The Value of Contrast-Enhanced Magnetic Resonance Imaging Enhancement in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular Cholangiocarinoma

Abstract

Background The distinction between combined hepatocellular-cholangiocarcinoma (cHCC-CC) and hepatocellular carcinoma (HCC) before the operation has an important clinical significance for optimizing the treatment plan and predicting the prognosis of patients. Magnetic resonance imaging (MRI) has been widely used in the preoperative diagnosis and evaluation of primary liver malignant tumors. Purpose The aim is to study the value of preoperative clinical data and enhanced MRI in the differential diagnosis of HCC and cHCC-CC and obtain independent risk factors for predicting cHCC-CC. Study type . Retrospective. Population. The clinical and imaging data of 157 HCC and 59 cHCC-CC patients confirmed by pathology were collected. Field Strength/Sequence . 1.5T; cross-sectional T1WI (gradient double echo sequence); cross-sectional T2WI (fast spin echo sequence, fat suppression); enhancement (3D LAVA technology). Assessment . The differences between the HCC and cHCC-CC patients were compared. Statistic Tests . Using the t -test, chi-square test, and logistic regression analysis, P < 0.05 was considered statistically significant. Result 1. CHCC-CC was more likely to show multiple lesions than HCC (28.81% vs. 10.83%, P = 0.001) and more prone to microvascular invasion (MVI) (36.31% vs. 61.02%, P < 0.001). However, HCC had a higher incidence of liver cirrhosis than cHCC-CC (50.85% vs. 72.61%, P = 0.003). 2. The incidence of nonsmooth margin was higher in the cHCC-CC group (84.75% vs. 52.23%, P < 0.001). The incidence of peritumor enhancement in the arterial phase was higher in the cHCC-CC group (11.46% vs. 62.71%, P < 0.001) 3. According to the multivariate analysis, arterial peritumor enhancement (OR = 8.833,95%CI:4.033,19.346, P < 0.001) was an independent risk factor for cHCC-CC ( P < 0.001)). It had high sensitivity (62.71%) and specificity (88.54%) in the diagnosis of cHCC-CC. Date Conclusions . Liver cirrhosis and the imaging findings of GD-DTPA-enhanced MRI are helpful for the differential diagnosis of HCC and cHCC-CC. In addition, the imaging sign of peritumoral enhancement in the arterial phase has high sensitivity and specificity for the diagnosis of cHCC-CC.

Comparison contrast-enhanced CT with contrast-enhanced US in diagnosing combined hepatocellular-cholangiocarcinoma: a propensity score-matched study

“…Cirrhosis detected by CECT is highly suggestive of HCC. In this study, we found that few at-risk patients with cHCC-CCA had a cirrhotic liver background due to the different origins of HCC and cHCC-CCA, which is similar to the findings of the latest studies [ 24 , 29 – 31 ]. Additionally, this study revealed that cHCC-CCA patients exhibited higher rates of nonrim APHE with a volume < 50%.…”

“…Several studies have evaluated the performance of imaging characteristics in differentiating cHCC-CCA and HCC in recent years [ 15 , 18 , 31 , 38 , 39 ]. The model developed in this study, which combined CECT features and CA 19-9 levels to distinguish cHCC-CCA, was put into a visual form as a nomogram and demonstrated a remarkable sensitivity of 93.3%, showing better performance than previous ones (ranging from 40 to 73.8% [ 15 , 18 , 38 ].…”

Radiomics Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Preoperative Differentiation of Combined Hepatocellular-Cholangiocarcinoma from Hepatocellular Carcinoma: A Multi-Center Study

“…Li et al reported in a small sample size study 22 that ultrasonic proteomics can better distinguish cHCC-CC from HCC than LI-RADS. Previous studies on these two types of tumors mostly used data from a single center with few samples and imaging features whose interpretation depends on clinical data and subjective judgment, 19 , 22 , 23 lacking universality and objectivity. With histopathological examination being the “gold standard” of preoperative diagnosis of cHCC-CC, there are some cases where the puncture is not in place or the collected samples are insufficient, leading to misdiagnosis of cHCC-CC as HCC.…”