Halskov Sebastian, Krenzien Felix, Segger Laura, Geisel Dominik, Hamm Bernd, Pelzer Uwe, Ihlow Jana, Schöning Wenzel, Auer Timo Alexander, Fehrenbach Uli
Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
Cancers (Basel). 2024 Mar 28;16(7):1314. doi: 10.3390/cancers16071314.
To investigate the prognostic value of enhancement patterns of intrahepatic mass-forming cholangiocarcinomas (IMCCs) during the hepatobiliary phase (HBP) in gadoxetic acid (Gd-EOB)-enhanced MRI.
We retrospectively identified 66 consecutive patients with histopathologically proven IMCCs (reference standard: resection) and preoperative Gd-EOB-enhanced MRI. Gd-EOB retention area was subjectively rated based on areas of intermediate signal intensity. Lesions were classified as either hypointense (0-25% retention area) or significantly-retaining (>25% retention area). Clinical, radiological, and prognostic features were compared between these groups. The primary endpoints were recurrence-free survival (RFS) and overall survival (OS) after primary surgical resection.
73% (48/66) of lesions were rated as hypointense and 29% (19/66) as significantly-retaining. While the hypointense subgroup more frequently featured local and distant intrahepatic metastases ( = 0.039 and = 0.022) and an infiltrative growth pattern ( = 0.005), RFS, OS, and clinical features did not differ significantly with estimated Gd-EOB retention area or quantitatively measured HBP enhancement ratios. Lymph node metastasis was an independent predictor of poor RFS ( = 0.001).
Gd-EOB-enhanced MRI revealed two subtypes of IMCC in the HBP: hypointense and signal-retaining. The hypointense subtype is associated with more frequent intrahepatic metastases and an infiltrative growth pattern, indicating potential tumor aggressiveness. However, this did not result in a significant difference in survival after the primary resection of IMCC.
探讨钆塞酸二钠（Gd-EOB）增强磁共振成像（MRI）肝胆期（HBP）肝内肿块型胆管癌（IMCC）强化模式的预后价值。
我们回顾性纳入了66例经组织病理学证实为IMCC（参考标准：手术切除）且术前行Gd-EOB增强MRI检查的连续患者。基于中等信号强度区域对Gd-EOB滞留面积进行主观评分。病变分为低信号（滞留面积0-25%）或显著滞留（滞留面积>25%）。比较两组的临床、影像学和预后特征。主要终点为初次手术切除后的无复发生存期（RFS）和总生存期（OS）。
73%（48/66）的病变被评为低信号，29%（19/66）为显著滞留。虽然低信号亚组更常出现肝内局部和远处转移（P = 0.039和P = 0.022）以及浸润性生长模式（P = 0.005），但RFS、OS和临床特征与估计的Gd-EOB滞留面积或定量测量的HBP强化率无显著差异。淋巴结转移是RFS差的独立预测因素（P = 0.001）。
Gd-EOB增强MRI在HBP期显示出IMCC的两种亚型：低信号型和信号滞留型。低信号亚型与更频繁的肝内转移和浸润性生长模式相关，提示潜在的肿瘤侵袭性。然而，这并未导致IMCC初次切除后生存期的显著差异。
