Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Cancer Imaging. 2023 Feb 13;23(1):15. doi: 10.1186/s40644-023-00533-2.
Appropriate preoperative identification of iCCA subtype is essential for personalized management, so the aim of this study is to investigate the role of MR imaging features in preoperatively differentiating the iCCA subtype.
Ninety-three patients with mass-forming intrahepatic cholangiocarcinoma (iCCA, 63 small duct type and 30 large duct type) were retrospectively enrolled according to the latest 5th WHO classification (mean age, males vs. females: 60.66 ± 10.53 vs. 61.88 ± 12.82, 50 men). Significant imaging features for differentiating large duct iCCA and small duct iCCA were identified using univariate and multivariate logistic regression analyses, and a regression-based predictive model was then generated. Furthermore, diagnostic performance parameters of single significant imaging features and the predictive model were obtained, and corresponding receiver operating characteristic (ROC) curves were subsequently presented.
The univariate analysis showed that tumor in vein, arterial phase hypoenhancement, intrahepatic duct dilatation, lack of targetoid restriction and lack of targetoid appearance in T2 were predictors of large duct type iCCA. Arterial phase hypoenhancement, intrahepatic duct dilatation and lack of targetoid restriction were independent predictors for large duct type iCCA in multivariate analysis. The regression-based predictive model has achieved the best preoperative prediction performance in iCCA subcategorization so far. The area under the ROC curve of the regression-based predictive model was up to 0.91 (95% CI: 0.85, 0.98), and it was significantly higher than every single significant imaging feature.
Arterial phase hypoenhancement, intrahepatic duct dilatation and lack of targetoid restriction could be considered reliable MR imaging indicators of large duct type iCCA. MR imaging features can facilitate noninvasive prediction of iCCA subtype with satisfactory predictive performance.
准确术前识别胆管细胞癌（iCCA）亚型对制定个体化治疗方案至关重要，本研究旨在探讨 MRI 特征在术前鉴别 iCCA 亚型中的作用。
本研究回顾性纳入 93 例肿块型 iCCA 患者（小胆管型 63 例，大胆管型 30 例），患者均根据最新第 5 版世界卫生组织（WHO）分类标准进行分组（平均年龄，男/女：60.66±10.53/61.88±12.82，男 50 例）。采用单因素和多因素逻辑回归分析确定鉴别大、小胆管型 iCCA 的显著影像学特征，并建立基于回归的预测模型。此外，获得单因素和预测模型的诊断性能参数，并绘制相应的受试者工作特征（ROC）曲线。
单因素分析显示肿瘤侵犯静脉、动脉期低强化、肝内胆管扩张、无靶征限制和 T2 上无靶征表现是大胆管型 iCCA 的预测因素。动脉期低强化、肝内胆管扩张和无靶征限制是大胆管型 iCCA 的独立预测因素。基于回归的预测模型在 iCCA 亚分类中实现了迄今为止最佳的术前预测性能。ROC 曲线下面积高达 0.91（95%CI：0.85，0.98），明显高于每个显著影像学特征。
动脉期低强化、肝内胆管扩张和无靶征限制可作为大胆管型 iCCA 的可靠 MRI 征象。MRI 特征可有助于无创预测 iCCA 亚型，具有良好的预测性能。
