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How to differentiate between combined hepatocellular carcinoma-cholangiocarcinoma and intrahepatic cholangiocarcinoma with rim arterial phase hyperenhancement?

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To analyze and compare the differences in MRI features between combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) and intrahepatic cholangiocarcinoma (iCCA) with arterial phase peripheral enhancement, so as to provide valuable references for preoperative differential diagnosis.

Methods

Seventy cHCC-CCA patients and 74 iCCA patients confirmed by pathology were included in this study. Their contrast-enhanced MRI showed rim arterial phase hyperenhancement (Rim APHE). The differences of clinicopathological data and MRI features between cHCC-CCA and iCCA were compared. Then, the sensitivity, specificity, and area under curve (AUC) were also analyzed and compared.

Results

Seventy cHCC-CCA patients (mean age, 55.7 ± 10.6 years) and 74 iCCA patients (mean age, 61.1 ± 10.5 years) were evaluated. In this study, univariable and multivariable regression analysis showed that AFP > 20 ng/ml (OR = 5.824, p = 0.006), enhancing capsule (OR = 7.252, p = 0.001), and mosaic architecture (OR = 32.732, p < 0.001) were independent risk factors of cHCC-CCA with Rim APHE. However, only hepatic capsule retraction (OR = 0.091, p < 0.001) was an independent predictor of iCCA. In addition, combining AFP > 20 ng/ml with enhancing capsule (96.7% vs. 79.2%, p < 0.001) and/or mosaic architecture (96.4% vs. 94.7%, p < 0.001) can improve the sensitivity of differentiating cHCC-CCA (vs. iCCA) with Rim APHE.

Conclusion

The combination of elevated AFP and MRI features, such as enhancing capsule and mosaic architecture, will help in preoperative differential diagnosis of cHCC-CCA and iCCA with Rim APHE.

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Abbreviations

AFP:

Alpha fetoprotein

CA19-9:

Carbohydrate antigen 19-9

CCA:

Cholangiocarcinoma

CEA:

Carcinoembryonic antigen

cHCC-CCA:

Combined hepatocellular carcinoma-cholangiocarcinoma

HCC:

Hepatocellular carcinoma

iCCA:

Intrahepatic cholangiocarcinoma

Rim APHE:

Rim arterial phase hyperenhancement

References

  1. Sempoux C, Kakar S, Kondo F et al (2019) Combined hepatocellular-cholangiocarcinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO classification of tumours: digestive system tumours. 5th ed. Lyon: IARC:260–262

  2. Sciarra A, ParK Y N, Sempoux C (2020) Updates in the diagnosis of combined hepatocellular-cholangiocarcinoma. Hum Pathol 96:48-55

    Article  CAS  PubMed  Google Scholar 

  3. Zhou C W, Wang Y, Ma L et al (2022) Combined hepatocellular carcinoma-cholangiocarcinoma: MRI features correlated with tumor biomarkers and prognosis. Eur Radiol 32:78-88

    Article  CAS  PubMed  Google Scholar 

  4. Jeon S K, Joo I, Lee D H et al (2019) Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol 29:373-382

    Article  PubMed  Google Scholar 

  5. Brunt E, Aishima S, Clavien PA et al (2018) cHCC-CCA: Consensus terminology for primary liver carcinomas with both hepatocytic and cholangiocytic differentiation. Hepatology 68:113-126

    Article  PubMed  Google Scholar 

  6. Kim T H, Kim H, Joo I et al (2020) Combined Hepatocellular- Cholangiocarcinoma: Changes in the 2019 World Health Organization Histological Classification System and Potential Impact on Imaging-Based Diagnosis. Korean J Radiol 21:1115-1125

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee H S, Kim M J, An C (2019) How to utilize LR-M features of the LI-RADS to improve the diagnosis of combined hepatocellular-cholangiocarcinoma on gadoxetate-enhanced MRI?. Eur Radiol 29:2408-2416

    Article  PubMed  Google Scholar 

  8. Kim M Y, Joo I, Kang H J et al (2020) LI-RADS M (LR-M) criteria and reporting algorithm of v2018: diagnostic values in the assessment of primary liver cancers on gadoxetic acid-enhanced MRI. Abdom Radiol (NY) 45:2440-2448

    Article  PubMed  Google Scholar 

  9. Chernyak V, Fowler K J, Kamaya A et al (2018) Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology 289:816-830

    Article  PubMed  Google Scholar 

  10. Wang Y, Yang Q, Li S et al (2019) Imaging features of combined hepatocellular and cholangiocarcinoma compared with those of hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in a Chinese population. Clin Radiol 74:e1-407

    Article  Google Scholar 

  11. Hwang J, Kim Y K, Park M J et al (2012) Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI. J Magn Reson Imaging 36:881-889

    Article  PubMed  Google Scholar 

  12. Jiang H, Song B, Qin Y et al (2021) Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features. Eur Radiol 31:3638-3648

