Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: Differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging

Abstract

Accurate preoperative differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in the setting of cirrhotic liver is of great clinical significance because the treatment and prognosis of these entities differ markedly. Through a retrospectively research, we sought to determine the diagnostic performances of intravoxel incoherent motion (IVIM) and diffusion weighted imaging (DWI) parameters in the differentiating of ICC and HCC. According to the results, we found that apparent diffusion coefficient (ADC) derived from mono-exponential model and true ADC (ADCslow) derived from bi-exponential model can be used to distinguish the ICC and HCC, and ADCslowentailed the higher diagnostic performance than ADC. However, pseudo-ADC (ADCfast) and perfusion fraction (f) can not be used to differentiate ICC and HCC. These results suggested that IVIM and DWI parameters can be useful in differentiating ICC and HCC and might be helpful in selecting the treatment plan and predicting prognosis.

Intravoxel incoherent motion diffusion-weighted imaging to differentiate hepatocellular carcinoma from intrahepatic cholangiocarcinoma

“…Data obtained from our study found significant differences among some of the IVIM-DWI parameters, including ADC, D slow , and D fast between HCC and ICC. The ADC and D slow of HCC tissues were obviously lower than those of ICC tissues, which is consistent with the results reported by Choi 17 and Wei et al 38 . The D fast value of HCC tissues was significantly higher than that of ICC tissues, which may be associated with the rich blood supply inherent to HCC, while the blood supply of ICC is poor 39 .…”

“…The D fast value of HCC tissues was significantly higher than that of ICC tissues, which may be associated with the rich blood supply inherent to HCC, while the blood supply of ICC is poor 39 . This result was not observed by Wei et al 38 . The differential efficacy of D fast for malignant hepatic nodules with different pathological features is higher than those of the ADC and D slow , suggesting that D fast can better reflect the changes in the tissue microstructure compared to the ADC and D slow .…”

“…The application of IVIM-DWI to identify benign and malignant hepatic nodules has been proven to be important by previous researchers [10][11][12][13][14][15][16][17][18] . However, studies on the differential diagnosis of malignant hepatic nodules with different pathological properties by IVIM-DWI are very limited 10,17,38 . Watanabe H et al 12 performed IVIM-DWI scans on a total of 120 hepatic nodules in 74 patients.…”

“…Among all of the parameters used to identify malignant nodules, D slow displayed the largest AUC, and there were significant positive correlations between the f value and the enhancement fraction and between the f value and the relative enhancement. A study by Wei et al 38 found that the ADC and D slow can be beneficial for the differential diagnosis of HCC and ICC. D slow showed a better discriminatory ability than the ADC, whereas D fast and f displayed no differentiating power for ICC and HCC.…”

Hepatitis B virus-Associated Intrahepatic Cholangiocarcinoma Has Distinct Clinical, Pathological and Radiological Characteristics: A Systematic Review

“…This phenomenon would be attributable to the changes in circulatory patterns due to portal hypertension, but there is limited information available on these possible changes in the literature. One way to differentiate between HBV-positive ICCs and HCCs is the use of apparent diffusion coefficient (ADC) derived from a mono-exponential model using diffusion weighted imaging (DWI) in MRI, but this method requires specific DWI imaging and is subject to further validation (68). Further research is needed to understand more on distinct radiological patterns on ICC tumours under the influence of HBV infection and cirrhosis.…”