Abstract: Objective This study was to summarize enhanced magnetic resonance imaging (MRI) features of patients with biphenotypic hepatocellular carcinoma (BPHCC). Methods 50 patients with BPHCC were encountered in our hospital between January 2019 and October 2023, and the diagnosis and pathological microvascular invasion (pMVI) were determined by histo-pathological examination. All patients underwent gadolinium disulfide (Gd-EOB-DTPA) enhancement scan to record signal intensity ratio in arterial phase (SIR-AP), signal intensity ratio in portal venous phase (SIR-PP), signal intensity ratio in transitional phase (SIR-EP), signal intensity ratio in hepatobiliary phase (SIR-HBP) and contrast enhancement ratio in arterial phase (CER-AP). Multivariate Logistic regression analysis was applied to find factors that hinted pMVI positive. Results Well-differentiated and pMVI negative BPHCC presented as lesions with distinct edges on MRI, heterogeneous enhancement in arterial phase and low signals in hepatobiliary phase, while poorly-differentiated and pMVI positive tumors exhibited large tumor volume, vague edges, peri-tumor enhancement in arterial phase, with low signals in portal and in equilibrium phase; of the 50 patients with BPHCC, histo-pathological examination found pMVI positive in 14 cases and pMVI negative in 36 cases; serum alpha-fetoprotein (AFP) level, tumor size, percentages of Edmondson-Steiner stage Ⅲ, peri-tumor enhancement in arterial phase and Mosaic signs in pMVI positive tumor were (421.2±123.7)ng/ml, (7.1±0.9)cm, 42.9%, 42.9% and 35.7%, all much greater or higher than [(311.6±127.6)ng/ml, (3.8±0.6)cm, 19.4%, 11.1% and 19.4%, respectively, P＜0.05] in pMVI negative tumor; SIR-PP and SIR-EP in pMVI positive tumor were (0.8±0.2) and (0.8±0.2), both significantly lower than [(1.1±0.2) and (1.0±0.1), respectively, P＜0.05] in pMVI negative tumor; multivariate Logistic regression analysis showed that SIR-PP[OR: 2.7(95％ CI:1.2-6.2)] and peri-tumor enhancement in arterial phase [OR: 3.6(95％ CI:1.4-9.6)] were the independent factors suggesting pMVI positive in patients with BPHCC(P＜0.05). Conclusion We don’t find special imaging features of patients with BPHCC, who might have early pMVI positive lesions, which needs further studies pathologically and clinically.

Key words: Biphenotypic hepatocellular carcinoma, Disodium gadolinate, Magnetic resonance imaging, Signal intensity ratio in portal venous phase, Signal intensity ratio in transitional phase, Microvascular invasion, Differentiation