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Predictive factors of microvascular invasion in patients with intrahepatic mass-forming cholangiocarcinoma based on magnetic resonance images

  • Hepatobiliary
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Abstract

Purpose

The aim of this retrospective study was to develop and validate a preoperative nomogram for predicting microvascular invasion (MVI) in patients with intrahepatic mass-forming cholangiocarcinoma (IMCC) based on magnetic resonance imaging (MRI).

Methods

In this retrospective study, 224 consecutive patients with clinicopathologically confirmed IMCC were enrolled. Patients whose data were collected from February 2010 to December 2020 were randomly divided into the training (131 patients) and internal validation (51 patients) datasets. The data from January 2021 to November 2021 (42 patients) were allocated to the time-independent validation dataset. Univariate and multivariate forward logistic regression analyses were used to identify preoperative MRI features that were significantly related to MVI, which were then used to develop the nomogram. We used the area under the receiver operating characteristic curve (AUC) and calibration curve to evaluate the performance of the nomogram.

Results

Interobserver agreement of MRI qualitative features was good to excellent, with κ values of 0.613–0.882. Multivariate analyses indicated that the following variables were independent predictors of MVI: multiple tumours (odds ratio [OR]) = 4.819, 95% confidence interval [CI] 1.562–14.864, P = 0.006), ill-defined margin (OR = 6.922, 95% CI 2.883–16.633, P < 0.001), and carbohydrate antigen 19–9 (CA 19–9) > 37 U/ml (OR = 2.890, 95% CI 1.211–6.897, P = 0.017). A nomogram incorporating these factors was established using well-fitted calibration curves. The nomogram showed good diagnostic efficacy for MVI, with AUC values of 0.838, 0.819, and 0.874 for the training, internal validation, and time-independent validation datasets, respectively.

Conclusion

A nomogram constructed using independent factors, namely the presence of multiple tumours, ill-defined margins, and CA 19–9 > 37 U/ml could predict the presence of MVI. This can facilitate personalised therapeutic strategy and clinical management in patients with IMCC.

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Abbreviations

ADC:

Apparent diffusion coefficient

AP:

Arterial phase

AUC:

Area under the curve

CA 19–9:

Carbohydrate antigen 19–9

CE:

Contrast-enhanced

DP:

Delayed phase

DWI:

Diffusion-weighted imaging

ECA:

Extracellular contrast agent

EMT:

Epithelial-mesenchymal transition

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid

Gd-DTPA:

Gadolinium diethylene triamine penta-acetic acid

HBA:

Hepatobiliary agent

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

MVI:

Microvascular invasion

NPV:

Negative predictive value

PPV:

Positive predictive value

PVP:

Portal venous phase

ROC:

Receiver operating characteristic

T1W IP-OP:

T1-weighted in-phase and out-phase

T2W-FS:

T2-weighted fat-suppressed

TP:

Transitional phase

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Funding

There is no funding information related to this retrospective study.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Shuang Chen, Lijuan Wan, Rui Zhao, Wenjing Peng & Hongmei Zhang

  2. Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Zhuo Li & Shuangmei Zou

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  1. Shuang Chen
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Contributions

Study concepts/study design: SC, HZ; data acquisition or data analysis/interpretation: LW, RZ, WP; statistical analysis: SC, LW, RZ; drafting the article or revising it critically for important intellectual content: SC, ZL, SZ, HZ; final approval of the version to be submitted: all authors.

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Correspondence to Zhuo Li, Shuangmei Zou or Hongmei Zhang.

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All authors (Shuang Chen, Lijuan Wan, Rui Zhao, Wenjing Peng, Zhuo Li, Shuangmei Zou, Hongmei Zhang) have no conflicts of interest to be disclosed related to this article.

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This study was approved by the institutional review board.

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Chen, S., Wan, L., Zhao, R. et al. Predictive factors of microvascular invasion in patients with intrahepatic mass-forming cholangiocarcinoma based on magnetic resonance images. Abdom Radiol 48, 1306–1319 (2023). https://doi.org/10.1007/s00261-023-03847-8

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  • DOI: https://doi.org/10.1007/s00261-023-03847-8

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