Yang Xue, Chang Jing, Li Ruili, Qi Yu, Zeng Xufen, Wang Wei, Li Hongjun
Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
Department of Pathology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
J Hepatocell Carcinoma. 2023 Jan 26;10:113-122. doi: 10.2147/JHC.S390820. eCollection 2023.
To explore the imaging performance for discrimination of combined hepatocellular- cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC).
In total, 35 patients with cHCC-CCA and a matched control group of HCC patients (n = 35) were included retrospectively. We quantitatively evaluated the hypovascular component in tumor and qualitatively assessed LI-RADS features and other aggressive features to develop model for cHCC-CCA diagnose. Subgroup analyses were performed by tumor size and LI-RADS category.
cHCC-CCA frequently showed a larger proportion (≥50%) of hypovascular areas followed by HCC (P = 0.000). Among those patients with ≥50% hypovascular areas, 8 patients did not present rim enhancement in atrial phase. The LI-RADS major features were more commonly observed in HCC (82.9-45.7%,), than cHCC-CCA ( = 0.003-0.022). The targetoid appearances and non-smooth margin frequently appeared in cHCC-CCA (34.3-63.9%), compared with HCC ( = 0.000-0.023). We developed a radiologic model based on ≥50% hypovascular component and delayed enhancement, which presented AUC of 0.821, accuracy of 80%. We also obtained good performance by radiologic model in LR-M group and tumor size <50mm group (AUC: 0.841 and 0.866, respectively). Combined group which included CA 19-9 and ≥50% hypovascular component and delayed enhancement did not improve the distinction performance between cHCC-CCA and HCC, which presented good performance of identifying cHCC-CCA in the LR-4/5 subgroup and tumor size ≥50 mm subgroup (AUC: 0.717, 0.730, respectively). cHCC-CCA group presented heterogeneous dominant pathology involving 15 of HCC, 7 of intrahepatic cholangiocarcinoma (iCCA) or cholangiolocellular carcinoma (CLC), 13 of intermediate cells component. Macrotrabecular appearances were higher in cHCC-CCA than that in HCC. The proportion of Hepa-1 was significantly higher in true negative (TN) patients (29 [93.5%]) and false negative (FN) patients (10 [100%]) than in true positive (TP) patients (16 [64%]; = 0.036).
Quantitative assessment of hypovascular component could help the discrimination of cHCC-CCA. Macrotrabecular appearances were more exhibited in cHCC-CCA than that in HCC.
探讨鉴别肝细胞-胆管细胞癌（cHCC-CCA）与肝细胞癌（HCC）的影像学表现。
回顾性纳入35例cHCC-CCA患者及与之匹配的HCC患者对照组（n = 35）。我们定量评估肿瘤内的乏血管成分，并定性评估LI-RADS特征及其他侵袭性特征，以建立cHCC-CCA诊断模型。按肿瘤大小和LI-RADS类别进行亚组分析。
cHCC-CCA常表现为较大比例（≥50%）的乏血管区域，其次是HCC（P = 0.000）。在乏血管区域≥50%的患者中，8例在动脉期未出现边缘强化。LI-RADS主要特征在HCC中（82.9 - 45.7%）比在cHCC-CCA中更常见（P = 0.003 - 0.022）。与HCC相比，靶样表现和边缘不光滑在cHCC-CCA中更常见（34.3 - 63.9%）（P = 0.000 - 0.023）。我们基于≥50%的乏血管成分和延迟强化建立了一个放射学模型，其曲线下面积（AUC）为0.821，准确率为80%。我们在LR-M组和肿瘤大小<50mm组中通过放射学模型也获得了良好的性能（AUC分别为0.841和0.866）。包括CA 19-9、≥50%的乏血管成分和延迟强化的联合组并未改善cHCC-CCA与HCC之间的鉴别性能，其在LR-4/5亚组和肿瘤大小≥50mm亚组中识别cHCC-CCA表现出良好性能（AUC分别为0.717、0.730）。cHCC-CCA组呈现异质性主导病理，其中15例为HCC，7例为肝内胆管癌（iCCA）或胆管细胞癌（CLC），13例为中间细胞成分。cHCC-CCA中粗大梁状表现高于HCC。真阴性（TN）患者（29例[93.5%]）和假阴性（FN）患者（10例[100%]）中Hepa-1的比例显著高于真阳性（TP）患者（16例[64%]；P = 0.036）。
乏血管成分的定量评估有助于鉴别cHCC-CCA。cHCC-CCA比HCC更易表现出粗大梁状表现。
