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Added value of ancillary imaging features for differentiating scirrhous hepatocellular carcinoma from intrahepatic cholangiocarcinoma on gadoxetic acid-enhanced MR imaging

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine ancillary features that help distinguish between scirrhous hepatocellular carcinoma (S-HCC) and intrahepatic cholangiocarcinoma (ICC) and investigate added value of ancillary features to enhancement pattern-based diagnosis on gadoxetic acid-enhanced MRI.

Methods

This retrospective study included 96 patients with S-HCCs and 120 patients with ICCs who underwent gadoxetic acid MRI before surgical resection. Two observers reviewed MRIs of the tumours. After determining ancillary features for differentiating tumour types, we measured the diagnostic performance of adding ancillary features to enhancement pattern-based diagnosis.

Results

T2 central darkness, capsule and septum were significant and independent features differentiating S-HCC from ICC (p ≤ .06). Adding ancillary features to enhancement pattern led to increased accuracy (observer 1, 78.9 vs. 93.8 %; observer 2, 80.3 vs. 92.8 %; p < .001), sensitivity (observer 1, 74.5 vs. 96.4 %; observer 2, 77.1 vs. 93.2 %; p < .001 and .001), and specificity (observer 1, 82.5 vs. 91.7 %; observer 2, 82.9 vs. 92.5 %; p = .006 and .005) for diagnosis of S-HCC by differentiation from ICC.

Conclusions

Adding ancillary features capsule, septum and T2 central darkness to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy, sensitivity and specificity for S-HCC diagnosis with differentiation from ICC.

Key Points

• Capsule, septum, and T2 central darkness were ancillary features for S-HCC.

• A typical HCC enhancement was seen in 31.3% of S-HCCs.

• Ancillary MRI features were useful in differentiation between S-HCC and ICC.

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Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

DWI:

Diffusion-weighted image

HBPI:

Hepatobiliary phase image

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

S-HCC:

Scirrhous HCC

SI:

Signal intensity

T1WI:

T1-weighted image

T2WI:

T2-weighted image

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. This work was supported by the Soonchunhyang University Research Fund.

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Authors and Affiliations

  1. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-Si, Gyeonggi-do, 14584, Korea

    Seo-Youn Choi

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, 06351, Korea

    Young Kon Kim, Tae Wook Kang & Woo Kyoung Jeong

  3. Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea

    Ji Hye Min

  4. Biostatics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, 06351, Korea

    Soohyun Ahn & Hojeong Won

Authors
  1. Seo-Youn Choi
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  2. Young Kon Kim
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  3. Ji Hye Min
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Corresponding author

Correspondence to Young Kon Kim.

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Guarantor

The scientific guarantor of this publication is Young Kon Kim in Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

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

Soohyun Ahn and Hojeong Won, Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Study subjects or cohorts overlap

Part of the study samples were included in prior reports by us [41 sHCCs, 41 ICCs (38.0 %) from reference 20, 86 cases (39.8 %) from reference 6, and 45 cases (20.8 %) from reference 5]

Methodology

• Retrospective

• Observational

• Performed at one institution

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Choi, SY., Kim, Y.K., Min, J.H. et al. Added value of ancillary imaging features for differentiating scirrhous hepatocellular carcinoma from intrahepatic cholangiocarcinoma on gadoxetic acid-enhanced MR imaging. Eur Radiol 28, 2549–2560 (2018). https://doi.org/10.1007/s00330-017-5196-y

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  • DOI: https://doi.org/10.1007/s00330-017-5196-y

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