Gd-EOB-DTPA-Enhanced MRI Combined with ALBI Score and AFP for Predicting Histologic Grade in Hepatocellular Carcinoma: A Multicenter Study from Vietnam

Objectives: Histologic grade is an important prognostic factor in hepatocellular carcinoma (HCC). Gd-EOB-DTPA-enhanced MRI may provide noninvasive im-aging markers related to tumour differentiation. This study aimed to evaluate the association of Gd-EOB-DTPA-enhanced MRI features, together with the albu-min-bilirubin (ALBI) score and alpha-fetoprotein (AFP), with HCC histologic grade and to assess the performance of combined predictive models. Methods: Methods: In this prospective cross-sectional study, 75 patients (mean age, 56.4 years; 66 men) with 88 histopathologically confirmed HCC lesions were en-rolled. Patients were classified into well-differentiated (grade I–II, n = 24) and poorly differentiated (grade III–IV, n = 51) groups according to the Edmondson–Steiner system. MRI was performed on a 1.5-T scanner and included T1-weighted in-phase/opposed-phase imaging, T2-weighted imaging, diffu-sion-weighted imaging, and dynamic Gd-EOB-DTPA-enhanced sequences, in-cluding arterial, portal venous, transitional, and 20-min hepatobiliary phases. Two radiologists, blinded to pathology, assessed predefined imaging features, and the lesion-to-liver ratio (LLR) was measured. Group comparisons were per-formed using Student’s t-test, the Mann–Whitney U test, and the chi-square or Fisher’s exact test, followed by multivariable logistic regression and ROC analy-sis with 500 bootstrap resamples. Results: Compared with well-differentiated HCC, poorly differentiated HCC showed a higher frequency of peritumoral hepatobiliary phase (HBP) hypointensity (62.7% vs. 4.2%, p < 0.001) and peritu-moral arterial hyperintensity (39.2% vs. 0%, p < 0.001). In multivariable analysis, peritumoral HBP hypointensity remained independently associated with poorly differentiated HCC (OR = 30.89, p = 0.002). The 2-parameter MRI model, includ-ing peritumoral HBP hypointensity and HBP tumour signal, yielded an AUC of 0.84. The combined MRI + ALBI + AFP model showed the highest discriminative performance, with an AUC of 0.87 and an accuracy of 78.7%. Conclusions: Con-clusions: Gd-EOB-DTPA-enhanced MRI features, particularly peritumoral HBP hypointensity, were associated with high histologic grade in HCC. In this cohort, combining MRI features with ALBI grade and AFP yielded higher discriminative performance than the MRI-only model. These findings may support preoperative histologic risk stratification, although external validation is required.