Qian Xianling, Ni Xiaoyan, Miao Gengyun, Wang Fang, Zhou Changwu, Huang Peng, Zhang Yunfei, Chen Lei, Yang Chun, Zeng Mengsu
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Medical Imaging, Shanghai, China.
J Magn Reson Imaging. 2025 Feb;61(2):997-1010. doi: 10.1002/jmri.29477. Epub 2024 Jun 25.
Regional lymph node metastasis (LNM) assessment is crucial for predicting intrahepatic cholangiocarcinoma (iCCA) prognosis. However, imaging assessment has limitations for identifying LNM.
To investigate the association between MRI radiomics features, regional LNM status, and prognosis in iCCA.
Retrospective.
Two hundred ninety-six patients (male = 197) with surgically confirmed iCCA.
FIELD STRENGTH/SEQUENCE: 1.5 T and 3.0 T. DWI, T2WI, and contrast-enhanced T1WI.
Clinical information, radiologic, and MRI-based radiomics features associated with LNM status were collected to establish models. Performance of MRI, PET/CT, and the combined LNM models were compared in training (N = 207) and test (N = 89) datasets. Overall survival (OS) was compared based on LNM status.
The independent features were selected by 5-fold cross-validation. The performance of MRI, PET/CT, and the models was evaluated using the area under receiver operating characteristic curve (AUC). Univariable and multivariable Cox regression were used to identify independent variables for OS. Kaplan-Meier curves were compared with the log-rank test between LNM positive and negative groups. P < 0.05 was considered statistically significant.
Intrahepatic duct dilatation, enhancement pattern, and CA19-9 were independent clinicoradiologic features. The radiomics model was constructed by the independent radiomics features extracted from T2WI and delay phase T1WI. The combined LNM model showed AUC of 0.888, 0.884, and 0.811 in training, validation, and test cohorts with a positive net benefit. PET/CT exhibited similar sensitivity to the combined LNM model (0.750 vs. 0.733, P > 0.999) while the combined LNM model showed higher specificity (0.703 vs. 0.630, P = 0.039) in the test cohort. High risk of regional LNM was significantly associated with worse OS (median: 24 months) than low risk (median: 30 months, P < 0.0001).
The combined LNM model has the strongest correlation with LNM status for mass-forming iCCA patients.
3 TECHNICAL EFFICACY: Stage 2.
区域淋巴结转移（LNM）评估对于预测肝内胆管癌（iCCA）的预后至关重要。然而，影像学评估在识别LNM方面存在局限性。
探讨MRI影像组学特征、区域LNM状态与iCCA预后之间的关联。
回顾性研究。
296例经手术确诊的iCCA患者（男性197例）。
场强/序列：1.5T和3.0T。扩散加权成像（DWI）、T2加权成像（T2WI）和对比增强T1加权成像。
收集与LNM状态相关的临床信息、放射学和基于MRI的影像组学特征以建立模型。在训练数据集（N = 207）和测试数据集（N = 89）中比较MRI、正电子发射断层显像/X线计算机体层摄影（PET/CT）及联合LNM模型的性能。根据LNM状态比较总生存期（OS）。
通过五折交叉验证选择独立特征。使用受试者工作特征曲线下面积（AUC）评估MRI、PET/CT及模型的性能。采用单变量和多变量Cox回归确定OS的独立变量。使用对数秩检验比较LNM阳性和阴性组之间的Kaplan-Meier曲线。P < 0.05被认为具有统计学意义。
肝内胆管扩张、强化方式和糖类抗原19-9（CA19-9）是独立的临床放射学特征。影像组学模型由从T2WI和延迟期T1WI提取的独立影像组学特征构建。联合LNM模型在训练、验证和测试队列中的AUC分别为0.888、0.884和0.811，净效益为阳性。PET/CT在测试队列中的敏感性与联合LNM模型相似（0.750对0.733，P > 0.999），而联合LNM模型显示出更高的特异性（0.703对0.630，P = 0.039）。区域LNM高风险组的OS明显比低风险组差（中位数：24个月对30个月，P < 0.0001）。
联合LNM模型与肿块型iCCA患者的LNM状态相关性最强。
3级 技术效能：2级
