Microvascular Invasion in Hepatocellular Carcinoma: Bridging the Global Gap between Imaging and Clinical Practice

Microvascular invasion (MVI) at surgical pathology predicts a worse prognosis in patients with hepatocellular carcinoma (HCC). MVI is a surgical pathologic diagnosis, and radiology-pathology studies have tried to link imaging findings associated with MVI ( 1 Tang Y. Lu X. Liu L. et al. A reliable and repeatable model for predicting microvascular invasion in patients with hepatocellular carcinoma. Acad Radiol. 2023; S1076–6332https://doi.org/10.1016/j.acra.2023.02.035 Abstract Full Text Full Text PDF Scopus (2) Google Scholar , 2 Renzulli M. Brocchi S. Cucchetti A. et al. Can current preoperative imaging be used to detect microvascular invasion of hepatocellular carcinoma?. Radiology. 2016; 279: 432-442https://doi.org/10.1148/radiol.2015150998 Crossref PubMed Scopus (240) Google Scholar , 3 Min J.H. Lee M.W. Park H.S. et al. Interobserver variability and diagnostic performance of gadoxetic acid-enhanced MRI for predicting microvascular invasion in hepatocellular carcinoma. Radiology. 2020; 297: 573-581https://doi.org/10.1148/radiol.2020201940 Crossref PubMed Scopus (51) Google Scholar ). Making early detection of MVI based on the pretreatment imaging can potentially guide treatment planning for choosing a transplant, partial hepatectomy, locoregional treatment, or systemic therapy. Because MVI is not a direct imaging finding identifiable in standard or advanced liver imaging, like tumor-in-vein, studies have focused on predicting the presence of MVI based on imaging surgical pathology studies. Therefore, predicting MVI on surgical pathology based on the imaging findings has focused on association models, which have been inconsistently linked to various individual or grouped imaging findings. The reproducibility of imaging models for predicting MVI in HCC patients remains questionable, with an inconsistent interpretation of imaging signs by less experienced radiologists ( 1 Tang Y. Lu X. Liu L. et al. A reliable and repeatable model for predicting microvascular invasion in patients with hepatocellular carcinoma. Acad Radiol. 2023; S1076–6332https://doi.org/10.1016/j.acra.2023.02.035 Abstract Full Text Full Text PDF Scopus (2) Google Scholar , 2 Renzulli M. Brocchi S. Cucchetti A. et al. Can current preoperative imaging be used to detect microvascular invasion of hepatocellular carcinoma?. Radiology. 2016; 279: 432-442https://doi.org/10.1148/radiol.2015150998 Crossref PubMed Scopus (240) Google Scholar , 3 Min J.H. Lee M.W. Park H.S. et al. Interobserver variability and diagnostic performance of gadoxetic acid-enhanced MRI for predicting microvascular invasion in hepatocellular carcinoma. Radiology. 2020; 297: 573-581https://doi.org/10.1148/radiol.2020201940 Crossref PubMed Scopus (51) Google Scholar ). Integrating radiomics with imaging findings has shown potential in identifying MVI preoperatively ( 4 Xia T.Y. Zhou Z.H. Meng X.P. et al. Predicting microvascular invasion in hepatocellular carcinoma using CT-based radiomics model. Radiology. 2023; 307 (Epub 2023 Apr 25)e222729https://doi.org/10.1148/radiol.222729 Crossref PubMed Scopus (4) Google Scholar ); however, the need to manually annotate and perform advanced analyses is not broadly applicable in most radiology practice settings. Given the weaknesses of prior MVI studies, Tang et al ( 1 Tang Y. Lu X. Liu L. et al. A reliable and repeatable model for predicting microvascular invasion in patients with hepatocellular carcinoma. Acad Radiol. 2023; S1076–6332https://doi.org/10.1016/j.acra.2023.02.035 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ) aimed to produce an imaging model to predict microvascular invasion.