Objective To evaluate the predictive value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) 3.0T enhanced magnetic resonance imaging (MRI) for microvascular invasion (MVI) in young and middle-aged patients with small hepatocellular carcinoma (SHCC).

Methods Seventy young and middle-aged patients with SHCC were divided into MVI (n=21) and non-MVI (n=49) groups. All patients underwent preoperative univariate analysis of qualitative and quantitative parameters of Gd-EOB-DTPA MRI enhancement, and multivariate logistic regression was performed using the parameters that differed between groups as independent variables. Receiver operating characteristic and Kaplan–Meier survival curves were drawn to determine the predictive parameters and predict postoperative recurrence and metastasis.

Results Significant differences in the qualitative parameters of tumor shape, tumor margin, pseudocapsule completeness, peritumoral hypointensity in the hepatobiliary phase, and peritumoral enhancement in the artery phase were found between the MVI and non-MVI groups (P<0.05); with regard to the quantitative parameters, the apparent diffusion coefficient (ADC) values of tumors between two groups were statistically significant (P<0.05). Multivariate logistic regression analysis showed that small ADC, peritumoral hypointensity in the hepatobiliary phase, and peritumoral enhancement were independent risk factors of MVI in young and middle-aged patients with SHCC (P<0.05). Survival analysis revealed that the recurrence rate of the MVI group was higher than that of the non-MVI group in the first two years.

Conclusion Gd-EOB-DTPA-enhanced MRI is valuable in predicting the presence of MVI and postoperative recurrence and metastasis in young and middle-aged patients with SHCC.