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Role of Central Hypo-enhancement in the Hepatic Arterial Phase of Dynamic Computed Tomography in Patients with Mass-Forming Intrahepatic Cholangiocarcinoma

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Abstract

Background/Purpose

The enhancement pattern in the hepatic arterial phase (HAP) of dynamic computed tomography (CT) is reportedly a prognostic marker in patients with intrahepatic cholangiocarcinoma (IHCC). This study was performed to clarify the significance of central hypo-enhancement in the HAP in patients with mass-forming IHCC.

Methods

Forty patients who had undergone initial surgical resection for mass-forming IHCC were enrolled. The dynamic CT was scanned 40 s after contrast agent injection as the HAP. A radiologist classified the patients into three groups based on the vascular pattern: the hyper-enhancement group (Hyper group), rim-enhancement group (Rim group), and hypo-enhancement group (Hypo group). The surgical specimens were immunohistochemically stained for hypoxia-inducible factor 1 (HIF-1). The correlation with clinicopathological findings and HIF-1 expression was investigated.

Results

The Hyper, Rim, and Hypo groups comprised 8, 7, and 25 patients, respectively. There were no significant correlations between the groups and clinicopathological factors. Overall survival (OS) was significantly worse in the Hypo than in the Hyper group (p = 0.03). OS was also significantly worse in the Rim + Hypo group (i.e., hypo-enhancement in the central tumor) than in the Hyper group (p = 0.04). Furthermore, inclusion in the Rim + Hypo group was a prognostic factor for OS (hazard ratio 6.68). High HIF-1 expression in the central part of the tumor was correlated with central hypo-enhancement (Hyper group: 25% and Rim + Hypo group: 72%).

Conclusions

Central hypo-enhancement was a prognostic factor in patients with IHCC. The high malignant potential of tumors with central hypo-enhancement might be associated with HIF-1 upregulation.

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Abbreviations

IHCC:

Intrahepatic cholangiocarcinoma

HAP:

Hepatic arterial phase

CT:

Computed tomography

HIF-1:

Hypoxia-inducible factor 1

IHC:

Immunohistochemistry

ROI:

Region of interest

PI:

Periductal infiltrating

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Acknowledgement

We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan

    Hiroki Teraoku, Yuji Morine, Tetsuya Ikemoto, Shuichi Iwahashi, Yu Saito, Chie Takasu, Satoru Imura & Mitsuo Shimada

  2. Department of Radiology, Tokushima University, Tokushima, 770-8503, Japan

    Naoto Uyama & Masafumi Harada

Authors
  1. Hiroki Teraoku
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  2. Yuji Morine
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  3. Naoto Uyama
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  4. Tetsuya Ikemoto
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  5. Shuichi Iwahashi
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  6. Yu Saito
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  10. Mitsuo Shimada
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Correspondence to Hiroki Teraoku.

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The authors declare that they have no competing interests.

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This study was approved by the Research Ethics Committee of Tokushima University Hospital, and written informed consent was obtained from all patients.

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Teraoku, H., Morine, Y., Uyama, N. et al. Role of Central Hypo-enhancement in the Hepatic Arterial Phase of Dynamic Computed Tomography in Patients with Mass-Forming Intrahepatic Cholangiocarcinoma. World J Surg 44, 2350–2358 (2020). https://doi.org/10.1007/s00268-020-05456-8

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  • DOI: https://doi.org/10.1007/s00268-020-05456-8

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