Liver-to-spleen ratio obtained from gadoxetate disodium-enhanced magnetic resonance imaging predicts intrahepatic recurrence after curative resection of hepatocellular carcinoma

Abstract

Aim

The purpose of this study was to evaluate whether parameters obtained from gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) could predict intrahepatic tumor recurrence in patients who underwent curative hepatectomy for hepatocellular carcinoma (HCC).

Methods

This study included 208 patients who underwent EOB-MRI before hepatectomy for HCC. The mean signal intensity of the liver (L20) and spleen (S20) was obtained from preoperative EOB-MRI, and liver-to-spleen ratio (LSR) was calculated from these values as: LSR = L20/S20. The association of LSR value with intrahepatic recurrence of HCC after curative hepatectomy was analyzed.

Results

Intrahepatic recurrence in the remnant liver developed in 111 (53%) patients during the median follow-up period of 52.0 (range, 7.0–134.9) months after hepatectomy. Cumulative incidence of intrahepatic recurrence was significantly higher in patients with low LSR (<2.0) than in those with high LSR (≥2.0) (p < 0.001). In multivariable analysis, low LSR was identified as an independent predictor of intrahepatic recurrence (hazard ratio, 1.83; 95% confidence interval [CI], 1.23–2.72; p = 0.002), together with multiple tumors, macroscopic vascular invasion, and high-grade fibrosis of the background liver. Subgroup analysis according to the time of recurrence (within 1 year or more) revealed that low LSR was significantly associated with late recurrence (hazard ratio, 2.35; 95% CI, 1.40–3.94; p = 0.001), but not with early recurrence.

Conclusions

Low LSR was an independent risk factor of intrahepatic recurrence after curative hepatectomy for HCC, and was especially associated with late recurrence developing more than 1 year after curative hepatectomy.