Abstract
Objectives
This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).
Methods
From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings.
Results
Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors.
Conclusions
The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.
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Abbreviations
- IMCC:
-
Intrahepatic mass-forming cholangiocarcinoma
- AP:
-
Arterial phase
- DP:
-
Delayed phase
- OS:
-
Overall survival
- DFS:
-
Disease-free survival
- CA19-9:
-
Carbohydrate antigen 19-9
References
Macias RIR, Kornek M, Rodrigues PM, et al. Diagnostic and prognostic biomarkers in cholangiocarcinoma. Liver Int. 2019 May;39 Suppl 1:108-122. doi:https://doi.org/10.1111/liv.14090.
Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014 Jun 21;383(9935):2168-79. doi: https://doi.org/10.1016/S0140-6736(13)61903-0.
Seo N, Kim DY, Choi JY. Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis. AJR Am J Roentgenol. 2017 Aug;209(2):W64-W75. doi: https://doi.org/10.2214/AJR.16.16923.
Kajiyama K, Maeda T, Takenaka K, et al. The significance of stromal desmoplasia in intrahepatic cholangiocarcinoma: a special reference of ‘scirrhous-type’ and ‘nonscirrhous-type’ growth. Am J Surg Pathol. 1999 Aug;23(8):892-902.
Aishima S, Oda Y. Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci. 2015 Feb;22(2):94-100. doi: https://doi.org/10.1002/jhbp.154
Bragazzi MC, Ridola L, Safarikia S, et al. New insights into cholangiocarcinoma: multiple stems and related cell lineages of origin. Ann Gastroenterol 2018;31(1): 42–55
Nakanuma Y, Sato Y, Harada K, et al. Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol 2010;2(12):419–427.
Zhou Y, Wang X, Xu C, et al. Mass-forming intrahepatic cholangiocarcinoma: Can diffusion-weighted imaging predict microvascular invasion? J Magn Reson Imaging. 2019 Jul;50(1):315-324. doi: https://doi.org/10.1002/jmri.26566.
Lee J, Kim SH, Kang TW, et al. Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker. Radiology. 2016 Oct;281(1):119-28. doi: https://doi.org/10.1148/radiol.2016151781.
Aherne EA, Pak LM, Goldman DA, et al. Intrahepatic cholangiocarcinoma: can imaging phenotypes predict survival and tumor genetics? Abdom Radiol (NY). 2018 Oct;43(10):2665-2672. doi: https://doi.org/10.1007/s00261-018-1505-4.
[11] Rhee H, Kim MJ, Park YN, et al. A proposal of imaging classification of intrahepatic mass-forming cholangiocarcinoma into ductal and parenchymal types: clinicopathologic significance. Eur Radiol. 2019 Jun;29(6):3111-3121. doi: https://doi.org/10.1007/s00330-018-5898-
[12] Maetani Y, Itoh K, Watanabe C, et al. MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roentgenol. 2001 Jun;176(6):1499-507.
[13] Fujita N, Asayama Y, Nishie A, et al. Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings. Eur Radiol. 2017 Feb;27(2):498-506. doi: https://doi.org/10.1007/s00330-016-4386-3.
[14] Min JH, Kim YK, Choi SY, et al. Intrahepatic Mass-forming Cholangiocarcinoma: Arterial Enhancement Patterns at MRI and Prognosis. Radiology. 2019 Mar;290(3):691-699. doi: https://doi.org/10.1148/radiol.2018181485.
[15] Kim S, An C, Han K, et al. Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma. Abdom Radiol (NY). 2019 Jan;44(1):110-121. doi: https://doi.org/10.1007/s00261-018-1727-5.
Nakanuma Y, Klimstra DS, Komuta M, et al. Intrahepatic cholangiocarcinoma. WHO Classification of Tumours of the Digestive System, 5th edition. World Health Organization. 2019:254–259.
[17] Baheti AD, Tirumani SH, Rosenthal MH, et al. Diagnosis and management of intrahepatic cholangiocarcinoma: a comprehensive update for the radiologist. Clin Radiol 2014;69(12):e463–e470.
[18] Ciresa M, De Gaetano AM, Pompili M, et al. Enhancement patterns of intrahepatic mass-forming cholangiocarcinoma at multiphasic computed tomography and magnetic resonance imaging and correlation with clinicopathologic features. Eur Rev Med Pharmacol Sci. 2015 Aug;19(15):2786-97.
[19] Asayama Y, Yoshimitsu K, Irie H, et al. Delayed-phase dynamic CT enhancement as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma. Radiology. 2006 Jan;238(1):150-5.
[20] Rimola J, Forner A, Reig M, et al. Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology. 2009 Sep;50(3):791-8. doi: https://doi.org/10.1002/hep.23071.
[21] Kang Y, Lee JM, Kim SH, et al. Intrahepatic mass-forming cholangiocarcinoma: enhancement patterns on gadoxetic acid-enhanced MR images. Radiology. 2012 Sep;264(3):751-60. doi: https://doi.org/10.1148/radiol.12112308.
[22] Lacomis JM, Baron RL, Oliver JH 3rd, Nalesnik MA, Federle MP. Cholangiocarcinoma: delayed CT contrast enhancement patterns. Radiology 1997;203(1):98–104.
[23] Zhao L, Ma X, Liang M, et al. Prediction for early recurrence of intrahepatic mass-forming cholangiocarcinoma: quantitative magnetic resonance imaging combined with prognostic immunohistochemical markers. Cancer Imaging. 2019 Jul 15;19(1):49. doi: https://doi.org/10.1186/s40644-019-0234-4.
[24] Koh J, Chung YE, Nahm JH, et al. Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Eur Radiol. 2016 Feb;26(2):407-16. doi: https://doi.org/10.1007/s00330-015-3846-5.
[25] Atanasov G, Dietel C, Feldbrügge L, et al. Tumor necrosis and infiltrating macrophages predict survival after curative resection for cholangiocarcinoma. Oncoimmunology. 2017 Jun 28;6(8):e1331806. doi: https://doi.org/10.1080/2162402X.2017.1331806.
[26] Aishima S, Iguchi T, Nishihara Y, et al. Decreased intratumoral arteries reflect portal tract destruction and aggressive characteristics in intrahepatic cholangiocarcinoma. Histopathology. 2009;54:452–61.
[27] Ariizumi S, Kotera Y, Takahashi Y, et al. Mass-forming intrahepatic cholangiocarcinoma with marked enhancement on arterial-phase computed tomography reflects favorable surgical outcomes. J Surg Oncol. 2011 Aug 1;104(2):130-9. doi: https://doi.org/10.1002/jso.21917.
[28] Kim SA, Lee JM, Lee KB, et al. Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern--correlation with clinicopathologic findings. Radiology. 2011 Jul;260(1):148-57. doi:https://doi.org/10.1148/radiol.11101777.
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Jin, Kp., Sheng, Rf., Yang, C. et al. Combined arterial and delayed enhancement patterns of MRI assist in prognostic prediction for intrahepatic mass-forming cholangiocarcinoma (IMCC). Abdom Radiol 47, 640–650 (2022). https://doi.org/10.1007/s00261-021-03292-5
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DOI: https://doi.org/10.1007/s00261-021-03292-5