.122), right kidney ( P = 0.167, 0.538, 0.957, 0.086), and left kidney ( P = 0.182, 0.281, 0.504, 0.405), but there were significant differences in the liver and pancreas. For normalized ADCs, there were no significant differences in the liver ( P = 0.315, 0.915, 0.198, 0.799), spleen ( P = 0.815, 0.689, 0.347, 0.423), pancreas ( P = 0.165, 0.336, 0.304, 0.584), right kidney ( P = 0.165, 0.336, 0.304, 0.584), and left kidney ( P = 0.496, 0.304, 0.443, 0.371). Inter‐reader agreements of non‐normalized ADCs were good to excellent (ICCs ranged from 0.861 to 0.983), and agreement and reproducibility were good to excellent depending on anatomic location (CVs ranged from 3.55% to 13.98%). Overall CVs for abdominal ADCs from the four scans were 6.25%, 7.62%, 7.08, and 7.60%. Data Conclusion The normalized ADCs from abdominal SMS‐DWI may be comparable between different vendors and breathing schemes, showing good agreement and reproducibility. ADC changes above approximately 8% may potentially be considered as a reliable quantitative biomarker to assess disease or treatment‐related changes. Level of Evidence 2 Technical Efficacy Stage 2

To explore whether intravoxel incoherent motion (IVIM) parameters could evaluate liver regeneration preoperatively. A total of 175 HCC patients were initially recruited. The apparent diffusion coefficient, true diffusion coefficient (D), pseudodiffusion coefficient (D*), pseudodiffusion fraction (f), diffusion distribution coefficient, and diffusion heterogeneity index (Alpha) were measured by two independent radiologists. Spearman’s correlation test was used to assess correlations between IVIM parameters and the regeneration index (RI), calculated as 100

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in detection and diagnosis for hepatocellular carcinoma (HCC), while transient severe motion artifact that affects the arterial phase (AP) images quality and reduces diagnosis performance remains a concern. A new diagnosis criterion for HCC integrating CTAP and MRAP images was introduced in this study and achieved a high sensitivity and comparable specificity when compared with the gadoxetic acid-enhanced MRI only. It may be able to improve the diagnostic performance of gadoxetic acid-enhanced MRI in patients with HCCs and further affect the clinical treatment plan.

Objective:To evaluate the clinical safety and diagnostic efficacy of domestic gadoxetate disodium (GdEOBDTPA).Methods:The imaging data from patients with space-occupying liver lesions who underwent GdEOBDTPA enhanced magnetic resonance examination at West China Hospital of Sichuan University between January 2020 and September 2020 were analyzed retrospectively. Clinical indicators were evaluated by the incidental condition of transient severe respiratory motion artifacts (TSM) in the arterial phase to assess the safety profile.The differences in quantitative and qualitative indicators for the risk factors of TSM in the arterial phase between the TSM group and the non-TSM group were compared by t-test and χ2 test. Observational indicators of the accuracy of diagnostic procedures: The 2018 version of the Liver Imaging Reporting and Data System (LI-RADS) was used to evaluate the main signs, auxiliary signs, and LR grades of lesions. Postoperative pathological findings were used as the gold standard for evaluating and diagnosing hepatocellular carcinoma (HCC). Simultaneously, the relative enhancement degree of the liver, the contrast between the lesion and the liver, and the cholangiography in the hepatobiliary phase were evaluated. The McNemar test was used to compare the differences in the diagnostic efficiency of physician 1 and physician 2 in the diagnosis of hepatocellular carcinoma according to the 2018 version of LI-RADS.Results:A total of 114 cases were included in this study. The incidence rate of TSM was 9.6% (11/114). Age [(53.8 ± 11.3) years vs. (55.4 ± 15.4) years, t = 0.465, P = 0.497], body weight [(65.8 ± 11.1) kg vs. (60.8 ± 7.6) kg, t = 1.468, P = 0.228], body mass index [(23.9 ± 3.1) kg/m 2 vs. (23.4 ± 3.0) kg/m 2, t = 0.171, P = 0.680], liver cirrhosis ratio (39 cases vs. 4 cases, χ2 =1.776, P = 0.183), proportion of mild to moderate pleural effusion (32 cases vs. 4 cases, χ2 = 0.000, P = 0.986), and proportion of mild to moderate ascites (47 cases vs. 5 cases χ2 = 0.000, P = 0.991) had no statistically significant difference between the groups of non-TSM and TSM patients. According to the 2018 version of LI-RADS for the LR5 category, there was no statistically significant difference between the two physicians’ HCC diagnoses in terms of sensitivity (91.4% vs.86.4%, χ2 = 1.500, P = 0.219), specificity (72.7 % vs. 69.7%, χ2 = 0.000, P = 1.000), positive predictive value (89.2% vs. 87.5%, χ2 = 2.250, P = 0.125), negative predictive value (77.4% vs. 67.6%, χ2 = 2.250, P = 0.125), and accuracy (86.0% vs. 81.6%, χ2 = 0.131, P = 0.125). According to physicians 1 and 2 film review results, 91.2% (104/114) and 89.5% (102/114) of the contrast agent were discharged into the common bile duct or duodenum, respectively. In addition, 86.0% (98/114) of the patients had good liver enhancement, and 91.2% (104/114) of the lesions showed low signals relative to the liver background. Conclusion:Domestic gadoxetate disodium has a good clinical safety profile and diagnostic efficacy.

