Pretreatment MRI Predicting Outcome After Radio-frequency Ablation of HCC

HCC is classified as keratin (K) 19 positive or K19 negative. K19 is a biliary/hepatic progenitor cell (HPC) marker only expressed in a subset of HCC with poor prognosis and high risk of early recurrence after treatment; particularly in radio-frequency ablation (RFA). These patients consequently show worse survival compared to patients with K19 negative HCC. A recent publication has shown the value of pretreatment biopsy with K19 staining and suggests that the role of routine biopsies in potentially curable HCC should be reconsidered. However, currently, pretreatment biopsies are rarely performed in the diagnosis of HCC due to the excellent performance of magnetic resonance imaging (MRI) in detection, diagnosis and staging of cirrhotic livers. Previous publications have indicated imaging patterns that may be associated with worse prognostic tumoral parameters. If MRI determined imaging parameters could indeed provide a surrogate marker for presence of K19 and/or microvascular invasion as potential important prognostic factors in RFA of HCC, these imaging parameters may thus hold prognostic information towards RFA treatment and possibly predict treatment outcome. . The purpose of the retrospective study is thus to evaluate MRI determined imaging parameters at pretreatment MRI for their predictive value towards outcome (disease free survival) of radio-frequency ablation for hepatocellular carcinoma. If successful, pretreatment MRI parameters may be used for selecting patient with high risk of unfavorable outcome after RFA and select the patients for more aggressive treatment such as surgical resection or upfront transplantation.