Preoperative prediction of early recurrence in hepatocellular carcinoma using simultaneous multislice diffusion kurtosis imaging.

[OBJECTIVE] This study aimed to evaluate the value of simultaneous multislice diffusion kurtosis imaging (SMS-DKI) for predicting early recurrence (within 2 years) in hepatocellular carcinoma (HCC) and to develop a predictive model.

[MATERIALS AND METHODS] This prospective study included 67 HCC patients who underwent SMS-DKI on a 3-T MRI between June 2021 and January 2023. Diffusion parameters, including the apparent diffusion coefficient (ADC), SMS-mean kurtosis (SMS-MK), and SMS-mean diffusivity (SMS-MD), along with radiological features, were analyzed. Logistic regression models were used to predict early recurrence, internally validated using 10-fold cross-validation, and assessed using AUC, calibration curves, and decision curve analysis (DCA).

[RESULTS] Among 67 patients (58 males; mean age, 53.5 ± 9.9 years), 30 (44.8%) experienced early recurrence. The early recurrence had significantly lower ADC (1.12 vs 1.22 × 10 mm/s) and SMS-MD (1.45 vs 1.70 × 10 mm/s), and higher SMS-MK (0.91 vs 0.75). SMS-MK showed the highest AUC (0.90, 95% CI: 0.80-0.96). Multivariate analysis identified SMS-MK (OR = 3.43 [1.31-8.89]), tumor size (OR = 4.22 [1.58-7.76]), non-smooth tumor margin (OR = 2.68 [1.58-7.96]), and complete capsule (OR = 0.22 [0.02-0.79]) as independent predictors of early recurrence. Based on these four parameters, the final model achieved an AUC of 0.94 (95% CI: 0.88-1.00). Calibration curves and DCA confirmed clinical utility.

[CONCLUSION] SMS-DKI enhances early recurrence prediction in HCC. The predictive model, incorporating SMS-MK, tumor size, and key radiological features, demonstrated good prognostic value.

[KEY POINTS] Question Can SMS-DKI predict HCC early recurrence within 2 years post-surgery? Findings Higher SMS-MK, larger tumor size, non-smooth margins, and incomplete capsule predict HCC early recurrence (model AUC = 0.94). Clinical relevance Integrating preoperative SMS-DKI biomarkers (SMS-MK) with tumor size and capsule status stratifies early HCC recurrence risk, guiding surgical planning and postoperative management.