Park Rohee, Kim Dong Hwan, Choi Sang Hyun, Kim Jeewuan, Lee Seung Soo, Byun Jae Ho, Won Hyung Jin, Shin Yong Moon
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
Eur Radiol. 2025 Jun 6. doi: 10.1007/s00330-025-11722-x.
To develop a preoperative risk scoring system to predict microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICCA) by incorporating clinical and gadoxetate-enhanced MRI features.
We retrospectively enrolled 197 consecutive patients with ICCA who underwent preoperative gadoxetate-enhanced MRI and curative surgical resection between 2009 and 2016. The patients were randomly divided into a development set (n = 139) and a validation set (n = 58). Two radiologists independently reviewed the MRI features. A risk scoring system to predict MVI was developed using multivariable logistic regression analysis, and its diagnostic performance was validated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed based on the MVI risk.
Gadoxetate-enhanced MRI features that were independently associated with MVI included tumor multiplicity (odds ratio (OR) 3.37, 95% confidence interval (CI): 1.37-8.28, p = 0.008), arterial-phase peritumoral enhancement (OR 4.47, 95% CI: 1.87-10.70, p = 0.001), and hepatobiliary-phase peritumoral hypointensity (OR 2.96, 95% CI: 1.29-6.77, p = 0.010). Using these features, the area under the receiver operating characteristic curve of the scoring system was 0.80 (95% CI: 0.72-0.87) in the development cohort and 0.84 (95% CI: 0.74-0.94) in the validation cohort. ICCA patients at high risk for MVI exhibited significantly shorter RFS and OS compared to those at low risk for MVI in both cohorts (p ≤ 0.031).
The risk scoring system based on gadoxetate-enhanced MRI features effectively predicted the risk of MVI in patients with ICCA, facilitating the preoperative identification of patients who are likely to have poorer survival outcomes following curative resection.
Question Microvascular invasion (MVI) is a well-established adverse prognostic factor in intrahepatic cholangiocarcinoma (ICCA). However, the preoperative prediction of MVI using gadoxetate-enhanced MRI remains unexplored. Findings A risk scoring system based on gadoxetate-enhanced MRI was developed, effectively predicting MVI in ICCA and linking high MVI risk to significantly poorer survival outcomes following resection. Clinical releveance This scoring system enables the accurate assessment of MVI risk in ICCA and provides valuable prognostic insights for patients undergoing curative surgery. Its use can help clinicians develop personalized treatment strategies to improve patient outcomes.
通过纳入临床和钆塞酸二钠增强MRI特征，开发一种术前风险评分系统，以预测肝内胆管癌（ICCA）的微血管侵犯（MVI）。
我们回顾性纳入了197例连续的ICCA患者，这些患者在2009年至2016年间接受了术前钆塞酸二钠增强MRI检查和根治性手术切除。患者被随机分为训练集（n = 139）和验证集（n = 58）。两名放射科医生独立评估MRI特征。使用多变量逻辑回归分析开发了一种预测MVI的风险评分系统，并对其诊断性能进行了验证。基于MVI风险分析无复发生存期（RFS）和总生存期（OS）。
与MVI独立相关的钆塞酸二钠增强MRI特征包括肿瘤多灶性（比值比（OR）3.37，95%置信区间（CI）：1.37 - 8.28，p = 0.008）、动脉期瘤周强化（OR 4.47，95%CI：1.87 - 10.70，p = 0.001）和肝胆期瘤周低信号（OR 2.96，95%CI：1.29 - 6.77，p = 0.010）。利用这些特征，评分系统在训练队列中的受试者操作特征曲线下面积为0.80（95%CI：0.72 - 0.87），在验证队列中为0.84（95%CI：0.74 - 0.94）。在两个队列中，MVI高风险的ICCA患者与MVI低风险患者相比，RFS和OS均显著缩短（p≤0.031）。
基于钆塞酸二钠增强MRI特征的风险评分系统有效地预测了ICCA患者的MVI风险，有助于术前识别根治性切除后生存结果可能较差的患者。
问题微血管侵犯（MVI）是肝内胆管癌（ICCA）公认的不良预后因素。然而，使用钆塞酸二钠增强MRI对MVI进行术前预测仍未得到探索。发现开发了一种基于钆塞酸二钠增强MRI的风险评分系统，有效地预测了ICCA中的MVI，并将高MVI风险与切除后显著较差的生存结果联系起来。临床意义该评分系统能够准确评估ICCA中的MVI风险，并为接受根治性手术的患者提供有价值的预后见解。其应用有助于临床医生制定个性化治疗策略以改善患者预后。
