背景：HBP期周围肝胆固醇相( HBP)低信号已经成为肝细胞癌（HCC）的一种已知的预后影像学特征，往往与微血管入侵（MVI）相关。需要类似的非HBP MRI预后特征。 目的：提出一种非肝胆固醇特异性MRI工具，具有与周围肝胆固醇HBP低信号类似的预后价值。 材料和方法：从2011年12月至2021年11月，连续入选行术前增强MRI检查的HCC患者，并随访至复发。所有MRI扫描由7年和10年具有肝脏MRI经验的两个盲评放射科医师进行评估。通过多元逻辑回归在分层抽样的EOB组训练集中确定与HBP低信号高度相关的非肝胆固醇特异性特征评分系统，并评估它们对于预测MVI和无复发生存期（RFS）的价值。 结果：共有660名患者（男性551例；中位年龄53岁；IQR为45-61岁）被纳入研究。 HBP期门静脉期低增强（OR=8.8），不完全的”胶囊”（OR=3.3），冠状强化（OR=2.6）和周围轻度-中度T2高信号（OR=2.2）(所有P <0.001)与周围肝胆固醇HBP低信号相关，并构成了“VICT2特征”（测试集下的受试者操作特征曲线下面积为0.84；95％CI：0.78,0.90）。对于EOB组，尽管VICT2对MVI的特异性更高(89% vs 80%，P = 0.01)，但是HBP期周围肝胆固醇相低信号（OR为MVI=2.5，P = 0.02；RFS的风险比为2.5，P <0.001）和VICT2特征（OR for MVI=5.1，P <.001；RFS的风险比为2.3，P <0.001）与MVI和RFS有关联。这些VICT2特征在除颗粒状二氧化钆组外的细胞外对比剂组中得到证实（MVI的OR=4.0;RFS的风险比为1.7，都为P <0.001）。 结论：基于四种非肝胆固醇特异性MRI特征，VICT2特征预测肝细胞癌的微血管入侵和术后复发与周围肝胆固醇期低信号相当。 © RSNA，2023 此文中提供补充材料。另见Harmath编写的本期社论。

Background Peritumoral hepatobiliary phase (HBP) hypointensity is an established prognostic imaging feature in hepatocellular carcinoma (HCC), often associated with microvascular invasion (MVI). Similar prognostic features are needed for non-HBP MRI. Purpose To propose a non-hepatobiliary-specific MRI tool with similar prognostic value to peritumoral HBP hypointensity. Materials and Methods From December 2011 to November 2021, consecutive patients with HCC who underwent preoperative contrast-enhanced MRI were retrospectively enrolled and followed up until recurrence. All MRI scans were reviewed by two blinded radiologists with 7 and 10 years of experiences with liver MRI. A scoring system based on non-hepatobiliary-specific features that highly correlated with peritumoral HBP hypointensity was identified in a stratified sampling-derived training set of the gadoxetate disodium (EOB) group by means of multivariable logistic regression, and its values to predict MVI and recurrence-free survival (RFS) were assessed. Results There were 660 patients (551 men; median age, 53 years; IQR, 45-61 years) enrolled. Peritumoral portal venous phase hypoenhancement (odds ratio [OR] = 8.8), incomplete "capsule" (OR = 3.3), corona enhancement (OR, 2.6), and peritumoral mild-moderate T2 hyperintensity (OR, 2.2) (all P < .001) were associated with peritumoral HBP hypointensity and constituted the "VICT2 trait" (test set area under the receiver operating characteristic curve = 0.84; 95% CI: 0.78, 0.90). For the EOB group, both peritumoral HBP hypointensity (OR for MVI = 2.5, P = .02; hazard ratio for RFS = 2.5, P < .001) and the VICT2 trait (OR for MVI = 5.1, P < .001; hazard ratio for RFS = 2.3, P < .001) were associated with MVI and RFS, despite a higher specificity of the VICT2 trait for MVI (89% vs 80%, P = .01). These values of the VICT2 trait were confirmed in the extracellular contrast agent group (OR for MVI = 4.0; hazard ratio for RFS = 1.7; both P < .001). Conclusion Based on four non-hepatobiliary-specific MRI features, the VICT2 trait was comparable to peritumoral hepatobiliary phase hypointensity in predicting microvascular invasion and postoperative recurrence of hepatocellular carcinoma. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Harmath in this issue.