Clinical and Experimental Hepatology
eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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abstract:
Original paper

Associations between diffusion-weighted imaging and immunohistochemical features in hepatocellular carcinoma: a preliminary analysis of tumor-infiltrating lymphocytes and microvessel density expression

Daniele Romeo
1, 2
,
Theresa Richter
1
,
Anne-Kathrin Höhn
3
,
Hans Michael Tautenhahn
4
,
Daniel Seehofer
4
,
Uwe Scheuermann
4
,
Timm Denecke
1
,
Hans-Jonas Meyer
1

  1. Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
  2. Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
  3. Department of Pathology, University of Leipzig, Leipzig, Germany
  4. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
Clin Exp HEPATOL 2025; 11, 4
DOI: https://doi.org/10.5114/ceh.2025.155477
Online publish date: 2025/11/13
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Introduction
Imaging modalities can predict histopathological characteristics of tumors such as cellularity and proliferation potential, which has also been shown for hepatocellular carcinoma (HCC). Diffusion-weighted imaging can reflect cellularity of tumors and provide apparent diffusion coefficient (ADC) values as a quantitative imaging marker. This analysis elucidates possible associations between ADC values and several immunohistochemical features of HCC.

Material and methods
A cohort of 25 patients (4 female; 16%) with a mean age of 63 ±8.9 years met the inclusion criteria of this analysis. The main inclusion criteria were the availability of an MRI pre-interventional examination within 9 months before surgery and the availability of the histopathologic analysis. Immunohistochemical features included programmed cell death-ligand 1 (PD-L1) scores (immune cell score [ICS], tumor proportion score [TPS], and combined positive score [CPS]), glypican-3, tumor-infiltrating lymphocytes (TIL), stroma infiltrating lymphocytes (SIL), CD68 positive cells and microvessel density (MVD). ADC values were measured as ADCmax, ADCmean, and ADCmin.

Results
CD3+ TIL showed a moderate inverse correlation with ADCmax (r = –0.50, p = 0.01), ADCmean (r = –0.52, p = 0.008). CD34+ MVD showed higher expression in the group that showed diffusion restriction (mean 40 ±10.8 vs. 54 ±5.5, p = 0.0046). There was no correlation between ADC values and CD68+ positive cells, PDL-1, glypican-3 expression, or CD3+ SIL.

Conclusions
The present analysis demonstrated an inverse correlation between CD3-positive tumor-infiltrating lymphocytes and ADCmean and ADCmax. Diffusion restriction is correlated with increased microvessel density in HCC. ADC values could help to better characterize the tumor microenvironment of HCC in a non-invasive manner.

keywords:

HCC, DWI, tumor microenvironment, diffusion restriction
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