Nghiên cứu đặc điểm hình ảnh và giá trị của cộng hưởng từ trong chẩn đoán ung thư biểu mô tế bào gan ở bệnh nhân có alpha-fetoprotein < 20ng/mL

Abstract

Objective: To describe imaging characteristics and evaluate the diagnostic value of magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC) in patients with alpha-fetoprotein (AFP) < 20 ng/mL. Subjects and method: A prospective cross-sectional study with histopathological correlation was conducted in 122 patients with AFP < 20 ng/mL who underwent liver MRI at K Hospital, Tan Trieu Campus, from June 2025 to December 2025. MRI diagnosis was based on LI-RADS 2018 in high-risk patients and a multiparametric assessment in patients not belonging to the high-risk group. Result: There were 57 HCC and 65 non-HCC lesions. HCC was mainly mass/nodular type (98.25%), solitary (66.67%), with a mean size of 43.56 ± 19.04 mm. Common MRI findings included non-rim APHE (94.74%), T2 hyperintensity (96.49%), T1 hypointensity (92.98%), DWI hyperintensity (96.49%), true diffusion restriction (70.18%), delayed washout (68.42%) and enhancing capsule (47.37%). MRI correctly identified 47 HCC cases, missed 10 HCC cases, correctly excluded HCC in 56 cases and yielded 9 false-positive cases. Sensitivity, specificity, PPV, NPV, accuracy and ROC-AUC were 82.46%, 86.15%, 83.93%, 84.85%, 84.43% and 0.843 (95%CI: 0.771-0.915), respectively. Conclusion: In patients with AFP < 20 ng/mL, HCC on MRI commonly shows non-rim APHE, T2/DWI hyperintensity, T1 hypointensity, diffusion restriction and more evident delayed washout, MRI showed high discriminatory performance for differentiating HCC from non-HCC liver lesions in this single-center cohort.