Skip to main content

Advertisement

SpringerLink
Log in

Diffusion-weighted imaging as an imaging biomarker for assessing survival of patients with intrahepatic mass-forming cholangiocarcinoma

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Mass-forming cholangiocarcinoma is the most common form of intrahepatic cholangiocarcinoma and is associated with a worse prognosis. This study aimed to assess the role of diffusion-weighted imaging and other imaging features as prognostic markers to predict the survival of patients with intrahepatic mass-forming cholangiocarcinoma (IMCC).

Materials and methods

The study included patients with pathologically proven IMCC from January 2011 to January 2018. Two radiologists retrospectively reviewed various imaging findings and manually estimated the area of diffusion restriction. Patients were grouped according to their restriction area into (group 1) restriction ≥ 1/3 of the tumor and (group 2) restriction < 1/3 of the tumor. Statistical analysis was performed to assess the relationship between various imaging features and patients’ survival.

Results

Seventy-three patients were included in the study. IMCC patients with tumor size ≥ 5 cm had increased intrahepatic- and peritoneal metastases (p = 039 and p = 0.001 for reader 1 and p = 0.048 and p = 0.057 for reader 2). There was no significant relationship between the diffusion restriction area and tumor size, enhancement pattern, vascular involvement, lymph node metastasis, peritoneal- and distant metastasis. The number of deaths was significantly higher in patients with group 2 restriction (63.6% for group 1 vs. 96.6% for group 2; p = 0.001 for reader 1)(68.2% for group 1 vs. 89.7%% for group 2; p = 0.030 for reader 2). Patients with group 2 restriction had shorter 1- and 3-year survival rates and lower median survival time. Multivariable survival analysis showed two independent prognostic factors relating to poor survival outcomes: peritoneal metastasis (p = 0.04 for reader 1 and p = 0.041 for reader 2) and diffusion restriction < 1/3 (p = 0.011 for reader 1 and p = 0.042 for reader 2). Lymph node metastasis and intrahepatic metastasis were associated with shorter survival in the univariate analysis. However, these factors were non-significant in the multivariate analysis.

Conclusion

Restriction diffusion of less than 1/3 and peritoneal metastasis were associated with shorter overall survival of IMCC patients. Other features that might correlate with the outcome are suspicious lymph nodes and multifocal lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Rizvi S, Gores GJ (2013) Pathogenesis, Diagnosis, and Management of Cholangiocarcinoma. Gastroenterology 145. https://doi.org/10.1053/j.gastro.2013.10.013

    Article  PubMed  Google Scholar 

  2. Yamasaki S (2003) Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. Journal of Hepato-Biliary-Pancreatic Surgery 10:288–291. https://doi.org/10.1007/s00534-002-0732-8

    Article  PubMed  Google Scholar 

  3. Razumilava N, Gores GJ (2014) Cholangiocarcinoma. The Lancet 383:2168–2179. https://doi.org/10.1016/S0140-6736(13)61903-0

    Article  Google Scholar 

  4. Guglielmi A, Ruzzenente A, Campagnaro T, et al (2009) Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 33:1247–1254. https://doi.org/10.1007/s00268-009-9970-0

    Article  PubMed  Google Scholar 

  5. Weber SM, Ribero D, O=Reilly EM, et al (2015) Intrahepatic Cholangiocarcinoma: expert consensus statement. HPB (Oxford) 17:669–680. https://doi.org/10.1111/hpb.12441

    Article  Google Scholar 

  6. Hong SB, Lee NK, Kim S, et al (2020) Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication. Jpn J Radiol. https://doi.org/10.1007/s11604-020-01068-3

    Article  PubMed  Google Scholar 

  7. Min JH, Kim YK, Choi S-Y, et al (2019) Intrahepatic Mass-forming Cholangiocarcinoma: Arterial Enhancement Patterns at MRI and Prognosis. Radiology 290:691–699. https://doi.org/10.1148/radiol.2018181485

    Article  PubMed  Google Scholar 

  8. Rhee H, Kim M-J, Park YN, An C (2019) A proposal of imaging classification of intrahepatic mass-forming cholangiocarcinoma into ductal and parenchymal types: clinicopathologic significance. Eur Radiol 29:3111–3121. https://doi.org/10.1007/s00330-018-5898-9

