Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
Abdom Radiol (NY). 2020 Oct;45(10):3109-3118. doi: 10.1007/s00261-020-02458-x.
To compare the differences of MR features between mass-forming intrahepatic cholangiocarcinoma (IMCC) with and without lymph node metastasis (LNM) and to search for new imaging biomarkers for predicting LNM.
The study included 91 patients with histopathologically confirmed single IMCC (20 patients with LNM and 71 patients without LNM). Findings of preoperative MR imaging including diffusion-weighted imaging (DWI) (b value 0, 500 mm/s) were analyzed and apparent diffusion coefficient (ADC) values (b = 500 mm/s) were calculated. Logistic regression analysis was performed to identify independent predictors of LNM. The diagnostic performance of independent predictors was assessed by receiver operating characteristic (ROC) and area under the curve (AUC) was compared.
Larger tumor size (p = 0.001), diameter of largest lymph node (LN) > 1 cm (p < 0.001), higher ADC value of primary IMCC lesion (ADC value) (p = 0.001), and positive CA19-9 level (p = 0.018) were correlated with LNM. Multivariate logistic regression analysis demonstrated that ADC value (odds ratio, 3.347; p = 0.001) and diameter of largest LN > 1 cm (odds ratio, 7.571; p = 0.004) were independent predictors of LNM. The AUCs for ADC value, diameter of largest LN > 1 cm,and combined method (the combination of ADC value and diameter of largest LN > 1 cm) were 0.782, 0.701,and 0.857, respectively. The AUC for combined method was significantly higher than that of diameter of largest LN > 1 cm (p = 0.033).
ADC value can be a potential imaging biomarker for predicting LNM of IMCC, especially in combination with diameter of largest LN > 1 cm.
比较伴与不伴淋巴结转移（LNM）的肿块型肝内胆管细胞癌（IMCC）的磁共振（MR）特征差异，寻找预测 LNM 的新影像标志物。
本研究纳入了 91 例经组织病理学证实的单发 IMCC 患者（20 例伴 LNM，71 例不伴 LNM）。分析了术前 MR 成像（包括弥散加权成像（DWI）（b 值为 0、500mm/s））的结果，并计算了表观弥散系数（ADC）值（b=500mm/s）。采用 logistic 回归分析确定 LNM 的独立预测因素。通过受试者工作特征（ROC）曲线评估独立预测因素的诊断性能，并比较曲线下面积（AUC）。
较大的肿瘤大小（p=0.001）、最大淋巴结（LN）直径>1cm（p<0.001）、原发 IMCC 病变的 ADC 值较高（ADC 值）（p=0.001）和 CA19-9 水平阳性（p=0.018）与 LNM 相关。多变量 logistic 回归分析表明，ADC 值（优势比，3.347；p=0.001）和最大 LN 直径>1cm（优势比，7.571；p=0.004）是 LNM 的独立预测因素。ADC 值、最大 LN 直径>1cm 和联合方法（ADC 值与最大 LN 直径>1cm 的联合）的 AUC 分别为 0.782、0.701 和 0.857。联合方法的 AUC 明显高于最大 LN 直径>1cm 的 AUC（p=0.033）。
ADC 值可能是预测 IMCC LNM 的潜在影像标志物，特别是与最大 LN 直径>1cm 联合使用时。
