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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Gut Liver 2024; 18:789-802. [PMID: 39223081 PMCID: PMC11391139 DOI: 10.5009/gnl240350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hee Yoon
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Korean J Radiol 2024; 25:773-787. [PMID: 39197823 PMCID: PMC11361797 DOI: 10.3348/kjr.2024.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 09/01/2024] Open
Abstract
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea.
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Sheng R, Zheng B, Zhang Y, Sun W, Yang C, Ding Y, Zhou J, Zeng M. "Very early" intrahepatic cholangiocarcinoma (≤ 2.0 cm): MRI manifestation and prognostic potential. Clin Radiol 2024; 79:608-617. [PMID: 38789332 DOI: 10.1016/j.crad.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/10/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
AIMS To explore the MRI characteristics and clinical outcome of the "very early" intrahepatic cholangiocarcinoma (iCCA) ≤2.0cm. MATERIALS AND METHODS Totally 213 pathologically confirmed iCCAs (44 ≤ 2.0cm and 169 of 2.0-5.0cm) from two institutes were included. Forty-four matching non-iCCA malignancies ≤2.0cm were also enrolled. Recurrence-free survival (RFS) was estimated and compared between iCCAs ≤2.0cm and 2.0-5.0cm. MRI features were analyzed and compared between iCCAs ≤2.0cm and 2.0-5.0cm, as well as between iCCAs ≤2.0cm and non-iCCAs ≤2.0cm. Univariate and multivariate regression analyses were performed to identify independent imaging features for discrimination. An MRI-based diagnostic model for iCCA ≤2.0cm was constructed by incorporating the independent imaging features. RESULTS ICCAs ≤2.0cm had a significantly longer RFS than those of 2.0-5.0cm (log rank P=0.014). Imaging features of homogeneous signal (odds ratio (OR) = 6.677, P<0.001) and lack of vessel invasion (OR=7.56, P<0.001) were more frequently displayed in iCCAs ≤2.0cm compared to iCCAs of 2.0-5.0cm independently. In the small lesions ≤2.0cm, imaging features of progressive or persistent enhancement pattern (OR=27.78, P=0.002) and rim diffusion restriction (OR=5.70, P=0.027) were independent imaging features suggestive of iCCA over non-iCCA malignancy; their combination yielded an area under the curve value of 0.824, with a sensitivity of 97.73%. CONCLUSION The "very early" iCCA ≤2.0cm was associated with a favorable outcome after surgery, it displayed different and relatively atypical imaging manifestations compared with those of 2.0-5.0cm. Furthermore, in the small lesions ≤ 2.0cm, MRI can be served as a useful non-invasive diagnostic tool for iCCA in clinical screening with high sensitivity.
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Affiliation(s)
- R Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian 361006, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - B Zheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Y Zhang
- Shanghai Institute of Medical Imaging, Shanghai 200032, China; Central Research Institute, United Imaging Healthcare, Shanghai 201800, China
| | - W Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - C Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Y Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - J Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian 361006, China; Xiamen Municipal Clinical Research Center for Medical Imaging and Xiamen Key Clinical Specialty for Radiology, Xiamen 361015, China
| | - M Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China.
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Elias-Neto A, Gonzaga APFC, Braga FA, Gomes NBN, Torres US, D'Ippolito G. Imaging Prognostic Biomarkers in Hepatocellular Carcinoma: A Comprehensive Review. Semin Ultrasound CT MR 2024:S0887-2171(24)00049-0. [PMID: 39067621 DOI: 10.1053/j.sult.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide with its incidence on the rise globally. This paper provides a comprehensive review of prognostic imaging markers in HCC, emphasizing their role in risk stratification and clinical decision-making. We explore quantitative and qualitative criteria derived from imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI), which can offer valuable insights into the biological behavior of the tumor. While many of these markers are not yet widely integrated into current clinical guidelines, they represent a promising future direction for approaching this highly heterogeneous cancer. However, standardization and validation of these markers remain important challenges. We conclude by emphasizing the importance of ongoing research to enhance clinical practices and improve outcomes for patients with HCC.
