Ex-vivo 7T MRI of human explanted cirrhotic liver with HCC: quantitative and qualitative evaluation with radiological-pathological correlation

Introduction: Hepatocellular carcinoma’s (HCC) pathological grading is a recognized factor influencing intrahepatic recurrence after treatment. Thus, understanding the HCC heterogeneity is crucial to select the best treatment option aiming at personalized medicine. 7T MRI can provide qualitative and quantitative data, potentially identifying imaging biomarkers for lesions characterization. Materials and methods: From May 2019 to December 2019, all explanted livers of patients undergoing liver transplant were enrolled. All patients underwent whole body CT before liver transplant and all the explanted livers were evaluated (ex-vivo) by 7T MRI within 12 h from liver removal with qualitative and quantitative acquisitions, including 2D/3D magnetic resonance fingerprinting (MRF). First, two expert radiologists qualitatively and quantitatively evaluated the imaging data focusing on both lesions and surrounding tissue, comparing conventional and MRF sequences. Then, specimens were evaluated by an expert pathologist regarding both liver tissues and lesions, particularly focusing on HCC grading. Conclusions: This work may represent the first step supporting the introduction of quantitative MR imaging (including MRF) in the clinical practice. Along with conventional protocol and dynamic contrast enhancement, the integration of quantitative MR imaging can provide imaging biomarkers useful to identify HCC lesions more prone to recurrence, leading to a better patient selection, according to a personalized medicine approach.