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–bilirubin (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–II, n = 24) and poorly differentiated (grades III–IV, n = 51) groups according to the Edmondson–Steiner 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’s t-test, a Mann–Whitney U test, and a chi-square or Fisher’s 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 < 0.001) and peritumoral arterial hyperintensity (39.2% vs. 0%, p < 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.

Background/Objectives: Vietnamese evidence on transarterial chemoembolization (TACE) plus lenvatinib for unresectable hepatocellular carcinoma (HCC) remains limited. We examined recorded early imaging responses and uncertainty from missing outcomes, exposure classification, and confounding. Methods: This single-center secondary cohort included all eligible available records during a shared post-approval period (21 February 2024–19 August 2025). The endpoint was a documented complete or partial response according to the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) at the first recorded post-index computed tomography (CT) or magnetic resonance imaging (MRI), an ascertainment-dependent surrogate rather than a standardized clinical-trial objective response rate. We reported risk differences (RDs), risk ratios (RRs), odds ratios (ORs), 95% confidence intervals (CIs), nonparametric bounds, tipping-point analysis, sequential models, and a comparator co-therapy audit. Results: Among 108 patients (23 combination; 85 comparator), recorded responses occurred in 17/23 (73.9%) and 30/85 (35.3%): RD, 38.6 percentage points (95% CI, 18.0–59.2); RR, 2.09 (95% CI, 1.44–3.05); and OR, 5.19 (95% CI, 1.85–14.57). With 6 and 34 undocumented outcomes, response-difference bounds ranged from −1.4 to 64.7 percentage points. Reclassifying 12 undocumented comparator outcomes as responses made Fisher’s p-value exceed 0.05; reclassifying 33 eliminated the point-estimate advantage when all six undocumented combination outcomes were nonresponses. The expanded complete-case estimate was attenuated (adjusted OR, 1.97; 95% CI, 0.45–8.60). Excluding five comparator records with explicit systemic co-therapy yielded an adjusted OR of 5.49 (95% CI, 1.93–15.61). Safety incidence and survival were not estimable. Conclusions: Recorded responses differed between strategies, but missingness, imaging ascertainment, treatment-selection confounding, and incompletely characterized comparator exposure prevented identification of a comparative treatment effect. This study identifies registry and implementation gaps and generates a hypothesis for prospective modified RECIST (mRECIST)-based evaluation.

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.