Intrahepatic Mass-forming Cholangiocarcinoma: Arterial Enhancement Patterns at MRI and Prognosis

Abstract

To identify whether arterial enhancement pattern at MRI could predict the prognosis after surgical resection of intrahepatic mass-forming cholangiocarcinoma (IMCC). Materials and Methods: Patients who underwent curative hepatic resection and preoperative MRI for IMCC from November 2007 to September 2016 were retrospectively evaluated. MRI enhancement pattern was classified by two radiologists. Recurrence and death data were retrieved until September 31, 2017. Prognostic factor analysis was performed by using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. Results: Data in 134 patients (median age, 63.0 years; 87 men and 47 women) were evaluated; median tumor size was 4.5 cm. Arterial phase MRI showed diffuse hypoenhancement in 33 patients, peripheral rim enhancement in 81 patients, and diffuse hyperenhancement in 20 patients. The 5-year risk of death in patients with IMCC with diffuse hyperenhancement was lower than that of patients with diffuse hypoenhancement or peripheral rim enhancement (5-year risk of death: 5.9% vs 87.9% vs 59.2%). Diffuse hypoenhancement (hazard ratio [HR], 41; 95% confidence interval [CI]: 5, 312; P , .01) and peripheral rim enhancement (HR, 11; 95% CI: 2, 85; P = .02) were associated with an increased risk of death compared with diffuse hyperenhancement. Patients with diffuse hyperenhancement of IMCCs had more frequent chronic liver disease (13 of 20; 65%), less frequent vascular invasion (six of 20; 30%), and less frequent tumor necrosis (three of 20; 15%) than other enhancement group (P , .05 for all). Conclusion: The MRI arterial enhancement pattern was a prognostic marker in the preoperative evaluation of patients with resectable intrahepatic mass-forming cholangiocarcinoma.

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

“…Favorable microvascular and macrovascular conduit in this study were associated with the best outcomes. In a retrospective study of patients with iCCA treated with resection, the 5-year risk of death in patients with diffuse tumor hyperenhancement per preoperative magnetic resonance imaging was lower when compared to tumors with either peripheral enhancement or diffuse hypoenhancement (5-year risk of death: 5.9% vs 59.2% vs 87.9%) [ 8 ]. Our study similarly identified hypoenhancement (unfavorable microvascular conduit) as a negative marker for survival with HR 5.7 (95% CI 1.1–28.9, p = 0.034).…”

“…Whether a similar dose relationship is present with cholangiocarcinoma remains unknown. Additionally, unresectable iCCA also presents with blood supply variation and anatomic complexity, which may affect outcomes [ 8 ].…”

Diversity in cell differentiation, histology, phenotype and vasculature of mass‐forming intrahepatic cholangiocarcinomas

“…Radiologically, hypervascular iCCAs harbour more favourable outcomes and a less aggressive nature than those with hypovascular features. [26][27][28] Hypervascular iCCAs are also associated with high microvascular density (MVD), arterial vessel density (AVD) and CLC subtype on histopathology. 26,27,[29][30][31] However, the vasculature of each iCCA histological subtype, reflecting divergences in blood imaging, remains to be clarified.…”

Outcomes assessment in intrahepatic cholangiocarcinoma using qualitative and quantitative imaging features

“…Mass-forming intrahepatic cholangiocarcinoma (ICC), the most common subtype of ICC (followed by periductal infiltrating and intraductal growth subtypes), is an epithelial malignancy of the intrahepatic bile ducts that is typically associated with poor patient outcomes; as less than 40% of patients with resectable ICC survive more than 5 years, and those with unresectable disease typically survive less than 12 months [1][2][3][4]. Although the incidence of ICC is highest in Asia, a rise in known risk factors (such as chronic viral hepatitis, cirrhosis, primary sclerosing cholangitis, fibropolycystic liver disease, and recurrent pyogenic cholangitis) has led to a worldwide rise in its incidence and mortality over the past two decades [1,[5][6][7][8].…”