European Radiology

, Volume 29, Issue 1, pp 373–382 | Cite as

Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging

  • Sun Kyung Jeon
  • Ijin JooEmail author
  • Dong Ho Lee
  • Sang Min Lee
  • Hyo-Jin Kang
  • Kyoung-Bun Lee
  • Jeong Min Lee



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.

Key Points

• 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.


Liver neoplasms Magnetic resonance imaging Gadolinium ethoxybenzyl DTPA 



Combined hepatocellular cholangiocarcinoma


Gadoxetic acid-enhanced magnetic resonance imaging


Liver Imaging Reporting and Data System


Probably HCC


Definitely HCC


Probably or definitely malignant, not HCC specific


Recurrence-free survival



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.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

This retrospective study performed at one institution was approved by the Institutional Review Board of Seoul National University Hospital.


• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5605_MOESM1_ESM.docx (64 kb)
ESM 1 (DOCX 64 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologySeoul National University HospitalSeoulKorea
  2. 2.Department of RadiologySeoul National University College of MedicineSeoulKorea
  3. 3.Department of RadiologyHallym University Sacred Heart HospitalAnyangKorea
  4. 4.Department of PathologySeoul National University HospitalSeoulKorea
  5. 5.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulKorea

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