Diffusion kurtosis imaging (DKI) of hepatocellular carcinoma: correlation with microvascular invasion and histologic grade

Hepatocellular carcinoma (HCC) is a common malignancy worldwide and the second leading cause of cancer-related death (1). Despite the emergence of several new therapeutic modalities, long-term survival of advanced HCC patients remains poor due to high-recurrence rates (2,3). Many biological factors of HCC are related with the notorious tumor recurrence. Microvascular invasion (MVI) is an important predictive factor for poor prognosis after curative liver resection or transplantation (4-7), because it provides the route for tumor cells to access the portal or systemic circulation. It has been reported that the one-year recurrence rate in MVI-positive patients was significantly higher than that in MVI-negative patients (7). In addition, tumor differentiation is also considered as an important predictive factor for patient prognosis (8,9). High-grade HCCs are usually associated with higher recurrence rates and poorer prognosis in comparison with low-grade HCCs (5,6). Unfortunately, information regarding MVI status and tumor differentiation is not routinely available preoperatively, thus, limiting their clinical utility in decision making. Therefore, preoperative radiologic prediction of these histopathological results can allow optimized management of HCC and help improve long-term survival for patients