Purpose: Microvascular invasion (MVI) is an important prognostic factor in patients with hepatocellular carcinoma (HCC). However, the reported results of magnetic resonance imaging (MRI) features for predicting MVI of HCC are variable and conflicting. Therefore, this meta-analysis aimed to identify the significant MRI features for MVI of HCC and to determine their diagnostic value. Methods: Original studies reporting the diagnostic performance of MRI for predicting MVI of HCC were identified in MEDLINE and EMBASE up until January 15, 2020. Study quality was assessed using QUADAS-2. A bivariate random-effects model was used to calculate the meta-analytic pooled diagnostic odds ratio (DOR) and 95% confidence interval (CI) for each MRI feature for diagnosing MVI in HCC. The meta-analytic pooled sensitivity and specificity were calculated for the significant MRI features. Results: Among 235 screened articles, we found 36 studies including 4,274 HCCs. Of the 15 available MRI features, 7 were significantly associated with MVI: larger tumor size (#x3e;5 cm) (DOR = 5.2, 95% CI [3.0–9.0]), rim arterial enhancement (4.2, 95% CI [1.7–10.6]), arterial peritumoral enhancement (4.4, 95% CI [2.8–6.9]), peritumoral hypointensity on hepatobiliary phase imaging (HBP) (8.2, 95% CI [4.4–15.2]), nonsmooth tumor margin (3.2, 95% CI [2.2–4.4]), multifocality (7.1, 95% CI [2.6–19.5]), and hypointensity on T1-weighted imaging (T1WI) (4.9, 95% CI [2.5–9.6]). Both peritumoral hypointensity on HBP and multifocality showed very high meta-analytic pooled specificities for diagnosing MVI (91.1% [85.4–94.8%] and 93.3% [74.5–98.5%], respectively). Conclusions: Seven MRI features including larger tumor size, rim arterial enhancement, arterial peritumoral enhancement, peritumoral hypointensity on HBP, nonsmooth margin, multifocality, and hypointensity on T1WI were significant predictors for MVI of HCC. These MRI features predictive of MVI can be useful in the management of HCC.
Liver Cancer

中文翻译：

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预测肝细胞癌微血管侵袭的MRI特征：系统评价和荟萃分析

目的：微血管浸润（MVI）是肝细胞癌（HCC）患者的重要预后因素。但是，用于预测HCC MVI的磁共振成像（MRI）功能的报道结果是可变的且相互矛盾。因此，这项荟萃分析旨在确定肝癌MVI的重要MRI特征并确定其诊断价值。方法：截至2020年1月15日，在MEDLINE和EMBASE中鉴定了报告MRI诊断HCC MVI的诊断性能的原始研究。使用QUADAS-2评估了研究质量。使用双变量随机效应模型为每个MRI特征计算荟萃分析合并诊断比值比（DOR）和95％置信区间（CI），以诊断HCC中的MVI。荟萃分析汇总的敏感性和特异性为重要的MRI特征。结果：在235篇筛选的文章中，我们发现了36​​项研究，包括4,274例HCC。在15个可用的MRI特征中，有7个与MVI显着相关：肿瘤较大（＃x3e; 5 cm）（DOR = 5.2，95％CI [3.0-9.0]），边缘动脉增强（4.2，95％CI [1.7] –10.6]），动脉瘤周围增强（4.4、95％CI [2.8-6.9]），肝胆期影像学检查（HBP）的肿瘤周围低血压（8.2、95％CI [4.4-15.2]），肿瘤边缘不光滑（3.2、95） ％CI [2.2-4.4]），多焦点（7.1、95％CI [2.6-19.5]）和T1加权成像（T1WI）的低强度（4.9，95％CI [2.5-9.6]）。HBP的肿瘤周围低血压和多灶性均显示出极高的荟萃分析综合诊断MVI的特异性（分别为91.1％[85.4–94.8％]和93.3％[74.5–98.5％]）。结论：七个较大的MRI特征包括较大的肿瘤大小，边缘动脉增强，动脉周围肿瘤增强，HBP上的肿瘤周围低血压，T1WI的边缘不光滑，多灶性和低强度，这是HCC MVI的重要预测指标。这些预示着MVI的MRI特征可用于肝癌的管理。
肝癌