Clinical association between intraoperative indocyanine green fluorescence imaging pattern, preoperative Gd-EOB-DTPA-enhanced magnetic resonance imaging findings, and histological differentiation in hepatocellular carcinoma

Takahiro Tomino; Shinji Itoh; Nobuhiro Fujita; Daisuke Okamoto; Yuki Nakayama; Katsuya Toshida; Takahiro Tomiyama; Yuriko Tsutsui; Yukiko Kosai; Takeshi Kurihara; Yoshihiro Nagao; Kazutoyo Morita; Noboru Harada; Yasuhiro Ushijima; Kenichi Kohashi; Kousei Ishigami; Yoshinao Oda; Tomoharu Yoshizumi

doi:10.1111/hepr.13902

Clinical association between intraoperative indocyanine green fluorescence imaging pattern, preoperative Gd-EOB-DTPA-enhanced magnetic resonance imaging findings, and histological differentiation in hepatocellular carcinoma

Hepatol Res. 2023 Aug;53(8):723-736. doi: 10.1111/hepr.13902. Epub 2023 Apr 13.

Authors

Takahiro Tomino¹, Shinji Itoh¹, Nobuhiro Fujita², Daisuke Okamoto², Yuki Nakayama¹, Katsuya Toshida¹, Takahiro Tomiyama¹, Yuriko Tsutsui¹, Yukiko Kosai¹, Takeshi Kurihara¹, Yoshihiro Nagao¹, Kazutoyo Morita¹, Noboru Harada¹, Yasuhiro Ushijima², Kenichi Kohashi³, Kousei Ishigami², Yoshinao Oda³, Tomoharu Yoshizumi¹

Affiliations

¹ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³ Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 36998205
DOI: 10.1111/hepr.13902

Abstract

Aim: We aimed to evaluate the association between the intraoperative indocyanine green (ICG) fluorescence imaging (FI) pattern, preoperative magnetic resonance imaging (MRI) findings using gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), preoperative diffusion-weighted imaging (DWI) of MRI, and histological differentiation of hepatocellular carcinoma (HCC).

Methods: We retrospectively reviewed the data for 80 tumors of 64 patients. Intraoperative ICG FI patterns were classified into cancerous or rim-positive type. We evaluated the signal intensity ratio of the tumor and the surrounding liver tissue in the portal phase (SIRPP) and intensity in the hepatobiliary phase (HBP) of Gd-EOB-DTPA-enhanced MRI, the apparent diffusion coefficient (ADC) in the DWI of MRI, and clinicopathologic factors.

Results: In the rim-positive group, the rate of poorly differentiated HCC and hypointensity type in HBP were significantly higher, and SIRPP and ADC were significantly lower than the rim-negative group. In the cancerous group, the rate of well or moderately differentiated HCC and hyperintensity type in HBP, SIRPP, and ADC were significantly higher than the noncancerous group. Multivariate analysis identified low SIRPP, low ADC, and hypointensity type in HBP as the significant predictive factors for rim-positive HCC and high SIRPP, high ADC, and hyperintensity type in HBP as the significant predictive factors for cancerous HCC. The positive rate of programmed cell death 1-ligand 1 and vessels that encapsulate tumor clusters status of the rim-positive HCC and HCC with low SIRPP were significantly higher than the control group.

Conclusions: The intraoperative ICG FI pattern of HCC closely correlated with histological differentiation, preoperative SIRPP and intensity type in the Gd-EOB-DTPA MRI, and preoperative ADC in the DWI of MRI.

Keywords: gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid; hepatocellular carcinoma; histological differentiation; indocyanine green; magnetic resonance imaging; tumor microenvironment.

Abstract

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