    Article  CAS  PubMed  Google Scholar 

  13. Shetty AS, Fowler KJ, Brunt EM, Agarwal S, Narra VR, Menias CO (2014) Combined hepatocellular-cholangiocarcinoma:what the radiologist needs to know about biphenotypic liver carcinoma. Abdom Imaging 39:310-322

    Article  PubMed  Google Scholar 

  14. Gera S, Ettel M, Acosta-Gonzalez G, Xu R (2017) Clinical features, histology, and histogenesis of combined hepatocellular-cholangiocarcinoma. World J Hepatol 9:300-309

    Article  PubMed  PubMed Central  Google Scholar 

  15. Groeschl R T, Turaga K K, Gamblin T C (2013) Transplantation versus resection for patients with combined hepatocellular carcinoma-cholangiocarcinoma. J Surg Oncol 107:608-612

    Article  PubMed  Google Scholar 

  16. Yin X, Zhang BH, Qiu SJ et al (2012) Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features, treatment modalities, and prognosis. Ann Surg Oncol 19:2869-2876

    Article  PubMed  Google Scholar 

  17. Kelley R K, Bridgewater J, Gores G J et al (2020) Systemic therapies for intrahepatic cholangiocarcinoma. J Hepatol 72:353-363

    Article  CAS  PubMed  Google Scholar 

  18. Wang XL, Wang WT, Ma XJ et al (2020) Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance? Eur Radiol 30:5337-5347

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kudo A, Matsumura S, Ban D et al (2014) Does the preoperative alpha-fetoprotein predict the recurrence and mortality after hepatectomy for hepatocellular carcinoma without macrovascular invasion in patients with normal liver function? Hepatol Res 44:E437-E446

    Article  CAS  PubMed  Google Scholar 

  20. Xiao Y Y, Zheng X D, Zhou C W et al (2023) Combined hepatocellular carcinoma-cholangiocarcinoma with a predominant HCC component: better survival and MRI-based prediction. Eur Radiol 33:1412-1421

    Article  CAS  PubMed  Google Scholar 

  21. Joo I, Kim H, Lee JM (2015) Cancer stem cells in primary liver cancers: pathological concepts and imaging findings. Korean J Radiol 16:50-68

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bergquist JR, Ivanics T, Storlie CB et al (2016) Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: a national cohort analysis. J Surg Oncol 114:475-482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kim S, An C, Han K et al (2019) Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma. Abdom Radiol 44:110-121

    Article  Google Scholar 

  24. Park H J, Kim Y K, Park M J et al (2013) Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging 38:793-801

    Article  PubMed  Google Scholar 

  25. Ni T, Shang X S, Wang W T et al (2018) Different MR features for differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma according to tumor size. Br J Radiol 91:20180017

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park SH, Lee SS, Yu E et al (2017) Combined hepatocellular-cholangiocarcinoma: gadoxetic acid-enhanced MRI findings correlated with pathologic features and prognosis. J Magn Reson Imaging 46:267-280

    Article  ADS  PubMed  Google Scholar 

  27. Lacomis JM, Baron RL, Oliver JH, Nalesnik MA, Federle MP (1997) Cholangiocarcinoma: delayed CT contrast enhancement patterns. Radiology 203:98-104

    Article  CAS  PubMed  Google Scholar 

  28. Asayama Y, Yoshimitsu K, Irie H et al (2006) Delayed-phase dynamic CT enhancement as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma. Radiology 238:150-155

    Article  PubMed  Google Scholar 

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Funding

This study was supported by National Science Foundation of China (Grant No. 82171897), Clinical Research Plan of SHDC (Grant No. SHDC2020CR1029B), and Science and Technology Commission of Shanghai Municipality (Grant No. 23Y11907400).

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Author notes

  1. Changwu Zhou and Peng Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China

    Changwu Zhou

  2. Shanghai Institute of Medical Imaging, Shanghai, China

    Changwu Zhou, Chun Yang & Mengsu Zeng

  3. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Changwu Zhou, Peng Huang, Fei Wu, Yuyao Xiao, Chun Yang & Mengsu Zeng

  4. Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Changwu Zhou, Peng Huang, Fei Wu, Yuyao Xiao, Chun Yang & Mengsu Zeng

Authors
  1. Changwu Zhou
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  2. Peng Huang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CZ and PH. The first draft of the manuscript was written by CZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chun Yang or Mengsu Zeng.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zhongshan Hospital, Fudan University.

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Informed consent was obtained from all individual participants included in the study.

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Zhou, C., Huang, P., Wu, F. et al. How to differentiate between combined hepatocellular carcinoma-cholangiocarcinoma and intrahepatic cholangiocarcinoma with rim arterial phase hyperenhancement?. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04194-y

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  • DOI: https://doi.org/10.1007/s00261-024-04194-y

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