Impact of apparent diffusion coefficient on prognosis of hepatocellular carcinoma within Milan criteria: a case control study

Abstract Background: We investigated the usefulness of apparent diffusion coefficients (ADC) from diffusion-weighted images (DWI) obtained using magnetic resonance imaging (MRI) for prognosis of hepatocellular carcinoma (HCC) within Milan criteria. Methods: We enrolled 102 patients who had undergone surgical resection for HCC within Milan criteria, and calculated their minimum ADC using DWI-MRI. We divided patients into ADCHigh (n=72) and ADCLow (n=30) groups, and compared clinicopathological factors between the two groups. Results: The ADCLow group showed higher protein induced by vitamin K absence-II (PIVKA-II) levels (p=0.04) and higher rates of infiltrative growth (p=0.06) compared with the ADCHigh group. In overall survival, the ADCLow group showed significantly worse prognosis than the ADCHigh group (p<0.01). Univariate analysis identified infiltrative growth, high PIVKA-II, and low ADC value as prognostic factors. Multivariate analysis identified only low ADC value as an independent prognostic factor. Conclusions: ADC values can be used to estimate the prognosis of HCC within Milan criteria.