Capsule, septum, and T2 hyperintense foci for differentiation between large hepatocellular carcinoma (≥5 cm) and intrahepatic cholangiocarcinoma on gadoxetic acid MRI

Hwang, Jiyoung; Kim, Young Kon; Min, Ji Hye; Choi, Sung Yong; Jeong, Woojin; Hong, Seong Sook; Kim, Hyun‐Joo; Ahn, Soohyun; Ahn, Hyeon Seon

doi:10.1007/s00330-017-4846-4

Cited by 24 publications

(28 citation statements)

References 34 publications

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“…Reviewers were blinded to clinical details, pathological results, as well as DWI findings. Diagnoses were made using the following five‐point scale (see Supplementary Material) : 1, probably HCC (S1); 2, possibly HCC (S2); 3, indeterminate (S3); 4, possibly IMCC (S4); and 5, probably IMCC (S5). Categories can be adjusted according to the presence of some imaging features in T 1 WI and T 2 WI.…”

Section: Methodsmentioning

confidence: 99%

Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass‐Forming Cholangiocarcinoma From Hepatocellular Carcinoma

Zou

Luo

et al. 2018

Magnetic Resonance Imaging

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Background: Accurate differentiation between intrahepatic mass-forming cholangiocarcinoma (IMCC) and hepatocellular carcinoma (HCC) is needed because treatment and prognosis differ significantly. Purpose: To explore whether volumetric apparent diffusion coefficient (ADC) histogram analysis can provide additional value to dynamic enhanced MRI in differentiating IMCC from HCC. Study Type: Retrospective. Population: In all, 131 patients with pathologically proven IMCC (n = 33) or HCC (n = 98). Field Strength/Sequence: 3.0T MRI/conventional T 1 -weighted imaging (T 1 WI), T 2 WI, and diffusion-weighted imaging (DWI) with b value of 800 sec/mm 2 , dynamic enhanced MRI with gadobenate dimeglumine. Assessment: Dynamic enhanced MR images were analyzed by two independent reviewers using a five-point scale to determine the diagnosis. Volumetric ADC assessments were performed independently by two radiologists to obtain different histogram parameters for each lesion. Quantitative histogram parameters were compared between the IMCC group and HCC group. Diagnostic performance of dynamic enhanced MRI, volumetric ADC histogram analysis, and the combination of both were analyzed. Statistical Tests: Intraclass correlation coefficient (ICC) analysis, independent Student's t-test, or Mann-Whitney U-test, receiver operator characteristic (ROC) curves analysis, and McNemar test. Results: The sensitivity and specificity for dynamic enhanced MRI to differentiate IMCC from HCC were 82.1% and 82.6%, respectively. For all volumetric ADC histogram parameters, the 75th percentile ADC (ADC 75% ) had the highest AUC (0.791) in differentiating IMCC from HCC, with sensitivity and specificity of 69.7% and 77.6%, respectively. When combining dynamic enhanced MRI with ADC 75% , the sensitivity and specificity were 82.1% and 91.9%, respectively. Compared to dynamic enhanced MRI alone, the specificity for combined dynamic enhanced MRI and ADC 75% was significantly increased (P = 0.008). Data Conclusion: Volumetric ADC histogram analysis provides additional value to dynamic enhanced MRI in differentiating IMCC from HCC. Level of Evidence: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2019;49:975-983. View this article online at wileyonlinelibrary.com.

