Quantitative Image Features of Gadoxetic Acid–enhanced MRI for Predicting Glypican-3 Expression of Small Hepatocellular Carcinoma ≤ 3 cm

Abstract Background/purpose of the study: Glypican-3 (GPC3) is associated with the occurrence and poor prognosis of hepatocellular carcinoma (HCC). To explore the value of quantitative image features of Gadoxetic Acid–enhanced magnetic resonance imaging (MRI) for predicting GPC3 expression of single HCC ≤ 3 cm.Methods: One hundred and forty-nine patients with pathologically confirmed HCC (training cohort: n=117; validation cohort: n=32) were included retrospectively. Quantitative image features and clinicopathological parameters were analyzed. The significant predictors for GPC3 expression were identified using multivariate logistic regression analyses. Nomograms were constructed from the prediction model and recurrence rates was evaluated by the Kaplan–Meier method.Results: Serum alpha-fetoprotein (AFP) > 20 ng/mL (odds ratio [OR] = 5.215; p = 0.004) and tumor-to-liver signal intensity (SI) ratio on hepatobiliary phase (HBP) (OR = 0.003; p = 0.005) were independent significant factors for GPC3 expression. When these two factors were combined, the diagnostic specificity of the training cohort and validation cohort was 87.9 (29/33) and 90.0 (9/10), respectively. The nomogram based on the predictive model performed satisfactorily in the training (C-index: 0.856) and validation (C-index: 0.877) cohort. Recurrence rates were significantly higher in patients with GPC3-positive HCCs compared with those with GPC3-negative HCCs after curative resection in the training (45.9% vs. 25.0%, P=0.034) and validation (54.5% vs. 30.0%, P=0.042) cohorts.Conclusion: Serum AFP > 20 ng/mL combined with tumor-to-liver SI ratio on HBP are potential predictive factors for GPC3 expression of HCC ≤ 3cm. GPC3-positive is correlated with a poor prognosis in HCC patients.