Quantitative Ultrasound Image Analysis Helps in the Differentiation of Hepatocellular Carcinoma (HCC) From Borderline Lesions and Predicting the Histologic Grade of HCC and Microvascular Invasion

Naoki Matsumoto, Masahiro Ogawa, Masahiro Kaneko, Mariko Kumagawa, Yukinobu Watanabe, Midori Hirayama, Hiroshi Nakagawara, Ryota Masuzaki, Tatsuo Kanda, Mitsuhiko Moriyama, Tadatoshi Takayama, Masahiko Sugitani

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Objectives: Quantitative image analysis is one of the methods to overcome the lack of objectivity of ultrasound (US). The aim of this study was to clarify the correlation between the features from a US image analysis and the histologic grade and microvascular invasion (MVI) of hepatocellular carcinoma (HCC) and differentiation of HCC smaller than 2 cm from borderline lesions. Methods: We retrospectively analyzed grayscale US images with histopathologic evidence of HCC or a precancerous lesion using ImageJ version 1.47 software (National Institutes of Health, Bethesda, MD). Results: A total of 148 nodules were included (borderline lesion, n = 31; early HCC [eHCC], n = 3; well-differentiated HCC [wHCC], n = 16; moderately differentiated HCC [mHCC], n = 79; and poorly differentiated HCC [pHCC], n = 19). A multivariate analysis selected lower minimum gray values (odds ratio [OR], 0.431; P =.003) and a higher standard deviation (OR, 1.880; P =.019) as predictors of HCC smaller than 2 cm. Median (range) minimum gray values of borderline lesions, eHCC, wHCC, mHCC, and pHCC were 29 (0–103), 7 (0–47), 6 (0–60), 10 (0–53), and 2 (0–38), respectively, and gradually decreased from borderline lesions to pHCC (P < 0.001). The multivariate analysis showed a higher aspect ratio (OR, 2.170; P =.001) and lower minimum gray value (OR, 0.475; P =.043) as predictors of MVI. An anechoic area diagnosed by a subjective evaluation was correlated with the minimum gray value (P <.0001). The proportion of the anechoic area gradually increased from eHCC to pHCC (P =.031). Conclusions: In a US image analysis, HCC smaller than 2 cm had features of greater heterogeneity and a lower minimum gray value than borderline lesions. Moderately differentiated HCC was smoother than borderline lesions, and the anechoic area correlated with histologic grading. Microvascular invasion was correlated with a slender shape and a lower minimum gray value.

Original languageEnglish
Pages (from-to)689-698
Number of pages10
JournalJournal of Ultrasound in Medicine
Volume40
Issue number4
DOIs
Publication statusPublished - Apr 2021

Keywords

  • borderline lesion
  • hepatocellular carcinoma
  • image analysis
  • microvascular invasion
  • ultrasound

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