Diffusion weighted imaging (DWI) serves as one of the most important functional magnetic resonance imaging techniques in abdominal and pelvic imaging. It is designed to reflect the diffusion of water molecules and is particularly sensitive to the malignancies. Yet, the limitations of image distortion and artifacts in single-shot DWI may hamper its widespread use in clinical practice. With recent technical advances in DWI, such as simultaneous multi-slice excitation, computed or reduced field-of-view techniques, as well as advanced shimming methods, it is possible to achieve shorter acquisition time, better image quality, and higher robustness in abdominopelvic DWI. This review discussed the recent advances of each DWI approach, and highlighted its future perspectives in abdominal and pelvic imaging, hoping to familiarize physicians and radiologists with the technical improvements in this field and provide future research directions.

To investigate whether simultaneous multi-slice (SMS) acceleration and gadoxetic acid administration affect the quantitative apparent diffusion coefficient (ADC) and signal-to-noise ratio (SNR) measurement of DWI in patients with HCC. This prospective study initially enrolled 208 patients with clinically suspected HCC. Free breathing SMS-DWI and conventional DWI (CON-DWI) were performed before and after gadoxetic acid administration. Lesion conspicuity, ADCs and SNRs of the HCC lesion and normal liver parenchyma were independently measured by two radiologists. The paired t test or Wilcoxon signed rank test was used to evaluate the differences of lesion conspicuity, ADCs and SNRs between SMS-DWI and CON-DWI, as well as those before and after gadoxetic acid administration. A total of 102 HCC patients (90 men and 12 women; mean age, 54.6 ± 11.7 years) were finally included for analysis. SMS-DWI and CON-DWI demonstrated comparable lesion conspicuity (P = 0.081–0.566). For the influence of SMS acceleration, the SNRs of liver parenchyma on enhanced SMS-DWI were significantly higher than enhanced CON-DWI (P = 0.015). For the influence of gadoxetic acid administration, the mean ADCs were significantly higher on enhanced SMS-DWI than unenhanced SMS-DWI (HCC, P = 0.013; liver parenchyma, P = 0.032). Quantitative ADC measurements of HCC and liver parenchyma were not affected by SMS acceleration, and SMS-DWI can provide higher SNR than CON-DWI. However, the ADC measurements can be affected by gadoxetic acid administration on SMS-DWI, so it is recommended to perform SMS-DWI before gadoxetic acid administration.

