Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China.
Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China.
Abdom Radiol (NY). 2022 Feb;47(2):640-650. doi: 10.1007/s00261-021-03292-5. Epub 2021 Nov 25.
This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).
From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings.
Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors.
The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.
本研究旨在评估磁共振延迟增强模式在预测肝内肿块型胆管细胞癌（IMCC）术后预后中的价值。
2011 年至 2015 年，231 例 IMCC 患者术前接受 DCE-MRI 检查。评估增强模式和 MRI 特征。比较不同增强模式的 IMCC 之间的复发和死亡率数据。使用术前和术后临床病理因素以及影像学发现进行预后因素分析。
动脉期（AP）呈低信号、边缘环形强化和弥漫性高信号的肿瘤分别有 56（24.2%）例、142（61.5%）例和 33（14.3%）例；门静脉期（DP）呈低信号、不均匀强化和均匀强化的肿瘤分别有 56（24.2%）例、81（35.1%）例和 94（40.7%）例。动脉弥漫性高信号或延迟均匀强化的 IMCC 患者术前 CA19-9 水平较低，肿瘤体积较小，手术较小，与淋巴结转移、血管侵犯、坏死或肿瘤分化不良的相关性较低（p < 0.05），因此总生存率和无病生存率较高（p < 0.05）。AP 和 DP 的联合增加了动脉边缘强化组中预后良好患者的检出率。多因素分析显示，延迟增强模式（DFS/OS 中低信号 HR=6.304/10.028；异质性 HR=4.579/4.972；DFS/OS）、病变数量（DFS/OS 中 1.6/1.5）和肿瘤大小（DFS 中 1.6）是独立的预后因素。
延迟 MRI 中的均匀增强模式是 IMCC 的独立最佳预后因素，与动脉弥漫性高信号模式相比，提高了预后良好患者的检出率。
