Park Sungeun, Lee Youngeun, Kim Haeryoung, Yu Mi Hye, Lee Eun Sun, Yoon Jeong Hee, Joo Ijin, Lee Jeong Min
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea.
Liver Cancer. 2022 Mar 30;11(3):233-246. doi: 10.1159/000521747. eCollection 2022 Jun.
Small-duct (SD) and large-duct (LD) subtypes of cholangiocarcinoma have been investigated for their prognostic factors. This study aimed to evaluate the diagnostic value of liver magnetic resonance imaging (MRI) in differentiating SD and LD types of intrahepatic cholangiocarcinoma (iCCA) and its prognostic value in predicting survival outcomes.
One hundred forty patients with surgically confirmed iCCAs (93 SD type and 47 LD type) who had available preoperative gadoxetic acid-enhanced liver MR images were retrospectively included. MRI features suggestive of the LD type over the SD type were analyzed using multivariate logistic analyses. Postoperative recurrence-free survival (RFS) and overall survival (OS) for 107 patients with available survival data were compared according to MRI features.
MRI features suggestive of the LD type included infiltrative contour (odds ratio [OR] 14.2, 95% confidence interval [CI]: 2.5-81.7, = 0.003), diffuse biliary dilatation (OR 9.7, 95% CI: 1.2-76.9, = 0.032), no arterial phase hyperenhancement (OR 17.8, 95% CI: 2.7-118.6, = 0.003), and vascular invasion (OR 4.5, 95% CI: 1.3-15.4, = 0.018). When two or more features were combined, sensitivity was 59.6% (28/47), and specificity was 95.7% (89/93) in discriminating the LD type. RFS/OS was significantly shorter in patients with two or more MRI features, compared to those with none or one (310 days vs. 529 days, = 0.011/964 days vs. 2,023 days, = 0.010).
Preoperative liver MRI may help predict the pathological subtype of iCCAs as either the SD type or LD type, allowing preoperative identification of patients with poorer survival outcomes.
胆管癌的小导管（SD）和大导管（LD）亚型的预后因素已得到研究。本研究旨在评估肝脏磁共振成像（MRI）在鉴别肝内胆管癌（iCCA）的SD和LD类型中的诊断价值及其在预测生存结局方面的预后价值。
回顾性纳入140例经手术确诊的iCCA患者（93例SD型和47例LD型），这些患者术前均有钆塞酸增强肝脏MR图像。使用多因素逻辑分析来分析提示LD型而非SD型的MRI特征。根据MRI特征比较了107例有生存数据的患者的术后无复发生存期（RFS）和总生存期（OS）。
提示LD型的MRI特征包括浸润性轮廓（优势比[OR] 14.2，95%置信区间[CI]：2.5 - 81.7，P = 0.003）、弥漫性胆管扩张（OR 9.7，95% CI：1.2 - 76.9，P = 0.032）、动脉期无强化（OR 17.8，95% CI：2.7 - 118.6，P = 0.003）和血管侵犯（OR 4.5，95% CI：1.3 - 15.4，P = 0.018）。当两种或更多特征组合时，鉴别LD型的敏感性为59.6%（28/47），特异性为95.7%（89/93）。与无或有一个MRI特征的患者相比，有两种或更多MRI特征的患者的RFS/OS显著更短（310天对529天，P = 0.011/964天对2023天，P = 0.010）。
术前肝脏MRI可能有助于预测iCCA的病理亚型是SD型还是LD型，从而在术前识别出生存结局较差的患者。
