Comparison of magnetic resonance imaging features of the tumors in hepatitis B and hepatitis C-related hepatocellular carcinoma cases

Aim: In our study, Magnetic Resonance Imaging (MRI) findings of hepatocellular carcinomas (HCC) related to viral hepatitis was researched. Since the hepatocarcinogenesis is different in chronic hepatitis B virus (HBV) and C virus (HCV) infections the MRI features were compared. Material and Method: The patients evaluated with abdominal MRI in Zonguldak Bülent University Faculty of Medicine Department of Radiology between March 2018 and May 2020 were retrospectively screened and the patients diagnosed HCC were determined. The patients without previous treatment and with chronic HBV or HCV hepatitis etiology were selected, the other causes (cryptogenic, alcohol, non-alcoholic steatohepatitis) were excluded. Other inclusion criteria were that the patient had not received any treatment before. The images of 27 patients, 16 with chronic HBV and 11 with chronic HCV infection, were retrospectively viewed. A total of 47 HCC lesions were detected. In each case, the number, size, border features of the lesions, the presence of capsule, intralesional lipid and hemorrhage, vascular and biliary invasion, the degree of arterial enhancement, and the quantitative value in the apparent diffusion coefficient (ADC) mapping were evaluated. Portal vein thrombosis, lymphadenopathy, ascite and cirrhosis were determined. The results were compared between patients with HBV and HCV infection. HBV ve HCV'ye bağlı gelişen HSK'da ADC ile arteryel boyanma oranı arasında negatif yönlü orta düzeyli istatistiksel anlamlı korelasyon saptandı (r=-0,392, p=0,012). ADC ile tümör boyutu arasında negatif yönlü orta düzeyli istatistiksel anlamlı korelasyon saptandı (r=-0,488, p=0,001). ADC değeri vasküler invazyonu saptamada anlamlı bulunmuş (p=0,046) olup en uygun değer 0,97 altında olmasıdır (Duyarlılık: %67, özgüllük: %74). Sınırı düzgün olan lezyonların arteryel boyanma oranı, belirsiz olanlardan daha düşüktür (p=0,01). Hemoraji olan olan lezyonların arteryel boyanma oranı, olmayanlardan daha düşüktür (p=0,013). T1 hiperintens sinyal intensitesinde olanların arteryel boyanma oranı T1 hipointens ve T1 izointens olanlardan daha düşüktür (sırasıyla p=0,023, p=0,005). T2 izointens olanların arteryel boyanma oranı hiperintens olanlardan daha düşüktür (p=0,021). Results: The lesions are larger in HBV-related HCC (p=0,025). T1 signal intensity is low in 29,6% of the HBV-related HCCs, while it is isointense in 60% of the HCV-related HCCs (p= 0,036). The borders of HCV-related HCCs tend to be more indeterminate (p=0,017). The frequency of a lymphadenopathy is increased in patients with HCC due to HBV (p=0,018). No statistically significant difference was found between the two groups in terms of the number of lesions, signal intensity in T2W (weighted) sequence, presence of capsule, intralesional lipid and hemorrhage, vascular and biliary invasion, arterial enhancement rate, ADC value, presence of ascite and cirrhosis, portal vein thrombosis, and serum AFP values. A negative moderate statistically significant correlation was found between ADC and arterial enhancement rate in HCC due to HBV and HCV (r=-0,392, p= 0,012). A moderate and statistically significant negative correlation was found between ADC and tumor size (r= -0,488, p= 0,001). The ADC value was found to be significant to detect vascular invasion (p=0,046) and the cutoff value was less than 0.97 (Sensitivity: 67%, specificity: 74%). The arterial enhancement ratio with well-defined lesions was lower than the ill-defined ones (p = 0,01). The arterial enhancement ratio of the hemmorhagic lesions was lower than those without (p=0,013). The arterial enhancement ratio of T1 hyperintense lesions was lower than those with T1 hypo/isointense ones (p=0,023, p= 0,005, respectively). T2 isointense lesions had lower arterial enhancement ratio than the hyperintense ones (p= 0,021). Conclusions: Some radiological findings of HCC may differ between patients with HBV and HCV infection. While ADC value shows an inverse relationship with the degree of arterial enhancement in HCC due to hepatitis B and C, it can also be used as a marker of vascular invasion. However, the findings need to be supported by larger studies. Keywords: Hepatocellular carcinoma; Hepatitis B virüs chronic; Hepatitis C virus chronic; Magnetic resonance imaging