Konošenoka Katrīna Marija, Zdanovskis Nauris, Kratovska Aina, Šilovs Artūrs, Zaiceva Veronika
Department of Radiology, Riga Stradins University, Dzirciema Street, 16, LV-1007 Riga, Latvia.
Department of Interventional Radiology, Riga East University Hospital, Hippocrates St., 2, LV-1038 Riga, Latvia.
Diagnostics (Basel). 2025 Jul 24;15(15):1861. doi: 10.3390/diagnostics15151861.
: Accurate noninvasive differentiation between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) remains a clinical challenge. This study aimed to assess the dignostic performance of apparent diffusion coefficient (ADC) values from diffusion-weighted MRI in distinguishing between HCC and ICC, with histological confirmation as the gold standard. : A retrospective analysis was performed on 61 patients (41 HCC, 20 ICC) who underwent liver MRI and percutaneous biopsy between 2019 and 2024. ADC values were measured from diffusion-weighted sequences (b-values of 0, 500, and 1000 s/mm), and regions of interest were placed over solid tumor areas. Statistical analyses included -tests, one-way ANOVA, and ROC curve analysis. : Mean ADC values did not differ significantly between HCC (1.09 ± 0.19 × 10 mm/s) and ICC (1.08 ± 0.11 × 10 mm/s). ROC analysis showed poor discriminative ability (AUC = 0.520; = 0.806). In HCC, ADC values decreased with lower differentiation grades ( = 0.008, η = 0.224). No significant trend was observed in ICC ( = 0.410, η = 0.100). Immunohistochemical markers such as CK-7, Glypican 3, and TTF-1 showed significant diagnostic value between tumor subtypes. : ADC values have limited utility for distinguishing HCC from ICC but may aid in HCC grading. Immunohistochemistry remains essential for accurate diagnosis, especially in poorly differentiated tumors. Further studies with larger cohorts are recommended to improve noninvasive diagnostic protocols.
肝细胞癌（HCC）和肝内胆管癌（ICC）之间准确的无创鉴别仍然是一项临床挑战。本研究旨在评估扩散加权磁共振成像（MRI）的表观扩散系数（ADC）值在区分HCC和ICC方面的诊断性能，并以组织学确诊作为金标准。
对2019年至2024年间接受肝脏MRI检查和经皮活检的61例患者（41例HCC，20例ICC）进行回顾性分析。从扩散加权序列（b值为0、500和1000 s/mm²）测量ADC值，并将感兴趣区域置于实体瘤区域上。统计分析包括t检验、单因素方差分析和ROC曲线分析。
HCC（1.09±0.19×10⁻³mm²/s）和ICC（1.08±0.11×10⁻³mm²/s）的平均ADC值差异无统计学意义。ROC分析显示鉴别能力较差（AUC = 0.520；P = 0.806）。在HCC中，ADC值随分化程度降低而降低（P = 0.008，η² = 0.224）。在ICC中未观察到显著趋势（P = 0.410，η² = 0.100）。细胞角蛋白7（CK-7）、磷脂酰肌醇蛋白聚糖3（Glypican 3）和甲状腺转录因子1（TTF-1）等免疫组化标志物在肿瘤亚型之间显示出显著的诊断价值。
ADC值在区分HCC和ICC方面的效用有限，但可能有助于HCC分级。免疫组化对于准确诊断仍然至关重要，尤其是在低分化肿瘤中。建议进行更大样本量的进一步研究以改进无创诊断方案。
