Zhang Sisi, Huo Lei, Feng Yayuan, Zhang Juan, Wu Yuxian, Liu Yiping, Lu Lun, Jia Ningyang, Liu Wanmin
Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai, China.
Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Oncol. 2022 Nov 23;12:986713. doi: 10.3389/fonc.2022.986713. eCollection 2022.
The present study aimed to determine the reliable imaging features to distinguish atypical hepatocellular carcinoma (HCC) with peripheral rim-like enhancement from intrahepatic mass-forming cholangiocarcinoma (IMCC) on contrast-enhanced magnetic resonance imaging (MRI).
A total of 168 patients (130 male, 57.10 ± 10.53 years) pathological confirmed HCC or IMCC who underwent contrast-enhanced MRI between July 2019 and February 2022 were retrospectively included. Univariate and multivariate logistic regression analyses were used to determine independent differential factors for distinguishing HCC from IMCC, and the model was established. Bootstrap resampling 1000 times was used to verify the model, which was visualized by nomograms. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical utility.
Radiological capsule (OR 0.024, 95% CI: 0.006, 0.095, P<0.001), heterogeneous signal intensity (SI) on T1WI (OR 0.009, 95%CI: 0.001,0.056, P<0.001) were independent differential factors for predicting HCC over IMCC. A lobulated contour (OR 11.732, 95%CI: 2.928,47.007, P = 0.001), target sign on DP (OR 14.269, 95%CI: 2.849,82.106, P = 0.007), bile duct dilatation (OR 12.856, 95%CI: 2.013, P = 0.001) were independent differential factors for predicting IMCCs over HCCs. The independent differential factors constituted a model to distinguish atypical HCCs and IMCCs. The area under receiver operating characteristic (ROC) curve, sensitivity, and specificity values of the model were 0.964(0.940,0.987), 0.88, and 0.906, indicating that the model had an excellent differential diagnostic performance. The decision curve analysis (DCA) curve showed that the model obtained a better net clinical benefit.
The present study identified reliable imaging features for distinguishing atypical HCCs with peripheral rim-like enhancement from IMCCs on contrast-enhanced MRI. Our findings may help radiologists provide clinicians with more accurate preoperative imaging diagnoses to select appropriate treatment options.
本研究旨在确定在对比增强磁共振成像（MRI）上，能够区分具有外周环形强化的非典型肝细胞癌（HCC）与肝内肿块型胆管癌（IMCC）的可靠影像学特征。
回顾性纳入2019年7月至2022年2月期间168例经病理证实为HCC或IMCC且接受了对比增强MRI检查的患者（男性130例，年龄57.10±10.53岁）。采用单因素和多因素逻辑回归分析确定区分HCC与IMCC的独立鉴别因素，并建立模型。采用Bootstrap重采样1000次对模型进行验证，并用列线图进行可视化展示。基于区分度、校准度和临床实用性对模型的预测性能进行评估。
放射状包膜（比值比[OR]0.024，95%置信区间[CI]：0.006，0.095，P<0.001）、T1加权成像（T1WI）上的信号强度不均匀（OR 0.009，95%CI：0.001，0.056，P<0.001）是预测HCC而非IMCC的独立鉴别因素。分叶状轮廓（OR 11.732，95%CI：2.928，47.007，P = 0.001）、延迟期（DP）上的靶征（OR 14.269，95%CI：2.849，82.106，P = 0.007）、胆管扩张（OR 12.856，95%CI：2.013，P = 0.001）是预测IMCC而非HCC的独立鉴别因素。这些独立鉴别因素构成了一个区分非典型HCC和IMCC的模型。该模型的受试者操作特征（ROC）曲线下面积、灵敏度和特异度值分别为0.964（0.940，0.987）、0.88和0.906，表明该模型具有出色的鉴别诊断性能。决策曲线分析（DCA）曲线显示该模型获得了更好的净临床效益。
本研究确定了在对比增强MRI上区分具有外周环形强化的非典型HCC与IMCC的可靠影像学特征。我们的研究结果可能有助于放射科医生为临床医生提供更准确的术前影像学诊断，以选择合适的治疗方案。
