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Combined arterial and delayed enhancement patterns of MRI assist in prognostic prediction for intrahepatic mass-forming cholangiocarcinoma (IMCC)

  • Hepatobiliary
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Abstract

Objectives

This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).

Methods

From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings.

Results

Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors.

Conclusions

The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.

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Abbreviations

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

AP:

Arterial phase

DP:

Delayed phase

OS:

Overall survival

DFS:

Disease-free survival

CA19-9:

Carbohydrate antigen 19-9

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Author notes

  1. Kai-pu Jin and Ruo-fan Sheng contributed the same to the article.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China

    Kai-pu Jin, Rou-fan Sheng, Chun Yang & Meng-su Zeng

  2. Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China

    Kai-pu Jin, Rou-fan Sheng, Chun Yang & Meng-su Zeng

  3. Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China

    Kai-pu Jin, Rou-fan Sheng, Chun Yang & Meng-su Zeng

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  1. Kai-pu Jin
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  2. Rou-fan Sheng
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Correspondence to Chun Yang or Meng-su Zeng.

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Jin, Kp., Sheng, Rf., Yang, C. et al. Combined arterial and delayed enhancement patterns of MRI assist in prognostic prediction for intrahepatic mass-forming cholangiocarcinoma (IMCC). Abdom Radiol 47, 640–650 (2022). https://doi.org/10.1007/s00261-021-03292-5

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