Added value of ancillary imaging features for differentiating scirrhous hepatocellular carcinoma from intrahepatic cholangiocarcinoma on gadoxetic acid-enhanced MR imaging
- 449 Downloads
To determine ancillary features that help distinguish between scirrhous hepatocellular carcinoma (S-HCC) and intrahepatic cholangiocarcinoma (ICC) and investigate added value of ancillary features to enhancement pattern-based diagnosis on gadoxetic acid-enhanced MRI.
This retrospective study included 96 patients with S-HCCs and 120 patients with ICCs who underwent gadoxetic acid MRI before surgical resection. Two observers reviewed MRIs of the tumours. After determining ancillary features for differentiating tumour types, we measured the diagnostic performance of adding ancillary features to enhancement pattern-based diagnosis.
T2 central darkness, capsule and septum were significant and independent features differentiating S-HCC from ICC (p ≤ .06). Adding ancillary features to enhancement pattern led to increased accuracy (observer 1, 78.9 vs. 93.8 %; observer 2, 80.3 vs. 92.8 %; p < .001), sensitivity (observer 1, 74.5 vs. 96.4 %; observer 2, 77.1 vs. 93.2 %; p < .001 and .001), and specificity (observer 1, 82.5 vs. 91.7 %; observer 2, 82.9 vs. 92.5 %; p = .006 and .005) for diagnosis of S-HCC by differentiation from ICC.
Adding ancillary features capsule, septum and T2 central darkness to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy, sensitivity and specificity for S-HCC diagnosis with differentiation from ICC.
• Capsule, septum, and T2 central darkness were ancillary features for S-HCC.
• A typical HCC enhancement was seen in 31.3% of S-HCCs.
• Ancillary MRI features were useful in differentiation between S-HCC and ICC.
KeywordsCarcinoma, hepatocellular Liver neoplasms Cholangiocarcinoma Bile duct neoplasm Magnetic resonance imaging
Apparent diffusion coefficient
Hepatobiliary phase image
Magnetic resonance imaging
Portal venous phase
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. This work was supported by the Soonchunhyang University Research Fund.
Compliance with ethical standards
The scientific guarantor of this publication is Young Kon Kim in Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Soohyun Ahn and Hojeong Won, Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea kindly provided statistical advice for this manuscript.
Institutional Review Board approval was obtained.
Written informed consent was waived by the Institutional Review Board.
Study subjects or cohorts overlap
• Performed at one institution
- 4.Horvat N, Nikolovski I, Long N et al (2017) Imaging features of hepatocellular carcinoma compared to intrahepatic cholangiocarcinoma and combined tumor on MRI using liver imaging and data system (LI-RADS) version 2014. Abdom Radiol (NY). https://doi.org/10.1007/s00261-017-1261-x
- 5.Hwang J, Kim YK, Min JH et al (2017) Capsule, septum, and T2 hyperintense foci for differentiation between large hepatocellular carcinoma (≥ 5 cm) and intrahepatic cholangiocarcinoma on gadoxetic acid MRI. Eur Radiol:1–10Google Scholar
- 6.Min JH, Kim YK, Choi S-Y et al (2017) Differentiation between cholangiocarcinoma and hepatocellular carcinoma with target sign on diffusion-weighted imaging and hepatobiliary phase gadoxetic acid-enhanced MR imaging: Classification tree analysis applying capsule and septum. Eur J Radiol 92:1–10CrossRefPubMedGoogle Scholar
- 24.Haradome H, Unno T, Morisaka H et al (2017) Gadoxetic acid disodium-enhanced MR imaging of cholangiolocellular carcinoma of the liver: imaging characteristics and histopathological correlations. Eur Radiol. https://doi.org/10.1007/s00330-017-4811-2
- 32.Joo I, Lee JM, Lee SM, Lee JS, Park JY, Han JK (2016) Diagnostic accuracy of liver imaging reporting and data system (LI-RADS) v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid-enhanced MRI. J Magn Reson Imaging 44:1330–1338CrossRefPubMedGoogle Scholar