Diagnostic Performance of Multimodality Imaging for Detecting Recurrent Hepatocellular Carcinoma Following Transarterial Chemoembolization in Geriatric Patients: A Retrospective Cohort Study.

Abstract

Background:

Recurrence after transarterial chemoembolization (TACE) remains a major challenge in hepatocellular carcinoma (HCC), especially in older adults, where comorbidities and post-treatment imaging changes complicate surveillance. This study evaluated multimodality imaging for detecting recurrent HCC after TACE in geriatric patients and identified predictors of recurrence.

Methodology:

This retrospective cohort study included patients aged ≥65 years with HCC who underwent TACE between January 2018 and December 2025 at a tertiary care center. Follow-up imaging included multiphasic contrast-enhanced CT, MRI with diffusion-weighted imaging (DWI), and PET/CT when clinically indicated. Recurrence was confirmed using serial imaging, multidisciplinary tumor board consensus, clinical assessment, retreatment decisions, and histopathology when available. Diagnostic accuracy was assessed using sensitivity, specificity, and AUC. Multivariable Cox regression identified predictors of recurrence.

Results:

A total of 180 patients were included, with a mean age of 72.4 ± 5.6 years; 68.3% were male. During a median follow-up of 24 months, recurrence occurred in 78 patients (43.3%). MRI with DWI showed the best diagnostic performance, with sensitivity of 91.0%, specificity of 88.2%, and AUC of 0.92, outperforming CT, which showed sensitivity of 76.9% and AUC of 0.78. Multimodality imaging improved diagnostic confidence by reducing false positives caused by lipiodol deposition and inflammatory post-treatment changes. Tumor size >5 cm and multifocal disease were independent predictors of recurrence.

Conclusion:

MRI with DWI demonstrated superior accuracy to conventional CT for detecting recurrent HCC after TACE in geriatric patients. Multimodality imaging may enhance surveillance and reduce diagnostic uncertainty. Prospective multicenter studies are needed to validate standardized imaging strategies for elderly patients with HCC.