肝细胞癌-胆管细胞癌混合型：钆塞酸增强磁共振成像的 LI-RADS v2017 分类用于鉴别诊断和预后评估。
Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging.
机构信息
Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
出版信息
Eur Radiol. 2019 Jan;29(1):373-382. doi: 10.1007/s00330-018-5605-x. Epub 2018 Jun 28.
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 χ 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.
目的
探讨 Liver Imaging Reporting and Data System (LI-RADS) v2017 在鉴别肝细胞癌 (HCC) 和预测钆塞酸增强磁共振成像 (Gd-EOB-MRI) 中肝胆管细胞癌 (cHCC-CCA) 预后中的表现。
方法
纳入经病理证实的 cHCC-CCA 高风险患者 (n = 70) 和匹配的 HCC 对照组 (n = 70)，均接受 Gd-EOB-MRI 检查。由两位放射科医生对每个病变进行 LI-RADS 分类。使用 χ 检验或 Fisher 确切检验比较 LR-M 和 LR-5/4 的 cHCC-CCA 的影像学特征和手术结果。使用 Kaplan-Meier 生存曲线估计无复发生存率 (RFS)，并使用对数秩检验进行比较。
结果
cHCC-CCA 和 HCC 分别被归类为 LR-M、LR-5/4 和 LR-TIV 的比例为 61.4% (43/70)、37.1% (26/70)和 1.4% (1/70)和 10.0% (7/70)、88.6% (62/70)和 1.4% (1/70)。与 LR-M 相比，LR-5/4 的 cHCC-CCA 显示出更高频率的主要 HCC 特征：动脉期强化 (96.2% (25/26) 比 58.1% (25/43)，p = 0.001)、洗脱外观 (80.8% (21/26) 比 48.8% (21/43)，p = 0.011) 和增强包膜 (34.6% (9/26) 比 11.6% (5/43)，p = 0.031)。在根治性手术后，LR-M 的 cHCC-CCA 患者早期复发率 (≤6 个月) 高于 LR-5/4 (27.8% (10/36) 比 4.8% (1/21)，p = 0.041)，但 RFS 无显著差异 (对数秩检验，p = 0.084)。
结论
在 Gd-EOB-MRI 上使用 LI-RADS，相当一部分 cHCC-CCA 可归类为非 LR-M。此外，影像学上表现为 HCC 样的 cHCC-CCA (LR-5/4) 可能比 LR-M 具有更好的手术预后，表现为早期复发率较低。
关键要点
cHCC-CCA 在 Gd-EOB-MRI 上可归类为 LR-M 或非 LR-M。
LR-5/4 的 cHCC-CCA 常表现出主要 HCC 的影像学特征。
LI-RADS 分类可能为 cHCC-CCA 手术后提供预后信息。
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