Objective To predict the postoperative recurrence of hepatocellular carcinoma (HCC) by using morphological and quantitative features of gadoxetic acid-enhanced magnetic resonance imaging (MRI).

Methods It was a retrospective study that included 88 patients with preoperative gadoxetic acid-enhanced MRI and confirmed as HCC (less than 3 cm in diameter) by histology. Multivariate analysis was used to screen significant imaging features associated with recurrence.

Results In the quantitative analysis, the postcontrast relative intensity ratio (RIR) and the contrast enhancement ratio (CER) of HCC were significantly correlated with the grade of HCC and postoperative recurrence (P < 0.05). In the multivariate Cox regression analysis, irregular tumor border during the hepatobiliary phase (HR=4.07, P=0.001) and lower tumor CER (HR=0.97, P=0.014) were independently associated with tumor recurrence. In patients with irregular tumor border, the recurrence rate was higher than those with smooth tumor border (P=0.002). In patients with lower CER, the recurrence rate was higher than that in patients with higher CER (P < 0.001).

Conclusions For gadoxetic acid-enhanced MRI, the irregular tumor border during the hepatobiliary phase and lower tumor contrast enhancement rate are significantly associated with postoperative recurrence of HCC patients.