Journal highlights

Hepatocellular carcinomas (HCCs), or liver cancer, may be divided into proliferative and nonproliferative classes according to their molecular and histologic observable characteristics. Proliferative HCCs, or those that multiply rapidly, account for 30%–50% of HCCs and represent a class of tumors with aggressive biologic behavior.

Generally, the diagnosis of proliferative HCC is confirmed with histologic analysis of biopsy samples. However, pretreatment biopsies are not mandatory in clinical practice because HCC is a unique tumor that can be diagnosed based on typical imaging features in patients with cirrhosis or chronic hepatitis.

Therefore, the noninvasive identification of the proliferative characteristics of tumors before treatment is crucial.

In an article published in Radiology, Yan Bao, MD, Second Xiangya Hospital of Central South University, China, and colleagues conducted a retrospective multicenter study to compare therapeutic outcomes in adults with HCC who underwent either liver resection or conventional transarterial chemoembolization (cTACE) between August 2013 and December 2020.

A CT-based predictive model, named the SMARS score, was used to identify proliferative HCCs. The patients in the cTACE cohort were stratified into groups with predicted proliferative or nonproliferative HCCs according to the model.

A total of 1,194 patients were included in the study, which included training, validation and test cohorts. Proliferative HCCs predicted by the CT-based model were associated with worse progression-free survival and overall survival after cTACE than nonproliferative HCCs.

“The predictive model demonstrated good performance for identifying proliferative HCCs. According to the SMARS score, patients with predicted proliferative HCCs have worse prognosis than those with predicted nonproliferative HCCs after cTACE,” the authors conclude.

To read the full article, “Identifying Proliferative Hepatocellular Carcinoma at Pretreatment CT: Implications for Therapeutic Outcomes after Transarterial Chemoembolization,” visit RSNA.org/Radiology. Follow the Radiology editor on X @RadiologyEditor.

Prostate cancer, the most prevalent cancer in men, displays diverse characteristics. While most cases of prostate cancers advance slowly, a minority of men will experience rapid disease progression.

Prostate cancer recurs in up to 15% to 40% of patients after radiation therapy, with a median time to recurrence of 24 to 39 months, signaled by an elevation in prostate-specific antigen (PSA) level, termed biochemical recurrence. Early biochemical recurrence, before 24 to 36 months, is associated with higher mortality rates.

In an upcoming article in RadioGraphics, Muhammad O. Awiwi, MD, University of Texas Health Science Center at Houston, and colleagues reviewed the MRI and prostate-specific membrane antigen (PSMA) PET appearances of recurrent prostate cancer, with emphasis on the strengths and limitations of each method.

According to the authors, multiparametric MRI excels in imaging local recurrence post-prostatectomy due to its superior spatial and tissue contrast resolution. PSMA PET employs radiotracers to target PSMA on prostate cancer cells’ surfaces and has high sensitivity for detection of prostate cancer metastases.

The authors noted that there are caveats for the use of both modalities that may produce false-positive or false-negative results. Hence, these techniques have complementary roles and should be interpreted in conjunction with each other, taking the patient history and results of any additional prior imaging studies into account.

“Multiparametric MRI is the most accurate modality for detection of local recurrence of prostate cancer after surgery. MRI and PSMA PET/CT have comparable diagnostic performance for identifying local recurrence after radiation therapy. Lymph node, bone, and visceral recurrence is better identified with PSMA PET/CT,” the authors conclude.