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Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma

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Abstract

Purpose

To identify imaging markers that independently predict the post-operative outcome of intrahepatic mass-forming cholangiocarcinoma (IMCC) using gadoxetate disodium-enhanced magnetic resonance imaging (MRI).

Methods

Data from 54 patients who underwent pre-operative gadoxetate disodium-enhanced MRI and curative surgery for IMCC were retrospectively evaluated. The prognostic power of various imaging and pathological features reportedly associated with recurrence-free survival (RFS) and overall survival (OS) was analyzed using Cox regression models. A model combining imaging and pathological features was developed and its performance was evaluated using the Harrell C-index and Akaike information criterion.

Results

Capsule penetration (P = 0.016) and tumor size (P = 0.015) were independent markers for worse RFS, while capsule penetration (P = 0.012) and hepatic vein obstruction (HVO, P = 0.016) were independent markers for worse OS, respectively, in the imaging-based model. Capsule penetration was the only imaging marker identified in the combined prediction model of RFS, and the combined model showed a higher C-index and lower AIC value compared with the model based on pathological features alone.

Conclusions

Capsule penetration and HVO on MRI are significantly worse imaging prognostic factors for post-operative outcomes in patients with IMCC. Incorporation of capsule penetration and HVO into a surgical staging system may improve prediction of the post-operative prognosis of IMCC.

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Abbreviations

ADC:

Apparent diffusion coefficient

AIC:

Akaike information criterion

AJCC:

American Joint Committee on Cancer

AP:

Arterial phase

AVI:

Any vascular invasion

BDI:

Bile duct invasion

BO:

Biliary obstruction

CI:

Confidence interval

CT:

Computed tomography

DWI:

Diffusion-weighted images

HBP:

Hepatobiliary phase

HR:

Hazard ratio

HVO:

Hepatic vein obstruction

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

LCSGJ:

Liver Cancer Study Group of Japan

MRI:

Magnetic resonance imaging

MVI:

Microvessel invasion

OS:

Overall survival

PVO:

Portal vein obstruction

RCS:

Restricted cubic splines

RFS:

Recurrence-free survival

SI:

Signal intensity

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Sungwon Kim, Chansik An, Kyunghwa Han & Myeong-Jin Kim

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  1. Sungwon Kim
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  2. Chansik An
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Correspondence to Myeong-Jin Kim.

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Kim, S., An, C., Han, K. et al. Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma. Abdom Radiol 44, 110–121 (2019). https://doi.org/10.1007/s00261-018-1727-5

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  • DOI: https://doi.org/10.1007/s00261-018-1727-5

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