    Article  PubMed  Google Scholar 

  9. Koh J, Chung YE, Nahm JH, et al (2016) Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Eur Radiol 26:407–416. https://doi.org/10.1007/s00330-015-3846-5

    Article  PubMed  Google Scholar 

  10. Seo N, Kim DY, Choi J-Y (2017) Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis. American Journal of Roentgenology 209:W64–W75. https://doi.org/10.2214/AJR.16.16923

    Article  PubMed  Google Scholar 

  11. Lee J, Kim SH, Kang TW, et al (2016) Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker. Radiology 281:119–128. https://doi.org/10.1148/radiol.2016151781

    Article  PubMed  Google Scholar 

  12. Yamada S, Morine Y, Imura S, et al (2020) Prognostic prediction of apparent diffusion coefficient obtained by diffusion-weighted MRI in mass-forming intrahepatic cholangiocarcinoma. Journal of Hepato-Biliary-Pancreatic Sciences 27:388–395. https://doi.org/10.1002/jhbp.732

    Article  PubMed  Google Scholar 

  13. Liao X, Zhang D (2020) The 8th Edition American Joint Committee on Cancer Staging for Hepato-pancreato-biliary Cancer: A Review and Update: Archives of Pathology & Laboratory Medicine 145:543–553. https://doi.org/10.5858/arpa.2020-0032-RA

  14. Yushkevich PA, Piven J, Hazlett HC, et al (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128. https://doi.org/10.1016/j.neuroimage.2006.01.015

    Article  PubMed  Google Scholar 

  15. Poultsides GA, Zhu AX, Choti MA, Pawlik TM (2010) Intrahepatic Cholangiocarcinoma. Surgical Clinics of North America 90:817–837. https://doi.org/10.1016/j.suc.2010.04.011

    Article  PubMed  Google Scholar 

  16. Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM (2014) Treatment and Prognosis for Patients With Intrahepatic Cholangiocarcinoma: Systematic Review and Meta-analysis. JAMA Surgery 149:565–574. https://doi.org/10.1001/jamasurg.2013.5137

    Article  PubMed  Google Scholar 

  17. Malayeri AA, El Khouli RH, Zaheer A, et al (2011) Principles and Applications of Diffusion-weighted Imaging in Cancer Detection, Staging, and Treatment Follow-up. RadioGraphics 31:1773–1791. https://doi.org/10.1148/rg.316115515

    Article  PubMed  Google Scholar 

  18. Lewis S, Besa C, Wagner M, et al (2018) Prediction of the histopathologic findings of intrahepatic cholangiocarcinoma: qualitative and quantitative assessment of diffusion-weighted imaging. Eur Radiol 28:2047–2057. https://doi.org/10.1007/s00330-017-5156-6

    Article  PubMed  Google Scholar 

  19. Zhou Y, Zhou G, Gao X, et al (2020) Apparent diffusion coefficient value of mass-forming intrahepatic cholangiocarcinoma: a potential imaging biomarker for prediction of lymph node metastasis. Abdom Radiol (NY) 45:3109–3118. https://doi.org/10.1007/s00261-020-02458-x

    Article  Google Scholar 

  20. Schmeel FC (2019) Variability in quantitative diffusion-weighted MR imaging (DWI) across different scanners and imaging sites: is there a potential consensus that can help reducing the limits of expected bias? Eur Radiol 29:2243–2245. https://doi.org/10.1007/s00330-018-5866-4

    Article  PubMed  Google Scholar 

  21. Tohka J (2014) Partial volume effect modeling for segmentation and tissue classification of brain magnetic resonance images: a review. World J Radiol 6(11):855. https://doi.org/10.4329/wjr.v6.i11.855

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schwarz CG, Gunter JL, Lowe VJ, Weigand S, Vemuri P, Senjem ML, Petersen RC, Knopman DS, Jack CR (2019) A comparison of partial volume correction techniques for measuring change in serial Amyloid PET SUVR. J Alzheimers Dis 67(1):181–195. https://doi.org/10.3233/JAD-180749

