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Imaging patterns on contrast-enhanced CT indicating malignant behavior and aggressive growth patterns are potential biomarkers for predicting hepatocellular carcinoma (HCC) recurrence, according to findings published in the Journal of Hepatocellular Carcinoma. Osman Öcal, MD, and colleagues retrospectively studied 178 patients with HCC who underwent a liver transplant to determine the value of CT-derived imaging biomarkers. HCC recurrence following liver transplant was seen in 31 of 178 patients (17.4%), and multivariable regression analysis identified six independent predictors associated with a higher risk for HCC recurrence: peritumoral enhancement, more than three tumor lesions, a largest tumor diameter of more than 3 centimeters, serum alpha-fetoprotein levels of more than 400 ng/mL, and the presence of a tumor capsule. A history of bridging therapies was associated with a lower risk for recurrence. The nomogram performed well, with a C-index of 0.835 and AUC values for predicting time to recurrence of 0.86 at 1 year, 0.88 at 3 years, and 0.85 at 5 years.