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Affiliation(s)
- Abrahão Elias-Neto
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Ana Paula F C Gonzaga
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Fernanda A Braga
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Natália B N Gomes
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Ulysses S Torres
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil; Department of Radiology, Grupo Fleury, São Paulo, São Paulo, Brazil.
| | - Giuseppe D'Ippolito
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil; Department of Radiology, Grupo Fleury, São Paulo, São Paulo, Brazil
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Pan J, Huang H, Zhang S, Zhu Y, Zhang Y, Wang M, Zhang C, Zhao YC, Chen F. Intraindividual comparison of CT and MRI for predicting vessels encapsulating tumor clusters in hepatocellular carcinoma. Eur Radiol 2024:10.1007/s00330-024-10944-9. [PMID: 38992109 DOI: 10.1007/s00330-024-10944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/30/2024] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To establish and validate scoring models for predicting vessels encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC) using computed tomography (CT) and magnetic resonance imaging (MRI), and to intra-individually compare the predictive performance between the two modalities. METHODS We retrospectively included 324 patients with surgically confirmed HCC who underwent preoperative dynamic CT and MRI with extracellular contrast agent between June 2019 and August 2020. These patients were then divided into a discovery cohort (n = 227) and a validation cohort (n = 97). Imaging features and Liver Imaging Reporting and Data System (LI-RADS) categories of VETC-positive HCCs were evaluated. Logistic regression analyses were conducted on the discovery cohort to identify clinical and imaging predictors associated with VETC-positive cases. Subsequently, separate CT-based and MRI-based scoring models were developed, and their diagnostic performance was compared using generalized estimating equations. RESULTS On both CT and MRI, VETC-positive HCCs exhibited a higher frequency of size > 5.0 cm, necrosis or severe ischemia, non-smooth tumor margin, targetoid appearance, intratumor artery, and heterogeneous enhancement with septations or irregular ring-like structure compared to VETC-negative HCCs (all p < 0.05). Regarding LI-RADS categories, VETC-positive HCCs were more frequently categorized as LR-M than VETC-negative cases (all p < 0.05). In the validation cohort, the CT-based model showed similar sensitivity (76.7% vs. 86.7%, p = 0.375), specificity (83.6% vs. 74.6%, p = 0.180), and area under the curve value (0.80 vs. 0.81, p = 0.910) to the MRI-based model in predicting VETC-positive HCCs. CONCLUSION Preoperative CT and MRI demonstrated comparable performance in the identification of VETC-positive HCCs, thus displaying promising predictive capabilities. CLINICAL RELEVANCE STATEMENT Both computed tomography and magnetic resonance imaging demonstrated promise in preoperatively identifying the vessel-encapsulating tumor cluster pattern in hepatocellular carcinoma, with no statistically significant difference between the two modalities, potentially adding additional prognostic value. KEY POINTS Computed tomography (CT) and magnetic resonance imaging (MRI) show promise in the preoperative identification of vessels encapsulating tumor clusters-positive hepatocellular carcinoma (HCC). HCC with vessels encapsulating tumor cluster patterns were more frequently LR-M compared to those without. These CT and MRI models showed comparable ability in identifying vessels encapsulating tumor clusters-positive HCC.
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Affiliation(s)
- Junhan Pan
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Huizhen Huang
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Siying Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Yanyan Zhu
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Yuhao Zhang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Meng Wang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Cong Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Yan-Ci Zhao
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China.