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Moghbel M, Mashohor S, Mahmud R, Saripan MI (2016) Automatic liver tumor segmentation on computed tomography for patient treatment planning and monitoring. EXCLI J 15:406–423. https://doi.org/10.17179/excli2016-402

    Article  PubMed  PubMed Central  Google Scholar 

  24. Payapwattanawong S, Maneenil K, Limtapatip S, Laohavinij S (2019) Survival and prognostic factors in cholangiocarcinoma: A single-center experience. Annals of Oncology 30:ix63. https://doi.org/10.1093/annonc/mdz422.065

  25. Ronnekleiv-Kelly SM, Pawlik TM (2017) Staging of intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr 6:35–43. https://doi.org/10.21037/hbsn.2016.10.02

  26. Hahn F, Müller L, Mähringer-Kunz A, et al (2020) Distant Metastases in Patients with Intrahepatic Cholangiocarcinoma: Does Location Matter? A Retrospective Analysis of 370 Patients. Journal of Oncology 2020:e7195373. https://doi.org/10.1155/2020/7195373

    Article  Google Scholar 

  27. Promsorn J, Soontrapa W, Somsap K, et al (2019) Evaluation of the diagnostic performance of apparent diffusion coefficient (ADC) values on diffusion-weighted magnetic resonance imaging (DWI) in differentiating between benign and metastatic lymph nodes in cases of cholangiocarcinoma. Abdom Radiol 44:473–481. https://doi.org/10.1007/s00261-018-1742-6

    Article  Google Scholar 

  28. Bartsch F, Hahn F, Müller L, et al (2020) Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma. BMC Surgery 20:75. https://doi.org/10.1186/s12893-020-00730-x

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ruys AT, Ten Kate FJ, Busch OR, et al (2011) Metastatic lymph nodes in hilar cholangiocarcinoma: does size matter? HPB (Oxford) 13:881–886. https://doi.org/10.1111/j.1477-2574.2011.00389.x

    Article  Google Scholar 

  30. Yu T, Chen X, Zhang X, et al (2021) Clinicopathological characteristics and prognostic factors for intrahepatic cholangiocarcinoma: a population-based study. Sci Rep 11:3990. https://doi.org/10.1038/s41598-021-83149-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Bagante F, Spolverato G, Merath K, et al (2019) Intrahepatic cholangiocarcinoma tumor burden: A classification and regression tree model to define prognostic groups after resection. Surgery 166:983–990. https://doi.org/10.1016/j.surg.2019.06.005

    Article  PubMed  Google Scholar 

  32. Kong J, Cao Y, Chai J, et al (2021) Effect of Tumor Size on Long-Term Survival After Resection for Solitary Intrahepatic Cholangiocarcinoma. Front Oncol 10:559911. https://doi.org/10.3389/fonc.2020.559911

    Article  PubMed  PubMed Central  Google Scholar 

  33. de Jong MC, Nathan H, Sotiropoulos GC, et al (2011) Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 29:3140–3145. https://doi.org/10.1200/JCO.2011.35.6519

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by Research and Graduate Studies, Khon Kaen University.

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Julaluck Promsorn, Kulyada Eurboonyanun & Payia Chadbunchachai

  2. Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Chaiwat Apivatanasiri

  3. Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Kosin Wirasorn, Jarin Chindaprasirt & Aumkhae Sookprasert

  4. Radiology Department, Massachusetts General Hospital, Boston, USA

    Mukesh Harisinghani

Authors
  1. Julaluck Promsorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kulyada Eurboonyanun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Payia Chadbunchachai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chaiwat Apivatanasiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kosin Wirasorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jarin Chindaprasirt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aumkhae Sookprasert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mukesh Harisinghani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kulyada Eurboonyanun.

Ethics declarations

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Promsorn, J., Eurboonyanun, K., Chadbunchachai, P. et al. Diffusion-weighted imaging as an imaging biomarker for assessing survival of patients with intrahepatic mass-forming cholangiocarcinoma. Abdom Radiol 47, 2811–2821 (2022). https://doi.org/10.1007/s00261-022-03569-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-022-03569-3

Keywords

Search

Navigation