Hepatic sarcomatoid carcinoma: magnetic resonance imaging evaluation by using the liver imaging reporting and data system

  • Nieun Seo
  • Myeong-Jin KimEmail author
  • Hyungjin Rhee



To evaluate how sarcomatoid carcinomas (SCs) would be classified on magnetic resonance imaging (MRI) by using the Liver Imaging Reporting and Data System (LI-RADS) and to assess imaging features of SC compared with other hepatic malignancies.


We retrieved 184 patients with pathologically confirmed SC (n = 46), hepatocellular carcinoma (HCC, n = 92), and intrahepatic cholangiocarcinoma (iCCA, n = 46) diagnosed between January 2006 and December 2017. Two readers independently reviewed MRI according to LI-RADS v2017. Classification rate of SC, as probably or definitely malignant but not specific for HCC (LR-M), was calculated. LR-TIV (tumor in vein) was subclassified as either 5V or MV. MRI features were compared between SC, HCC, and iCCA and between SC of LR-M and non-LR-M categories.


Chronic liver disease was present in 71.7% (33/46) of patients with SC, and LI-RADS was applied for these patients. SC was classified as LR-M in 24 (72.7%) of 33 patients at risk. SCs that had been classified as LR-4/5/5V were significantly smaller (median, 1.9 cm; range, 1.0–4.2 cm) than SCs classified as LR-M/MV (median, 4.3 cm; range, 1.3–20.6 cm) on independent t test (p = 0.012). SCs commonly showed MRI features similar to iCCAs than to HCCs. Targetoid appearance and capsular retraction were more frequent in iCCA than in SC (p ≤ 0.009) on Pearson’s chi-squared test or Fisher’s exact test.


Most SCs can be classified as LR-M on MRI, but small lesions may be indistinguishable from HCCs.

Key Points

• Most sarcomatoid carcinomas (SCs) are classified as LR-M on MRI by using LI-RADS v2017.

• SC showed various LR-M features similar to those of intrahepatic cholangiocarcinoma.

• Size of LR-4/5/5V SC was significantly smaller than that of LR-M/MV SC.


Hepatocellular carcinoma Cholangiocarcinoma Magnetic resonance imaging Liver neoplasms 



Chronic liver disease


Diffusion-weighted imaging


Hepatobiliary phase


Hepatocellular carcinoma


Intrahepatic cholangiocarcinoma


Liver Imaging Reporting and Data System


Magnetic resonance imaging


Sarcomatoid carcinoma


T1-weighted imaging


T2-weighted imaging


Tumor in vein



The authors thank Ha Yan Kim for her help with the statistical advice.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Myeong-Jin Kim.

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

Nieun Seo performed statistical analysis, who is one of the coauthors. Ha Yan Kim, Ph.D., who is a member of our biostatistics collaboration unit, Yonsei University College of Medicine, gave us advice on the statistical analysis.

Informed consent

Written informed consent was waived by the Institutional Review Board for this retrospective case-control study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulSouth Korea

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