Background The prognosis of hepatocellular carcinoma (HCC) is still poor largely due to the high incidence of recurrence. We aimed to develop and validate predictive models of early postoperative recurrence for HCC using clinical and gadoxetic acid-enhanced magnetic resonance (MR) imaging-based findings. Methods In this retrospective case-control study, 209 HCC patients, who underwent gadoxetic acid-enhanced MR imaging before curative-intent resection, were enrolled. Boruta algorithm and backward stepwise selection with Akaike information criterion (AIC) were used for variables selection Random forest, Gradient-Boosted decision tree and logistic regression model analysis were used for model development. The area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis were used to evaluate model’s performance. Results One random forest model with Boruta algorithm (RF-Boruta) was developed consisting of preoperative serum ALT and AFP levels and six MRI findings, while preoperative serum AST and AFP levels and four MRI findings were included in one logistic regression model with backward stepwise selection method (Logistic-AIC).The two predictive models demonstrated good discrimination performance in both the training set (RF-Boruta: AUC, 0.820; Logistic-AIC: AUC, 0.853), internal validation set (RF-Boruta: AUC, 0.857, Logistic-AIC: AUC, 0.812) and external validation set(RF-Boruta: AUC, 0.805, Logistic-AIC: AUC, 0.789). Besides, in both the internal validation and external validation sets, the RF-Boruta model outperformed Barcelona Clinic Liver Cancer (BCLC) stage ( p < 0.05). Conclusions The RF-Boruta and Logistic-AIC models with good prediction performance for early postoperative recurrence may lead to optimal and comprehensive treatment approaches, and further improve the prognosis of HCC after resection.

Background The diagnostic performance for hepatocellular carcinoma (HCC) is hampered using gadoxetic acid-enhanced magnetic resonance (MR) imaging due to the high incidence of transient severe motion in arterial phase (AP). Dynamic contrast enhanced computed tomography (CT) imaging yield high detection rate for hepatic nodules in AP, and the combined use of CT arterial phase (CTAP) imaging with gadoxetic acid-enhanced MR imaging may improve the diagnostic performance for HCC. Thus, this study aimed to determine whether the combined use of CTAP and gadoxetic acid-enhanced MR imaging can improve the diagnostic performance for HCC based on various imaging diagnostic criteria. Methods A total of 169 surgically histologically confirmed hepatic nodules (137 HCCs and 32 non-HCC-nodules) were retrospectively enrolled. Two different imaging protocol sets were reviewed: (I) full gadoxetic acid-enhanced magnetic resonance imaging (MRI) sequences; and (II) CTAP imaging combined with the gadoxetic acid-enhanced MRI but excluding the MR imaging AP images. Three independent reviewers followed the 2018 Liver Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), and 2018 Korean guidelines to characterize these heaptic nodules by reviewing the two imaging protocol sets and the diagnostic peformance were compared by using McNemar test. Results The detection rate of AP hyperenhancement (APHE) was higher in CTAP than in the MR arterial phase (MRAP) for hepatic nodules (87.57% vs. 75.15%) and HCCs (97.08% vs. 82.48%) (all P<0.001). For the LI-RADS criteria, the Protocol-II increased the sensitivity to 75.91% from 70.80% of Protocol-I (P=0.016), with a minimal decrease of the specificity to 71.88% from 75.00% (P=1.000). For the EASL criteria, the numerical increases were found of Protocol-II than Protocol-I in both sensitivity (81.02% vs. 78.10%) and specificity (75.00% vs.71.88%), but with no statistical significance. For the Korean criteria, the Protocol-II increased the sensitivity to 94.89% from 83.21% of Protocol-I (P<0.001). The specificity increased to 65.63% from 62.50%, with no statistical significance (P=1.000). Conclusions Using CTAP instead of gadoxetic acid-enhanced MRAP can improve the diagnostic sensitivity for HCC and also yields a comparable specificity. Thus, the combined use of CTAP and gadoxetic acid-enhanced MR imaging may improve the diagnostic performance for HCC.

