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Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To investigate the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2017 for combined hepatocellular cholangiocarcinoma (cHCC-CCA) in the differential diagnosis from hepatocellular carcinoma (HCC) and prediction of prognosis on gadoxetic acid-enhanced MRI (Gd-EOB-MRI).

Methods

Patients at high risk of HCC with pathologically confirmed cHCC-CCAs (n = 70) and a matched control of HCCs (n = 70) who had undergone Gd-EOB-MRI were included. LI-RADS category was assigned for each lesion by two radiologists. Imaging features and surgical outcomes were compared between cHCC-CCAs of LR-M and LR-5/4 using the χ2 test or Fisher’s exact test. Recurrence-free survival (RFS) was estimated using Kaplan–Meier survival curves and compared using the log-rank test.

Results

cHCC-CCAs and HCCs were categorised as LR-M, LR-5/4 and LR-TIV in 61.4% (43/70), 37.1% (26/70) and 1.4% (1/70) and 10.0% (7/70), 88.6% (62/70) and 1.4% (1/70), respectively. cHCC-CCAs of LR-5/4, in comparison to LR-M, showed significantly higher frequencies of major HCC features: arterial hyperenhancement (96.2% (25/26) vs. 58.1% (25/43), p = 0.001), washout appearance (80.8% (21/26) vs. 48.8% (21/43), p = 0.011) and enhancing capsule (34.6% (9/26) vs. 11.6% (5/43), p = 0.031). After curative surgery, patients with cHCC-CCAs of LR-M showed a higher early recurrence rate (≤ 6 months) than did those with LR-5/4 (27.8% (10/36) vs. 4.8% (1/21), p = 0.041), whereas no significant difference was observed in RFS (log-rank p = 0.084).

Conclusions

By using LI-RADS on Gd-EOB-MRI, a substantial proportion of cHCC-CCAs can be categorised as non-LR-M. In addition, cHCC-CCAs mimicking HCCs on imaging (LR-5/4) may indicate better surgical outcomes with regard to early recurrence than those of LR-M.

Key Points

• cHCC-CCAs can be categorised as either LR-M or non-LR-M on Gd-EOB-MRI.

• cHCC-CCAs of LR-5/4 frequently demonstrate major HCC imaging features.

• LI-RADS categorisation may provide prognostic information after surgery in cHCC-CCAs.

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Abbreviations

cHCC-CCA:

Combined hepatocellular cholangiocarcinoma

Gd-EOB-MRI:

Gadoxetic acid-enhanced magnetic resonance imaging

LI-RADS:

Liver Imaging Reporting and Data System

LR-4:

Probably HCC

LR-5:

Definitely HCC

LR-M:

Probably or definitely malignant, not HCC specific

RFS:

Recurrence-free survival

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Sun Kyung Jeon, Ijin Joo, Dong Ho Lee, Hyo-Jin Kang & Jeong Min Lee

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Sun Kyung Jeon, Ijin Joo, Dong Ho Lee, Hyo-Jin Kang & Jeong Min Lee

  3. Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea

    Sang Min Lee

  4. Department of Pathology, Seoul National University Hospital, Seoul, Korea

    Kyoung-Bun Lee

  5. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Jeong Min Lee

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  1. Sun Kyung Jeon
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Correspondence to Ijin Joo.

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The scientific guarantor of this publication is Ijin Joo.

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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

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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This retrospective study performed at one institution was approved by the Institutional Review Board of Seoul National University Hospital.

Methodology

• retrospective

• case-control study

• performed at one institution

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Jeon, S.K., Joo, I., Lee, D.H. et al. Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol 29, 373–382 (2019). https://doi.org/10.1007/s00330-018-5605-x

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  • DOI: https://doi.org/10.1007/s00330-018-5605-x

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