Association of steatotic liver disease with tumour burden and MRI features in hepatocellular carcinoma: a retrospective comparative study

To investigate the associations of steatotic liver disease (SLD) with the clinical characteristics, tumour burden at diagnosis, and major magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC). This retrospective study included 130 patients with pathologically confirmed hepatocellular carcinoma who underwent preoperative MRI. Clinical characteristics, tumour burden, and MRI features were compared between patients with and without SLD. Interobserver agreement was assessed using intraclass correlation coefficients and Cohen’s κ statistics. The Benjamini–Hochberg procedure was used to control the false discovery rate across multiple comparisons of MRI features. Univariate and multivariable logistic regression analyses were performed to evaluate the association between concurrent SLD and a maximum tumour diameter > 5 cm, with adjustment for age, sex, cirrhosis, alcohol consumption, and hepatitis B surface antigen status in the multivariable model. Patients with concurrent steatotic liver disease (SLD) had a significantly larger maximum tumour diameter than those without SLD (6.30 cm vs. 3.65 cm; P = 0.007) and a higher proportion of tumours with a maximum diameter > 5 cm (60.0% vs. 33.0%; P = 0.011). After adjustment for age, sex, cirrhosis, alcohol consumption, and hepatitis B surface antigen status, SLD remained independently associated with a maximum tumour diameter > 5 cm. An exploratory MRI-defined high tumour burden was also more frequent in the SLD group (73.3% vs. 48.0%; OR = 2.98, 95% CI: 1.21–7.32; P = 0.021). Regarding metabolic characteristics, patients with SLD had a higher prevalence of hypertension and higher γ-glutamyl transferase and triglyceride levels ( P < 0.05). None of the conventional MRI features remained statistically significant after false discovery rate correction. Concurrent SLD in patients with HCC may be associated with a greater tumour burden at diagnosis, characterised by a larger tumour diameter and a higher MRI-defined tumour burden, while the major LI-RADS diagnostic features appear to remain unchanged.