Abstract
Purpose
Steatohepatitic hepatocellular carcinoma (SH-HCC) is characterized by intratumoral fat with > 50% inflammatory changes. However, intratumoral fat (with or without inflammation) can also be found in not-otherwise specified HCC (NOS-HCC). We compared the imaging features and outcome of resected HCC containing fat on pathology including SH-HCC (> 50% steatohepatitic component), NOS-HCC with < 50% steatohepatitic component (SH-NOS-HCC), and fatty NOS-HCC (no steatohepatitic component).
Material and methods
From September 2012 to June 2021, 94 patients underwent hepatic resection for fat-containing HCC on pathology. Imaging features and categories were assessed using LIRADS v2018. Fat quantification was performed on chemical-shift MRI. Recurrence-free and overall survival were estimated.
Results
Twenty-one patients (26%) had nonalcoholic steatohepatitis (NASH). The median intra-tumoral fat fraction was 8%, with differences between SH-HCC and SH-NOS-HCC (9.5% vs. 5% p = 0.03). There was no difference in major LI-RADS features between all groups; most tumors were classified as LR-4/5. A mosaic architecture on MRI was rare (7%) in SH-HCC, a fat in mass on CT was more frequently depicted (48%) in SH-HCC. A combination of NASH with no mosaic architecture on MRI or NASH with fat in mass on CT yielded excellent specificity for diagnosing SH-HCC (97.6% and 97.7%, respectively). The median recurrence-free and overall survival were 58 and 87 months, with no difference between groups (p = 0.18 and p = 0.69).
Conclusion
In patients with NASH, an SH-HCC may be suspected in L4/LR-5 observations with no mosaic architecture at MRI or with fat in mass on CT. Oncological outcomes appear similar between fat-containing HCC subtypes.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Alexandre Faure, Marco Dioguardi Burgio, Roberto Cannella. The first draft of the manuscript was written by Alexandre Faure, Marco Dioguardi Burgio and Maxime Ronot and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.”
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This study was performed in line with the principles of the Declaration of Helsinki. Local IRB (CERIM) approved this retrospective study and waiver of written informed consent was obtained due to de retrospective approach.
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Faure, A., Dioguardi Burgio, M., Cannella, R. et al. Imaging and prognostic characterization of fat-containing hepatocellular carcinoma subtypes. Radiol med 129, 687–701 (2024). https://doi.org/10.1007/s11547-024-01807-w
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DOI: https://doi.org/10.1007/s11547-024-01807-w