Journal of Hebei Medical University ›› 2025, Vol. 46 ›› Issue (6): 656-661.doi: 10.3969/j.issn.1007-3205.2025.06.006

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The value of preoperative MRI characteristics combined with the ratio of alkaline phosphatase (ALP) to prealbumin (PA) in predicting microvascular invasion in hepatocellular carcinoma

  

  1. 1.Department of Radiology, Suining Hospital of Traditional Chinese Medicine, Sichuan Province, Suining 
    062900, China; 2.Department of Radiology, Suining Central Hospital, Sichuan Province, 
    Suining 062900, China; 3.Department of Radiology, the Third People′s Hospital of 
    Suining City, Sichuan Province, Suining 062900, China

  • Online:2025-06-25 Published:2025-07-04

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Abstract: Objective To explore the value of preoperative MRI characteristics combined with the ratio of alkaline phosphatase (ALP) to prealbumin (PA) in predicting microvascular invasion in hepatocellular carcinoma. 
Methods A retrospective analysis was performed on medical records of 152 patients with hepatocellular carcinoma (HCC) who underwent surgical treatment at Suining Hospital of Traditional Chinese Medicine from January 2022 to October 2023. Using postoperative pathology as the gold standard, the subjects were divided into the microvascular invasion group and the non-invasion group. Factors influencing microvascular invasion in HCC were analyzed, and the predictive efficacy of preoperative magnetic resonance imaging (MRI) characteristics and the ratio of ALP to PA for microvascular invasion of HCC was evaluated. 
Results Among the 152 HCC patients, 54 patients were confirmed to have microvascular invasion postoperatively, accounting for 35.53%. The proportion of CNLC stage Ⅱ in the invasion and non-invasion groups was 63.27% and 36.73%, respectively, the proportion of incomplete tumor capsule was 77.78% and 59.18%, respectively, and the proportion of heterogeneous tumor signal on T2WI was 74.07% and 40.82%, respectively; the proportion of peritumoral hypointensity in the hepatobiliary phase was 74.07% and 48.98%, respectively, and the ALP/PA scores were (0.72±0.16) and (0.54±0.13), and the difference was significant (P＜0.05). CNLC staging (OR=6.001, 95%CI: 2.753-13.082), incomplete tumor capsule (OR=4.080, 95%CI: 1.913-8.702), heterogeneous tumor signal on T2WI (OR=4.660, 95%CI: 2.246-9.667), peritumoral hypointensity in the hepatobiliary phase (OR=4.375, 95%CI: 2.069-9.252), and ALP/PA ratio (OR=3.904, 95%CI: 1.830-8.328) were identified as risk factors for microvascular invasion in HCC (P＜0.05). The combined prediction of incomplete tumor capsule, heterogeneous tumor signal on T2WI, peritumoral hypointensity in the hepatobiliary phase, and ALP/PA ratio yielded an area under the curve of 0.842 (95%CI: 0.761-0.922) for predicting microvascular invasion in HCC. 
Conclusion Preoperative MRI characteristics combined with the ALP/PA ratio show good efficacy in predicting microvascular invasion in HCC. 


Key words: carcinoma, hepatocellular, microvascular invasion, magnetic resonance characteristics