From the Department of Radiology and Center for Imaging Science (J.H.M., Y.K.K., T.W.K., S.J.L.) and Department of Surgery (J.M.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Republic of Korea; Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea (S.Y.C.); Department of Mathematics, Ajou University, Suwon, Republic of Korea (S.A.); and Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (H.C.).
Radiology. 2019 Mar;290(3):691-699. doi: 10.1148/radiol.2018181485. Epub 2019 Jan 8.
Purpose To identify whether arterial enhancement pattern at MRI could predict the prognosis after surgical resection of intrahepatic mass-forming cholangiocarcinoma (IMCC). Materials and Methods Patients who underwent curative hepatic resection and preoperative MRI for IMCC from November 2007 to September 2016 were retrospectively evaluated. MRI enhancement pattern was classified by two radiologists. Recurrence and death data were retrieved until September 31, 2017. Prognostic factor analysis was performed by using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. Results Data in 134 patients (median age, 63.0 years; 87 men and 47 women) were evaluated; median tumor size was 4.5 cm. Arterial phase MRI showed diffuse hypoenhancement in 33 patients, peripheral rim enhancement in 81 patients, and diffuse hyperenhancement in 20 patients. The 5-year risk of death in patients with IMCC with diffuse hyperenhancement was lower than that of patients with diffuse hypoenhancement or peripheral rim enhancement (5-year risk of death: 5.9% vs 87.9% vs 59.2%). Diffuse hypoenhancement (hazard ratio [HR], 41; 95% confidence interval [CI]: 5, 312; P < .01) and peripheral rim enhancement (HR, 11; 95% CI: 2, 85; P = .02) were associated with an increased risk of death compared with diffuse hyperenhancement. Patients with diffuse hyperenhancement of IMCCs had more frequent chronic liver disease (13 of 20; 65%), less frequent vascular invasion (six of 20; 30%), and less frequent tumor necrosis (three of 20; 15%) than other enhancement group (P < .05 for all). Conclusion The MRI arterial enhancement pattern was a prognostic marker in the preoperative evaluation of patients with resectable intrahepatic mass-forming cholangiocarcinoma. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Yoon and Lee .
探讨 MRI 动脉期增强模式能否预测肝内肿块型胆管细胞癌（intrahepatic mass-forming cholangiocarcinoma，IMCC）切除术后的预后。
回顾性分析 2007 年 11 月至 2016 年 9 月期间因 IMCC 行根治性肝切除术并接受术前 MRI 检查的患者。由 2 名放射科医生对 MRI 增强模式进行分类。检索至 2017 年 9 月 31 日的复发和死亡数据。采用术前和术后临床病理因素以及影像学表现进行预后因素分析。
共评估了 134 例患者（中位年龄，63.0 岁；87 例男性，47 例女性；中位肿瘤直径 4.5 cm）。动脉期 MRI 显示弥漫性低增强 33 例，周边环形增强 81 例，弥漫性高增强 20 例。弥漫性高增强组患者的 IMCC 5 年死亡风险低于弥漫性低增强组（5 年死亡风险：5.9%比 87.9%比 59.2%）。弥漫性低增强（HR，41；95%CI：5，312；P<.01）和周边环形增强（HR，11；95%CI：2，85；P=.02）与死亡风险增加相关。与其他增强组相比，弥漫性高增强组 IMCC 患者更常伴有慢性肝病（20 例中有 13 例；65%），较少发生血管侵犯（20 例中有 6 例；30%），较少发生肿瘤坏死（20 例中有 3 例；15%）（所有 P 值均<.05）。
MRI 动脉期增强模式是可切除性肝内肿块型胆管细胞癌患者术前评估的预后标志物。
