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Combined Hepatocellular-Cholangiocarcinoma: Magnetic Resonance Imaging Features and Prognosis According to Risk Factors for Hepatocellular Carcinoma

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Abstract
Background Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) can develop in patients with and without risk factors for hepatocellular carcinoma (HCC).

Purpose To compare the clinical and magnetic resonance imaging (MRI) characteristics of cHCC-CCA in patients with and without risk factors for HCC, and to assess the influence of risk factors on patient prognosis.

Study Type Retrospective.

Population A total of 152 patients with surgically confirmed cHCC-CCA.

Field Strength/Sequence 1.5-T and 3-T/T1-weighted dual gradient-echo in- and opposed-phase, T2-weighted turbo-spin-echo, diffusion-weighted single-shot spin-echo echo-planar, and T1-weighted three-dimensional gradient-echo contrast-enhanced sequences.

Assessment MRI features according to the Liver Imaging Reporting and Data System (LI-RADS) and pathologic findings based on revised classification were compared between patients with and without risk factors for HCC. Overall survival (OS) and recurrence-free survival (RFS) were also compared between the two groups, and factors associated with survival were evaluated.

Statistical Tests The clinico-pathologic and MRI features of the two groups were compared using Student's t-tests, Mann-Whitney U-tests, and chi-square tests. OS and RFS were evaluated by the Kaplan-Meier method, and factors associated with survival were evaluated by Cox proportional hazard model.

Results cHCC-CCA in patients with risk factors were more frequently classified as LI-RADS category 4 or 5 (LR-4/5; probably or definitely HCC) (48.7%), whereas those without risk factors were more frequently classified as category M (LR-M; probably malignant, not specific for HCC) (63.6%). RFS and OS did not differ significantly according to risk factors (P = 0.63 and 0.83). Multivariable analysis showed that pathologic tumor type (hazard ratio 2.02; P < 0.05) and LI-RADS category (hazard ratio 2.19; P < 0.05) were significantly associated with RFS and OS, respectively.

Data Conclusion Although MRI features of cHCC-CCA differed significantly between patients with and without risk factors for HCC, postsurgical prognosis did not. LI-RADS category and pathologic tumor type were independently correlated with postsurgical prognosis in patients with cHCC-CCA.

Level of Evidence 3

Technical Efficacy Stage 2
Author(s)
김동환최상현김동욱이승수임영석김소연김형중김진희변재호
Issued Date
2021
Type
Article
Keyword
combined hepatocellular‐cholangiocarcinomagadoxetic acid‐enhanced magnetic resonance imagingHepatomaLiverMagnetic resonance imagingMedical researchMedicineExperimentalPrognosisRisk factors
DOI
10.1002/jmri.27528
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7368
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2488169088&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Combined%20Hepatocellular-Cholangiocarcinoma:%20Magnetic%20Resonance%20Imaging%20Features%20and%20Prognosis%20According%20to%20Risk%20Factors%20for%20Hepatocellular%20Carcinoma&amp;offset=0&amp;pcAvailability=true
Publisher
JOURNAL OF MAGNETIC RESONANCE IMAGING
Location
미국
Language
영어
ISSN
1053-1807
Citation Volume
53
Citation Number
6
Citation Start Page
1803
Citation End Page
1812
Appears in Collections:
Medicine > Medicine
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