Wu Hongzhen, Liang Yingying, Wang Zihua, Tan Caihong, Yang Ruimeng, Wei Xinhua, Jiang Xinqing
Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China.
Department of Radiology, 593063Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, PR China.
Acta Radiol. 2023 Mar;64(3):926-935. doi: 10.1177/02841851221113265. Epub 2022 Jul 27.
Accurate diagnosis of intrahepatic mass-forming cholangiocarcinoma (IMCC) is crucial with regard to the choice of patient management and treatment options.
To evaluate the feasibility and diagnostic performance of the LI-RADS M (LR-M) targetoid criteria on computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in differentiating IMCC from hepatocellular carcinoma (HCC).
A total of 118 patients with IMCC and HCC were included who underwent CT and EOB-MRI examinations. Multivariate analysis was used to determine the strongest predictors differentiating IMCC from HCC. Using these predictors, a predictive model for differentiating IMCC from HCC was constructed and the performance of the model was confirmed using the receiver operating characteristic curve.
Multivariate analyses revealed rim-like arterial phase hyperenhancement (rim APHE) on CT and rim APHE, delayed central enhancement (DCE), and targetoid hepatobiliary phase (HBP) on MRI as independent variables significantly differentiating IMCC from HCC. The multivariate logistic regression model incorporating the three variables on EOB-MRI was constructed with an area under the curve (AUC) of 0.946, sensitivity of 87.80%, specificity of 92.21%, and accuracy of 94.60%. Per the DeLong test, the multivariate logistic regression model showed significantly higher AUC than rim APHE on CT (0.946 vs. 0.871; = 0.008) and MRI (0.946 vs. 0.876; = 0.003), whereas rim APHE on CT and MRI did not differ significantly ( = 0.809).
The multivariate logistic regression model based on rim APHE, DCE, and targetoid HBP on EOB-MRI can effectively distinguish IMCC from HCC and is superior to any other targetoid appearance criterion of LI-RADS on CT and EOB-MRI.
准确诊断肝内肿块型胆管癌（IMCC）对于患者管理和治疗方案的选择至关重要。
评估肝脏影像报告和数据系统M（LI-RADS M）类靶征标准在计算机断层扫描（CT）和钆塞酸二钠增强磁共振成像（EOB-MRI）上鉴别IMCC与肝细胞癌（HCC）的可行性及诊断性能。
纳入118例接受CT和EOB-MRI检查的IMCC和HCC患者。采用多因素分析确定鉴别IMCC与HCC的最强预测因素。利用这些预测因素构建鉴别IMCC与HCC的预测模型，并通过受试者操作特征曲线验证该模型的性能。
多因素分析显示，CT上的边缘样动脉期强化（边缘APHE）以及MRI上的边缘APHE、延迟中心强化（DCE）和类靶征肝胆期（HBP）是鉴别IMCC与HCC的独立变量。构建了包含EOB-MRI上这三个变量的多因素逻辑回归模型，曲线下面积（AUC）为0.946，灵敏度为87.80%，特异度为92.21%，准确度为94.60%。根据德龙检验，多因素逻辑回归模型的AUC显著高于CT上的边缘APHE（0.946对0.871；P = 0.008）和MRI上的边缘APHE（0.946对0.876；P = 0.003），而CT和MRI上的边缘APHE差异无统计学意义（P = 0.809）。
基于EOB-MRI上的边缘APHE、DCE和类靶征HBP的多因素逻辑回归模型能够有效区分IMCC与HCC，且优于LI-RADS在CT和EOB-MRI上的任何其他类靶征表现标准。