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Section: Methodsmentioning

confidence: 99%

Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass‐Forming Cholangiocarcinoma From Hepatocellular Carcinoma

Zou

Luo

et al. 2018

Magnetic Resonance Imaging

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“…On the other hand, central ischemia or necrosis in biologically aggressive tumors such as poorly differentiated HCCs or sarcomatoid HCCs may also result in the targetoid appearance (394041). In addition, large HCCs (≥ 5 cm) also frequently show the targetoid appearance on imaging studies due to heterogeneous internal contents, including necrotic content (4243).…”

Section: Hccs With Atypical Imaging Featuresmentioning

confidence: 99%

“…In a similar vein, large HCCs (≥ 5 cm) often show relatively large amount of necrosis and hemorrhage in their internal contents. Consequently, large HCCs could show LR-M (probably or definitely malignant but not HCC specific) features such as peripheral enhancement with centripetal fill-in on CT or MRI (4243). Hwang et al (43) demonstrated that capsule, septum, and T2 hyperintense foci were more frequently observed in large HCCs than in ICCs on gadoxetic acid-enhanced MRI.…”

Section: Hccs With Atypical Imaging Featuresmentioning

confidence: 99%

“…Consequently, large HCCs could show LR-M (probably or definitely malignant but not HCC specific) features such as peripheral enhancement with centripetal fill-in on CT or MRI (4243). Hwang et al (43) demonstrated that capsule, septum, and T2 hyperintense foci were more frequently observed in large HCCs than in ICCs on gadoxetic acid-enhanced MRI. They also commented that biliary dilatation and surface retraction were less frequently identified in large HCCs than in ICCs (43).…”

Section: Hccs With Atypical Imaging Featuresmentioning

confidence: 99%

“…Hwang et al (43) demonstrated that capsule, septum, and T2 hyperintense foci were more frequently observed in large HCCs than in ICCs on gadoxetic acid-enhanced MRI. They also commented that biliary dilatation and surface retraction were less frequently identified in large HCCs than in ICCs (43).…”

Section: Hccs With Atypical Imaging Featuresmentioning

confidence: 99%

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Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging

2019

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Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.

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Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

et al. 2020

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Objective To establish nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). Methods A cohort of 422 patients with HCC or ICC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent differential factors. Through combining these independent differential factors, a nomogram was established for differential diagnosis between ICC and HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The results were validated using a prospective study on 98 consecutive patients operated on from January 2019 to November 2019 at the same institution. Results Sex (OR = 9.001, 95% CI: 3.268‐24.792, P < .001), hepatitis (OR = 0.323, 95% CI: 0.121‐0.860, P = .024), alpha‐fetoprotein (AFP) (OR = 0.997, 95% CI: 0.995‐1.000, P = .046), carbohydrate antigen 19‐9 (CA199) (OR = 1.016, 95% CI: 1.007‐1.025, P < .001), and aspartate transaminase‐to‐neutrophil ratio index (ANRI) (OR = 0.904, 95% CI: 0.843‐0.969, P = .004) were the independent differential factors for ICC. Nomogram was established with well‐fitted calibration curves through incorporating these 5 factors. Comparing model 1 including gender, hepatitis, AFP, and CA199 (C index = 0.903, 95% CI: 0.849‐0.957) and model 2 enrolling AFP and CA199 (C index = 0.850, 95% CI: 0.791‐0.908), the nomogram showed a better discrimination between ICC and HCC, with a C index of 0.920 (95% CI, 0.872‐0.968). The results were consistent in the validation cohort. DCA also confirmed the conclusion. Conclusion A nomogram was established for the differential diagnosis between ICC and HCC preoperatively, and better therapeutic choice would be made if it was applied in clinical practice.

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Capsule, septum, and T2 hyperintense foci for differentiation between large hepatocellular carcinoma (≥5 cm) and intrahepatic cholangiocarcinoma on gadoxetic acid MRI

Abstract: • Capsule, septum, and T2 hyperintense foci were useful for characterizing large HCC. • Adding ancillary features to enhancement pattern increased accuracy for diagnosing large HCC. • Interobserver agreement was substantial to excellent for ancillary features.

Cited by 24 publications

References 34 publications

Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass‐Forming Cholangiocarcinoma From Hepatocellular Carcinoma

Volumetric Apparent Diffusion Coefficient Histogram Analysis in Differentiating Intrahepatic Mass‐Forming Cholangiocarcinoma From Hepatocellular Carcinoma

Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging

Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

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