Abstract: Objective The aim of this study was to investigate magnetic resonance imaging (MRI) features impacting recurrence of tumor in patients with hepatocellular carcinoma (HCC) after hepatectomy. Methods 58 patients with HCC were encountered in our hospital between June 2022 and June 2025, and all underwent hepatectomy after gadoxetic acid disodium-enhanced MRI scan. Patients were followed-up until February 2026. Relative intensity ratio (RIR) was calculate based on MRI. Cytokeratin 19 (CK19) expression was detected by immunochemical staining. Multivariate Logistic regression analysis was applied to find impacting factors for tumor recurrence. Results By end of follow-up, intrahepatic tumor recurrence was found in 23 cases (39.7%) in our series; baseline serum protein induced by vitamin K absence or antagonist-II (PIVKA-II), alpha fetoprotein levels, diameters of tumors, poor histological differentiation, CK19 positive rate and percentage of T2N0M0 in tumor recurrence group were significantly higher or greater than in non-recurrence group (P＜0.05); RIR at hepatobiliary phase was (0.5±0.2), much lower than [(0.7±0.1),P<0.05] in non-recurrence group; multivariate Logistic regression analysis showed that serum PIVKA-II, poor differentiation, TNM staging, mosaic pattern and peritumoral hypointensity at hepatobiliary phase were all the independent risk factors, while RIR at hepatobiliary phase was the independent protective factor(P＜0.05) for tumor recurrence. Conclusion Gadoxetic acid disodium-enhanced MRI features in combination with clinical materials could help predict tumor recurrence in patients with HCC after hepatectomy, which might guide individualized surveillance strategies.

Key words: Hepatoma, Gadoxetic acid disodium-enhanced magnetic resonance imaging, Hepatectomy, Tumor recurrence, Risk factors