European Radiology

, Volume 28, Issue 6, pp 2549–2560 | Cite as

Added value of ancillary imaging features for differentiating scirrhous hepatocellular carcinoma from intrahepatic cholangiocarcinoma on gadoxetic acid-enhanced MR imaging

  • Seo-Youn Choi
  • Young Kon KimEmail author
  • Ji Hye Min
  • Tae Wook Kang
  • Woo Kyoung Jeong
  • Soohyun Ahn
  • Hojeong Won



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.

Key Points

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.


Carcinoma, hepatocellular Liver neoplasms Cholangiocarcinoma Bile duct neoplasm Magnetic resonance imaging 



Apparent diffusion coefficient


Computed tomography


Diffusion-weighted image


Hepatobiliary phase image


Hepatocellular carcinoma


Intrahepatic cholangiocarcinoma


Magnetic resonance imaging


Portal venous phase


Scirrhous HCC


Signal intensity


T1-weighted image


T2-weighted image



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.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Study subjects or cohorts overlap

Part of the study samples were included in prior reports by us [41 sHCCs, 41 ICCs (38.0 %) from reference 20, 86 cases (39.8 %) from reference 6, and 45 cases (20.8 %) from reference 5]


• Retrospective

• Observational

• Performed at one institution

Supplementary material

330_2017_5196_MOESM1_ESM.docx (4.3 mb)
ESM 1 (DOCX 4450 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologySoonchunhyang University College of Medicine, Bucheon HospitalBucheon-SiKorea
  2. 2.Department of Radiology and Center for Imaging ScienceSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
  3. 3.Department of Radiology, Chungnam National University HospitalChungnam National University College of MedicineDaejeonKorea
  4. 4.Biostatics and Clinical Epidemiology Center, Research Institute for Future MedicineSamsung Medical CenterSeoulKorea

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