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Tamai. Hepatoma Res 2018;4:75 Hepatoma Research
DOI: 10.20517/2394-5079.2018.98

Review Open Access

The prediction of microvascular invasion of
hepatocellular carcinoma using multiple imaging
modalities

Hideyuki Tamai

Department of Hepatology, Wakayama Rosai Hospital, Wakayama 640-8505, Japan.
Correspondence to: Dr. Hideyuki Tamai, Department of Hepatology, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama-shi,
Wakayama 640-8505, Japan. E-mail: hdy-tamai@wakayamah.johas.go.jp

How to cite this article: Tamai H. The prediction of microvascular invasion of hepatocellular carcinoma using multiple imaging
modalities. Hepatoma Res 2018;4:75. http://dx.doi.org/10.20517/2394-5079.2018.98

Received: 10 Sep 2018 First Decision: 12 Oct 2018 Revised: 20 Nov 2018 Accepted: 27 Nov 2018 Published: 18 Dec 2018

Science Editor: Guang-Wen Cao Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
To implement an adequate treatment strategy for solitary hepatocellular carcinoma (HCC), the prediction of
microvascular invasion (MVI) is crucial. Metastatic recurrences after curative treatments can result from occult
metastasis derived from invisible MVI. For predicting MVI, poorly differentiated or non-singular nodular HCC with
a high risk of MVI should be evaluated by common imaging modalities such as ultrasound, contrast enhanced
computed tomography (CECT), or magnetic resonance imaging (MRI). Summarizing these predictabilities in
previous reports, the accuracies for predicting MVI were 78% in contrast enhanced ultrasonography (CEUS),
76%-89% in CECT, and 62%-77% in MRI. Those for predicting poor differentiation were 69%-92% in CEUS,
52%-90% in CECT, and 71%-75% in MRI. Those for predicting non-singular nodular type were 92%-95% in CEUS,
81%-89% in MRI, and 91%-93% in the combination of MRI and CECT. Among common imaging modalities, MRI
can provide tissue characterization of the HCC using signal intensity. Gadolinium-ethoxybenzyl diethylenetriamine
penta-acetic acid-enhanced MRI including diffusion imaging is the most informative imaging modality to predict
MVI. Combination of MRI with other imaging modalities or tumor markers may provide a more accurate predicting
for MVI. HCC with a high risk of MVI should be treated as advanced HCC even after curative treatment.

Keywords: Hepatocellular carcinoma, microvascular invasion, histologic differentiation, ultrasound, computed
tomography, magnetic resonance imaging

INTRODUCTION
There have been rapid advances in the development of imaging modalities as diagnostic tools in recent years.
In hepatocellular carcinoma (HCC), imaging plays a greater part than biopsy in its diagnosis. In addition,

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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