Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a highly prevalent malignant tumor worldwide, with Chinese patients accounting for over 50% of cases. Microvascular invasion (MVI) is a critical risk factor for postoperative recurrence. Preoperative identification and prediction of MVI remain clinically challenging. OBJECTIVE: To evaluate the clinical value of 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) and Gd-EOB-DTPA dynamic contrast-enhanced MRI in predicting MVI in HCC before liver transplantation, and to construct a nomogram prediction model by integrating laboratory indicators. METHODS: A total of 121 HCC patients undergoing liver transplantation were retrospectively enrolled. The correlation between clinical characteristics, laboratory parameters, imaging findings (from PET/CT and MRI), and MVI status was analyzed. Independent predictors were identified through univariate and multivariate logistic regression analyses, and a nomogram was developed. Model performance was assessed using calibration and receiver operating characteristic (ROC) curves. RESULTS: Multivariate analysis identified PIVKA-II, peritumoral hypointensity on hepatobiliary phase MRI, and PET heterogeneity index as independent predictors of MVI. The combined model achieved an area under the ROC curve of 0.875, significantly outperforming any single parameter. The nomogram demonstrated excellent calibration. CONCLUSION: 18 F-FDG PET/CT and Gd-EOB-DTPA MRI can effectively predict the risk of MVI in HCC patients prior to liver transplantation. The nomogram model provides a reliable tool for individualized preoperative assessment.