{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T03:44:51Z","timestamp":1782704691395,"version":"3.54.5"},"reference-count":25,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: The histologic grade is an important prognostic factor in hepatocellular carcinoma (HCC). A Gd-EOB-DTPA-enhanced MRI may provide noninvasive imaging markers related to tumour differentiation. This study aimed to evaluate the association of Gd-EOB-DTPA-enhanced MRI features, together with the albumin\u2013bilirubin (ALBI) score and alpha-fetoprotein (AFP), with the HCC histologic grade and to assess the performance of combined predictive models. Methods: In this prospective cross-sectional study, 75 patients (mean age, 56.4 years; 66 men) with 88 histopathologically confirmed HCC lesions were enrolled. Patients were classified into well-differentiated (grades I\u2013II, n = 24) and poorly differentiated (grades III\u2013IV, n = 51) groups according to the Edmondson\u2013Steiner system. The MRIs were performed on a 1.5-T scanner and included T1-weighted in-phase\/opposed-phase imaging; T2-weighted imaging; diffusion-weighted imaging; and dynamic Gd-EOB-DTPA-enhanced sequences, including arterial, portal venous, transitional, and 20 min hepatobiliary phases. Two radiologists, blinded to the pathology, assessed predefined imaging features, and the lesion-to-liver ratio (LLR) was measured. Group comparisons were performed using Student\u2019s t-test, a Mann\u2013Whitney U test, and a chi-square or Fisher\u2019s exact test, followed by a multivariable logistic regression and ROC analysis with bootstrap resampling. 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 &lt; 0.001) and peritumoral arterial hyperintensity (39.2% vs. 0%, p &lt; 0.001). In the multivariable analysis, peritumoral HBP hypointensity remained independently associated with poorly differentiated HCC (OR = 30.89, p = 0.002). The two-parameter MRI model, including peritumoral HBP hypointensity and HBP tumour signal, yielded an AUC of 0.84. The combined MRI + ALBI + AFP model yielded an AUC of 0.87 and an accuracy of 78.7%, representing only a small exploratory improvement over the two-parameter MRI model (AUC = 0.84) in this cohort. Conclusions: Gd-EOB-DTPA-enhanced MRI features, particularly peritumoral HBP hypointensity, were associated with a high histologic grade in HCC. In this surgically treated, predominantly HBV-related cohort with mostly preserved liver function, these findings provide a preliminary basis for preoperative histologic risk stratification; however, they remain exploratory and require external validation in larger, more diverse cohorts before broader clinical application.<\/jats:p>","DOI":"10.3390\/diagnostics16132018","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:16:44Z","timestamp":1782699404000},"page":"2018","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gd-EOB-DTPA-Enhanced MRI Combined with ALBI Score and AFP for Predicting Histologic Grade in Hepatocellular Carcinoma: A Multicentre Study from Vietnam"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4001-710X","authenticated-orcid":false,"given":"Van Hung","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Diagnostic Imaging, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Department of Diagnostic Imaging, Thai Binh University of Medicine and Pharmacy, Hung Yen 17000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6493-3411","authenticated-orcid":false,"given":"Dang Luu","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Institute of Radiology and Intervention, Bach Mai Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"The Anh","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary-Pancreatic Surgery, K Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong Long","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Gastroenterology-Hepatology Center, Bach Mai Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Van Khang","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Institute of Radiology and Intervention, Bach Mai Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0951-4628","authenticated-orcid":false,"given":"Ngoc Trung","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Thai Binh University of Medicine and Pharmacy, Hung Yen 17000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0828-5643","authenticated-orcid":false,"given":"Le Minh","family":"Vu","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Center, K Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ham Hoi","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Digestive Surgery Center, Bach Mai Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA A Cancer J. 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