Mass‐forming intrahepatic cholangiocarcinoma: Can diffusion‐weighted imaging predict microvascular invasion?

Abstract

Background Microvascular invasion (MVI) is a risk factor influencing the survival rate of patients with mass‐forming intrahepatic cholangiocarcinoma (IMCC). Purpose To investigate whether diffusion‐weighted imaging (DWI) could be useful in predicting MVI of IMCC. Study Type Retrospective. Subjects Eighty patients with surgically resected single IMCC (21 MVI‐positive lesions and 59 MVI‐negative lesions). Field Strength/Sequence Preoperative hepatic MRI (1.5T), including T1‐ and T2‐weighted images (T1WI, T2WI), DWI, and dynamic enhancement imaging. Assessment Morphologic characteristics including contour of the lesion, biliary dilation and hepatic capsule retraction, signal features on T1WI, T2WI, and DWI, and dynamic enhancement patterns were qualitatively evaluated. The quantitative analysis was performed for the size and apparent diffusion coefficient (ADC) values. Statistical Tests Chi‐square test, Fisher's exact test, and the independent t‐test were used for univariate analysis to determine the relationships between these radiological parameters and the presence of MVI. Logistic regression analysis was used to identify the independent predictors of MVI among these radiological parameters. Receiver operating characteristic curve analysis was performed to evaluate their diagnostic performance. Results Larger tumor size (P = 0.006) and higher ADC values (P < 0.001) were positively correlated with MVI. Multivariate logistic regression analysis demonstrated that the ADC value (odds ratio, 3.099; P = 0.001) was an independent predictor for MVI of IMCC. The ADC value for MVI of IMCC showed an area under the receiver operating characteristic curve of 0.782 (optimal cutoff value was 1.59 × 10−3 mm2/s). Data Conclusion Larger tumor size was associated with MVI and higher ADC values can be a useful predictor of MVI during the preoperative evaluation of IMCC. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:315–324.

MRI features predict microvascular invasion in intrahepatic cholangiocarcinoma

“…Our study results show that a higher CA19-9 level (≥37 U/ml) is a risk factor that increase the probability of MVI in patients with ICC. This result is different from that reported by Zhou et al [12]. This difference may be because the date range of the selected cases differs; in addition, as the number of cases in our study is small, some selection bias must be acknowledged.…”

“…1); these patients included 78 male and 30 female patients, with a sex ratio (M:F) of 2.6:1. Among the 108 patients, the imaging findings of 23 patients with ICC have been previously reported [12]. Compared with previous studies, which focused on the measurement of DWI and ADC quantitative values by one MR model, our research focuses on morphological data and a small amount of quantitative data from six different MR models in order to determine whether a correlation exists between MR imaging features and MVI.…”

“…Hence, the ability to predict MVI preoperatively is of particular importance. Unfortunately, few studies have explored the preoperative prediction of MVI in patients with ICC [12,13], and their research focuses on diffusionweighted imaging (DWI) and quantitative data on whether ADC values can predict MVI in ICC. As a single-center study, the primary objective of this study was to retrospectively analyze the clinicopathologic features and preoperative magnetic resonance (MR) imaging findings of 108 ICC patients undergoing primary surgery for a single tumor with the hope of discovering new MR imaging indicators for the preoperative prediction of MVI in ICC.…”

Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?

“…Some imaging findings, such as "arterial peritumoral enhancement," "tumor margin," and "peritumoral hypointensity on hepatobiliary phase (HBP)," have been reported to be related to MVI in HCC [20]; some studies have shown that "incomplete tumor capsule" has a significant relationship with MVI in HCC [21]. A small number of studies have also used MRI to predict the MVI of massforming intrahepatic cholangiocarcinoma [22]. Currently, almost all the existing MRI studies have only described the imaging features or clinical characteristics of cHCC-CCA compared to those of pure HCC and ICC, usually with a small sample size [23][24][25][26][27][28][29].…”

Clinical features of sarcomatoid change in patients with intrahepatic cholangiocarcinoma and prognosis after surgical liver resection: A Propensity Score Matching analysis

“…However, the diagnosis of MVI often depended on pathological confirmation after liver resection. Recent studies have reported that preoperative diffusion‐weighted imaging can help the diagnosis of MVI in iCCA patients before liver resection, which was conducive to helping surgeons choose the best treatment . Diabetes mellitus was found to be an additional independent risk factor for RFS in iCCA patients and may be related to the reduction in immunity caused by elevated blood sugar.…”