Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging
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To investigate the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2017 for combined hepatocellular cholangiocarcinoma (cHCC-CCA) in the differential diagnosis from hepatocellular carcinoma (HCC) and prediction of prognosis on gadoxetic acid-enhanced MRI (Gd-EOB-MRI).
Patients at high risk of HCC with pathologically confirmed cHCC-CCAs (n = 70) and a matched control of HCCs (n = 70) who had undergone Gd-EOB-MRI were included. LI-RADS category was assigned for each lesion by two radiologists. Imaging features and surgical outcomes were compared between cHCC-CCAs of LR-M and LR-5/4 using the χ2 test or Fisher’s exact test. Recurrence-free survival (RFS) was estimated using Kaplan–Meier survival curves and compared using the log-rank test.
cHCC-CCAs and HCCs were categorised as LR-M, LR-5/4 and LR-TIV in 61.4% (43/70), 37.1% (26/70) and 1.4% (1/70) and 10.0% (7/70), 88.6% (62/70) and 1.4% (1/70), respectively. cHCC-CCAs of LR-5/4, in comparison to LR-M, showed significantly higher frequencies of major HCC features: arterial hyperenhancement (96.2% (25/26) vs. 58.1% (25/43), p = 0.001), washout appearance (80.8% (21/26) vs. 48.8% (21/43), p = 0.011) and enhancing capsule (34.6% (9/26) vs. 11.6% (5/43), p = 0.031). After curative surgery, patients with cHCC-CCAs of LR-M showed a higher early recurrence rate (≤ 6 months) than did those with LR-5/4 (27.8% (10/36) vs. 4.8% (1/21), p = 0.041), whereas no significant difference was observed in RFS (log-rank p = 0.084).
By using LI-RADS on Gd-EOB-MRI, a substantial proportion of cHCC-CCAs can be categorised as non-LR-M. In addition, cHCC-CCAs mimicking HCCs on imaging (LR-5/4) may indicate better surgical outcomes with regard to early recurrence than those of LR-M.
• cHCC-CCAs can be categorised as either LR-M or non-LR-M on Gd-EOB-MRI.
• cHCC-CCAs of LR-5/4 frequently demonstrate major HCC imaging features.
• LI-RADS categorisation may provide prognostic information after surgery in cHCC-CCAs.
KeywordsLiver neoplasms Magnetic resonance imaging Gadolinium ethoxybenzyl DTPA
Combined hepatocellular cholangiocarcinoma
Gadoxetic acid-enhanced magnetic resonance imaging
Liver Imaging Reporting and Data System
Probably or definitely malignant, not HCC specific
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Ijin Joo.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the institutional review board.
This retrospective study performed at one institution was approved by the Institutional Review Board of Seoul National University Hospital.
• case-control study
• performed at one institution
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