Zhang Hongbin, Chen Lintao, Zhang Jing, Li Ziqian, Wang Yifan, Sun Fangyu, Du Wenting, Zhang Xiuming, Liang Wenjie
Department of Radiology, Yiwu Central Hospital of Wenzhou Medical University, Yiwu, China.
Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Quant Imaging Med Surg. 2025 Aug 1;15(8):7470-7482. doi: 10.21037/qims-24-914. Epub 2025 Jul 29.
Cytokeratin 19-positive hepatocellular carcinoma (CK19 HCC) is an uncommon subtype of hepatocellular carcinoma (HCC). The purpose of this study was to identify radiological characteristics with diagnostic value for CK19 HCC.
This was a case-control study. A retrospective analysis of 104 patients with surgically resected, pathologically confirmed CK19 HCC was conducted. The contrast-enhanced computed tomography characteristics of the enrolled patients were assessed, and differences in characteristics between groups were identified by statistical analysis. A multivariate logistic regression model was established to identify CK19 HCC, and receiver operating characteristic curves were plotted to evaluate the diagnostic performance of the model.
The univariate analysis revealed that the frequency of regular morphology (55.8% 35.6%, P<0.001), hypodensity (99.0% 91.8%, P=0.010), intratumoral necrosis (61.5% 25.0%, P<0.001), heterogeneous enhancement (96.2% 86.5%, P=0.008), peripheral washout (5.8% 1.4%, P=0.031), non-peripheral washout (88.5% 45.7%, P<0.001), Liver Imaging Reporting and Data System category 5 (67.3% 40.4%, P<0.001), and Liver Imaging Reporting and Data System - Category tumor in vein (LR-TIV) (16.3% 2.4%, P<0.001) were significantly higher in CK19 HCC than the non-CK19+ hepatic tumor patients. Conversely, the incidence of rim enhancement in the arterial phase (7.7% 22.6%, P=0.001), transient hepatic attenuation difference (THAD; 4.8% 23.1%, P<0.001), pseudocapsule formation (12.5% 23.6%, P=0.021), progressive enhancement (5.8% 50.5%, P<0.001), and lymphadenopathy (9.6% 24.5%, P=0.002) was significantly lower in the CK19 HCC than the non-CK19 hepatic tumor patients. The multivariate analysis identified intratumoral necrosis, THAD, pseudocapsule formation, progressive enhancement, and LR-TIV as independent predictors of CK19+ HCC (P<0.05). The joint prediction model had an area under the curve of 0.867 in terms of its ability to detect CK19 HCC, and a sensitivity of 88.46% and a specificity of 69.71%.
CK19 HCC is characterized by an increased prevalence of intratumoral necrosis and LR-TIV, as well as a lower incidence of THAD, pseudocapsule formation, and progressive enhancement, which collectively contribute to the identification of this HCC variant.
细胞角蛋白19阳性肝细胞癌（CK19 HCC）是肝细胞癌（HCC）的一种罕见亚型。本研究的目的是确定对CK19 HCC具有诊断价值的影像学特征。
这是一项病例对照研究。对104例经手术切除、病理确诊的CK19 HCC患者进行回顾性分析。评估纳入患者的增强计算机断层扫描特征，并通过统计分析确定组间特征差异。建立多因素逻辑回归模型以识别CK19 HCC，并绘制受试者工作特征曲线以评估该模型的诊断性能。
单因素分析显示，CK19 HCC患者中规则形态（55.8%对35.6%，P<0.001）、低密度（99.0%对91.8%，P=0.010）、瘤内坏死（61.5%对25.0%，P<0.001）、不均匀强化（96.2%对86.5%，P=0.008）、周边廓清（5.8%对1.4%，P=0.031）、非周边廓清（88.5%对45.7%，P<0.001）、肝脏影像报告和数据系统5类（67.3%对40.4%，P<0.001）以及肝脏影像报告和数据系统-静脉内肿瘤（LR-TIV）（16.3%对2.4%，P<0.001）的发生率显著高于非CK19+肝肿瘤患者。相反，CK19 HCC患者动脉期边缘强化（7.7%对22.6%，P=0.001）、肝实质一过性强化差异（THAD；4.8%对23.1%，P<0.001）、假包膜形成（12.5%对23.6%，P=0.021）、渐进性强化（5.8%对50.5%，P<0.001）和淋巴结肿大（9.6%对24.5%，P=0.002）的发生率显著低于非CK19肝肿瘤患者。多因素分析确定瘤内坏死、THAD、假包膜形成、渐进性强化和LR-TIV为CK19+ HCC的独立预测因素（P<0.05）。联合预测模型检测CK19 HCC的曲线下面积为0.867，灵敏度为88.46%，特异度为69.71%。
CK19 HCC的特征是瘤内坏死和LR-TIV的发生率增加，以及THAD、假包膜形成和渐进性强化的发生率降低，这些共同有助于识别这种HCC变体。
