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

  • Gastrointestinal
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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

CLD:

Chronic liver disease

DWI:

Diffusion-weighted imaging

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

iCCA:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

SC:

Sarcomatoid carcinoma

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

TIV:

Tumor in vein

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Acknowledgements

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

Funding

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

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Nieun Seo, Myeong-Jin Kim & Hyungjin Rhee

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  1. Nieun Seo
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  2. Myeong-Jin Kim
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  3. Hyungjin Rhee
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Correspondence to Myeong-Jin Kim.

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Guarantor

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.

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Institutional Review Board approval was obtained.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Seo, N., Kim, MJ. & Rhee, H. Hepatic sarcomatoid carcinoma: magnetic resonance imaging evaluation by using the liver imaging reporting and data system. Eur Radiol 29, 3761–3771 (2019). https://doi.org/10.1007/s00330-019-06052-8

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  • DOI: https://doi.org/10.1007/s00330-019-06052-8

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