Preoperative Gadoxetic-Acid-Enhanced MRI Features Associated with Rapid Recurrence (<6 Months) After Curative Resection for Hepatocellular Carcinoma

Background/Objectives: To evaluate the incidence of rapid recurrence within 6 months of curative resection for hepatocellular carcinoma (HCC) and to identify preoperative gadoxetic-acid-enhanced MRI features associated with rapid recurrence (<6 months) in the entire cohort. Methods: This retrospective study included 200 patients who underwent curative resection for HCC and had preoperative gadoxetic-acid-enhanced MRI between January 2016 and December 2023. Patients were categorized into a rapid recurrence group (n = 21) and a non-rapid recurrence group (n = 179). Preoperative MRI features, including tumor size, multiplicity, tumor margin, arterial peritumoral enhancement, peritumoral hepatobiliary phase (HBP) hypointensity, diffusion restriction, apparent diffusion coefficient (ADC) values, and presence of non-hypervascular hepatobiliary phase hypointense nodule (NHHN), were evaluated. Univariate and multivariate Firth penalized logistic regression analyses were performed. Results: Rapid recurrence occurred in 10.5% (21/200) of patients (median, 4.0 months). Multivariate analysis revealed that larger tumor size (odds ratio OR, 1.25 per 1-cm increase; p = 0.012) and the presence of NHHN (OR, 11.30; p < 0.001) were independent predictors of rapid recurrence. A nomogram incorporating these features demonstrated excellent discriminative performance, with a bootstrap-corrected area under the curve (AUC) of 0.864 (95% CI, 0.791–0.922). Conclusions: The presence of NHHN and larger tumor size on preoperative MRI were associated with rapid recurrence (<6 months) after curative resection for HCC. These findings may provide additional support for preoperative risk stratification and the planning of postoperative surveillance strategies.