MRI features reflect aggressive vs. indolent hepatocellular carcinoma biology

MRI can distinguish proliferative-class hepatocellular carcinoma (HCC), tied to microvascular invasion and poor outcomes, from non-proliferative-class HCC. Features like rim arterial phase hyperenhancement and necrosis signal aggressive disease, while capsule appearance and intr…

• Aggressive MRI features include rim APHE, non-smooth margins, necrosis, intratumoral arteries, low ADC, peritumoral APHE, and peritumoral HBP hypointensity.
• Favorable MRI features include capsule appearance, intratumoral fat, and HBP hyperintensity.
• Imaging features suggestive of aggressive subtypes may guide selective biopsy, molecular profiling, and treatment planning.

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