To establish a risk score integrating preoperative gadoxetic acid–enhanced magnetic resonance imaging (EOB-MRI) and clinical parameters to predict recurrence after hepatectomy for patients with hepatocellular carcinoma (HCC) and to compare its performance with that of a postoperative score and four clinical staging systems. Consecutive patients with surgically confirmed HCC who underwent preoperative EOB-MRI between July 2015 and November 2020 were retrospectively included. Two recurrence risk scores, one incorporating only preoperative variables and the other incorporating all preoperative and postoperative variables, were constructed via Cox regression models. A total of 214 patients (derivation set, n = 150; test set, n = 64) were included. Six preoperative variables, namely tumor number, infiltrative appearance, corona enhancement, alpha-fetoprotein (AFP) level, aspartate aminotransferase (AST) level, and sex, were independently associated with recurrence. After adding postoperative features, microvascular invasion and tumor differentiation were additional significant variables in lieu of corona enhancement and AFP level. Using the above variables, the preoperative score achieved a C-index of 0.741 on the test set, which was comparable with that of the postoperative score (0.729; p = 0.235). The preoperative score yielded a larger time-dependent area under the receiver operating characteristic curve at 1 year (0.844) than three existing systems (0.734–0.742; p < 0.05 for all). Furthermore, the preoperative score stratified patients into two prognostically distinct risk strata with low and high risks of recurrence (p < 0.001). The preoperative score integrating EOB-MRI features, AFP and AST levels, and sex improves recurrence risk estimation in HCC. • The preoperative risk score incorporating three EOB-MRI findings, AFP and AST levels, and sex achieved comparable performance with that of the postoperative score for predicting recurrence after hepatectomy in patients with HCC. • Two risk strata with low and high risks of recurrence were obtained based on the preoperative score. • The preoperative score may help tailor pretreatment decision-making and facilitate candidate selection for adjuvant clinical trials.

With the development of heteronuclear fluorine, sodium, phosphorus, and other probes and imaging technologies as well as the optimization of magnetic resonance imaging (MRI) equipment and sequences, multi-nuclear magnetic resonance (multi-NMR) has enabled localize molecular activities in vivo that are central to a variety of diseases, including cardiovascular disease, neurodegenerative pathologies, metabolic diseases, kidney, and tumor, to shift from the traditional morphological imaging to the molecular imaging, precision diagnosis, and treatment mode. However, due to the low natural abundance and low gyromagnetic ratios, the clinical application of multi-NMR has been hampered. Several techniques have been developed to amplify the NMR sensitivity such as the dynamic nuclear polarization, spin-exchange optical pumping, and brute-force polarization. Meanwhile, a wide range of nuclei can be hyperpolarized, such as 2H, 3He, 13C, 15 N, 31P, and 129Xe. The signal can be increased and allows real-time observation of biological perfusion, metabolite transport, and metabolic reactions in vivo, overcoming the disadvantages of conventional magnetic resonance of low sensitivity. HP-NMR imaging of different nuclear substrates provides a unique opportunity and invention to map the metabolic changes in various organs without invasive procedures. This review aims to focus on the recent applications of multi-NMR technology not only in a range of preliminary animal experiments but also in various disease spectrum in human. Furthermore, we will discuss the future challenges and opportunities of this multi-NMR from a clinical perspective, in the hope of truly bridging the gap between cutting-edge molecular biology and clinical applications.

ObjectiveEarly detection and diagnosis of hepatocellular carcinoma (HCC) is essential for prognosis; however, the imaging hallmarks for tumor detection and diagnosis has remained the same for years despite the use of many new immerging imaging methods. This study aimed to evaluate the detection performance of hepatic nodules in high risk patients using either hepatobiliary specific contrast (HBSC) agent or extracellular contrast agent (ECA), and further to compare the diagnostic performances for hepatocellular carcinoma (HCC) using different diagnostic criteria with the histopathological results as reference standard.MethodsThis prospective study included 247 nodules in 222 patients (mean age, 53.32 ± 10.84 years; range, 22–79 years). The detection performance and imaging features of each nodule were evaluated in all MR sequences by three experienced abdominal radiologists. The detection performance of each nodule on all MR sequences were compared and further the diagnostic performance of various diagnostic criteria were evaluated.ResultsFor those patients who underwent ECA-MRI, the conventional imaging hallmark of “AP + PVP and/or DP” was recommended, as 60.19% diagnostic sensitivity, 80.95% specificity and 100% lesion detection rate. Additionally, for those patients who underwent HBSC-MRI, the diagnostic criteria of “DWI + HBP” was recommended. This diagnostic criteria demonstrated, both in all tumor size and for nodules ≤2 cm, higher sensitivity (93.07 and 90.16%, all p <0.05, respectively) and slightly lower specificity (64.71 and 87.50%, all p >0.05, respectively) than that of the European Association for the Study of the Liver (EASL) criteria.ConclusionsDifferent abbreviated MR protocols were recommended for patients using either ECA or HBSC. These provided imaging settings demonstrated high lesion detection rate and diagnostic performance for HCC.