Correlation between 18 F-FDG PET/CT, Gd-EOB-DTPA MRI combined with laboratory parameters and microvascular invasion, and the potential of nomogram to predict microvascular invasion of hepatocellular carcinoma before liver transplantation

Background Hepatocellular carcinoma (HCC) is a highly prevalent malignant tumor worldwide, with Chinese patients accounting for more than 50%. Microvascular invasion (MVI) is a key risk factor for postoperative HCC recurrence. Currently, preoperative identification and prediction of MVI in HCC remains challenging and a clinical challenge. Numerous studies have utilized clinical, laboratory, molecular, and imaging methods to predict MVI in HCC preoperatively, but these efforts have proven limited in effectiveness. Objective To investigate the clinical value of 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) and Gd-EOB-DTPA dynamic contrast-enhanced MRI in predicting MVI of HCC before liver transplantation, and to construct a nomogram prediction model by combining laboratory indicators. Methods A total of 121 HCC patients who underwent liver transplantation were retrospectively enrolled (71 patients in the MVI-positive group and 50 patients in the MVI-negative group). Clinical characteristics, laboratory parameters, 18 F-FDG, the correlation between PET/CT and Gd-EOB-DTPA MRI findings, and MVI were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors, and a nomogram model was constructed. Calibration curves and receiver operating characteristic (ROC) curves were used to evaluate the model performance. Results Univariate analysis showed significant differences between the two groups in abnormal prothrombin (PIVKA-II), alpha-fetoprotein, tumor size, peritumoral hypointensity during the hepatobiliary phase, maximum standardized uptake value, mean standardized uptake value, peak standardized uptake value, total lesion glycolysis, coefficient of variation, heterogeneity index, and tumor-to-liver ratio (all P < 0.05). Multivariate analysis revealed that PIVKA-II [odds ratio (OR) = 1.001, P = 0.002], peritumoral hypointensity during the hepatobiliary phase (OR = 5.556, P < 0.001), and heterogeneity index (OR = 2.064, P = 0.004) were independent predictors of MVI. The combined model achieved an area under the ROC curve of 0.875 (95% confidence interval: 0.808–0.941), significantly outperforming any single parameter. Nomogram calibration curves demonstrated high agreement between the predicted and observed probabilities (mean absolute error = 0.016). Conclusion 18 F-FDG PET/CT and Gd-EOB-DTPA dynamic contrast-enhanced MRI can effectively predict the risk of MVI in HCC patients before liver transplantation. The nomogram model constructed by combining laboratory indicators provides a reliable tool for preoperative individualized assessment.