The value of MRI enhancement in the differential diagnosis of hepatocellular carcinoma and combined hepatocellular-cholangiocarinoma

doi:10.21203/rs.3.rs-1558017/v1

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The value of MRI enhancement in the differential diagnosis of hepatocellular carcinoma and combined hepatocellular-cholangiocarinoma

https://doi.org/10.21203/rs.3.rs-1558017/v1

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Background Combined hepatocellular-cholangicarcinoma ( cHCC-CC) is a rare primary liver malignant tumor, the distinction between cHCC-CC and HCC before operation has important clinical significance for optimizing the treatment plan and predicting the prognosis of patients. This study intends to study the value of preoperative clinical date and enhanced MRI in the differential diagnosis of HCC and cHCC-CC and to obtain independent risk factors for predicting cHCC-CC.

Methods The clinical and imaging data of 157 HCC and 59 cHCC-CC patients confirmed by pathology were collected, and the differences between the two groups of patients were compared by t test, chi-square test, and logistic regression analysis.

Results CHCC-CC was more likely to show multiple lesions than HCC (28.81% Vs 10.83%，P=0.001) and more prone to microvascular invasion (MVI) (36.31%Vs 61.02%，P＜0.001). However, HCC had a higher incidence of liver cirrhosis than cHCC-CC (50.85% Vs72.61% ，P=0.003). The incidence of non-smooth margin was higher in cHCC-CC group (84.75% Vs52.23%，P＜0.001). The incidence of peritumor enhancement in arterial phase was higher in cHCC-CC group (11.46%Vs 62.71%，P＜0.001) Multivariate analysis showed that liver cirrhosis and arterial peritumor enhancement were independent risk factors for predicting cHCC-CC. In addition, the imaging sign of arterial phase peritumor enhancement had high sensitivity (62.71%) and specificity (88.54%) in the diagnosis of cHCC-CC.

Conclusions Liver cirrhosis and the imaging findings of GD-DTPA-enhanced MRI are helpful for the differential diagnosis of HCC and cHCC-CC. In addition, the imaging sign of peritumoral enhancement in the arterial phase has high sensitivity and specificity for the diagnosis of cHCC-CC.

combined hepatocellular- cholangicarcinoma

hepatocellular carcinoma

preoperative clinical information

magnetic resonance imaging

differential diagnosis

Table.1 Comparison of patient characteristics according to tumor type

Characteristics	Total	HCC	cHCC-CC	P
sex	216	157	59
Male	182	134	48	0.472
Female	34	23	11
age	55.00(10.44)	55.80(10.44)	52.88(10.23)	0.067
Size(cm)				0.116
<5	156	118	38
≥5	60	39	21
AFP(ng/L)				0.407
＞0, ≤20	89	69	20
＞20, ≤400	79	55	24
＞400	48	33	15
HBsAg				0.589
Negative	34	26	8
Positive	182	131	51
HBeAg				0.159
Negative	161	113	48
Positive	55	44	11
Tumor number				0.001
Single	182	140	42
Multiple	34	17	17
Cirrhosis				0.003
Negative	72	43	29
Positive	144	114	30
MVI				0.001
Negative	123	100	23
Positive	93	57	36
MRI features
Capsule				0.061
Negative	168	117	51
Positive	48	40	8
Arterial rim enhancement				0.687
Negative	116	83	33
Positive	100	74	26
Arterial peritumoral enhancement				<0.001
Negative	161	139	22
Positive	55	18	37
Tumor margin				<0.001
Smooth	84	75	9
Non-smooth	132	82	50

Table 2. Univariate and multivariate analyses of preoperative MRI imaging findings in predicting tumor type

	Univariate analysis		multivariate analyses
	OR（95%CI）	P	OR（95%CI）	P
Tumor number	3.333(1.566,7.096)	0.002	2.393(0.952,6.012)	0.063
Cirrhosis	0.390(0.210,0.725)	0.003	0.373(0.175,0.793)	0.010
Capsule	0.459(0.201,1.049)	0.065	0.758(0.278,2.064)	0.587
Arterial rim enhancement	0.884(0.484,1.613)	0.687
Arterial peritumoral enhancement	12.986(6.316,26.698)	<0.001	8.833(4.033,19.346)	<0.001
Tumor margin	5.081(2.339,11.037)	<0.001	2.356(0.953,5.824)	0.063

Table 3. Diagnostic performance of MRI imaging findings in prediction of tumor type

	Sensitivity	Specificity	Accuracy	PPV	NPV
Cirrhosis	50.85%(30/59)	27.39%(43/157)	33.80%(73/216)	20.83%(30/144)	59.72%(43/72)
Arterial peritumoral enhancement	62.71%(37/59)	88.54%(139/157)	81.48%(73/216)	67.27%(37/55)	86.34%(139/161)
Combination of two findings(series connection)	28.81%(17/59)	90.45%(142/157)	73.61%(73/216)	53.13%(17/32)	77.17%(142/184)
Combination of two findings(parallel connection)	84.75%(50/59)	25.48%(40/157)	41.67%(73/216)	29.94%(50/167)	81.63%(40/49)

No competing interests reported.

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The value of MRI enhancement in the differential diagnosis of hepatocellular carcinoma and combined hepatocellular-cholangiocarinoma

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