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Okumura K, Kozaka K, Kitao A, Yoneda N, Ogi T, Ikeda H, Gabata T, Kobayashi S. Imaged periductal infiltration: Diagnostic and prognostic role in intrahepatic mass-forming cholangiocarcinoma. Eur J Radiol Open 2024; 12:100554. [PMID: 38390438 PMCID: PMC10881313 DOI: 10.1016/j.ejro.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose This study examines periductal infiltration in intrahepatic mass-forming cholangiocarcinoma (IMCC), focusing on its importance for differentiating hepatic tumors and its influence on post-surgical survival in IMCC patients. Methods Eighty-three consecutive patients with IMCC (n = 43) and liver cancer whose preoperative images showed intrahepatic bile duct dilatation adjacent to the tumor for differential diagnosis from hepatocellular carcinoma (HCC) [n = 21], metastatic liver cancer (MLC) [n = 16] and combined hepatocellular-cholangiocarcinoma (cHCC-CC) [n = 3] were enrolled. CT and MRI findings of simple bile duct compression, imaged periductal infiltration, and imaged intrabiliary growth adjacent to the main tumor were reviewed. Clinicopathological and imaging features were compared in each group. The sensitivity, specificity, and odds ratio were calculated for each imaging finding of IMCC versus the other tumor groups. Overall survival was compared between cases of IMCC with and without imaged periductal infiltration. Results Simple bile duct compression and imaged intrabiliary growth were more frequently observed in HCC than in the others (p < 0.0001 and 0.040, respectively). Imaged periductal infiltration was observed more often in histopathologically confirmed large-duct type IMCC than in the small-duct type IMCC (p = 0.034). Multivariable analysis demonstrated that only imaged periductal infiltration (odds ratio, 50.67) was independently correlated with IMCC. Patients with IMCC who had imaged periductal infiltration experienced a poorer prognosis than those without imaged periductal infiltration (p = 0.0034). Conclusion Imaged periductal infiltration may serve as a significant marker for differentiating IMCC from other liver cancers. It may also have the potential to predict post-surgical outcomes in patients with IMCC.
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Affiliation(s)
- Kenichiro Okumura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Azusa Kitao
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Takahiro Ogi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Satoshi Kobayashi
- Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan
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Wang L, Feng B, Liang M, Li D, Cong R, Chen Z, Wang S, Ma X, Zhao X. Prognostic performance of MRI LI-RADS version 2018 features and clinical-pathological factors in alpha-fetoprotein-negative hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:1918-1928. [PMID: 38642093 DOI: 10.1007/s00261-024-04278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To evaluate the role of the magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) version 2018 features and clinical-pathological factors for predicting the prognosis of alpha-fetoprotein (AFP)-negative (≤ 20 ng/ml) hepatocellular carcinoma (HCC) patients, and to compare with other traditional staging systems. METHODS We retrospectively enrolled 169 patients with AFP-negative HCC who received preoperative MRI and hepatectomy between January 2015 and August 2020 (derivation dataset:validation dataset = 118:51). A prognostic model was constructed using the risk factors identified via Cox regression analysis. Predictive performance and discrimination capability were evaluated and compared with those of two traditional staging systems. RESULTS Six risk factors, namely the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade, were associated with recurrence-free survival. The prognostic model constructed using these factors achieved C-index of 0.705 and 0.674 in the derivation and validation datasets, respectively. Furthermore, the model performed better in predicting patient prognosis than traditional staging systems. The model effectively stratified patients with AFP-negative HCC into high- and low-risk groups with significantly different outcomes (p < 0.05). CONCLUSION A prognostic model integrating the LI-RADS category, blood products in mass, microvascular invasion, tumor size, cirrhosis, and albumin-bilirubin grade may serve as a valuable tool for refining risk stratification in patients with AFP-negative HCC.
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Affiliation(s)
- Leyao Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bing Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Meng Liang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dengfeng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Rong Cong
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhaowei Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Sicong Wang
- Magnetic Resonance Imaging Research, General Electric Healthcare (China), Beijing, 100176, China
| | - Xiaohong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Lee JH, Hwang JA, Gu K, Shin J, Han S, Kim YK. Magnetic resonance elastography as a preoperative assessment for predicting intrahepatic recurrence in patients with hepatocellular carcinoma. Magn Reson Imaging 2024; 109:127-133. [PMID: 38513784 DOI: 10.1016/j.mri.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Magnetic resonance elastography (MRE) is a noninvasive tool for diagnosing hepatic fibrosis with high accuracy. We investigated the preoperative clinical and imaging predictors of intrahepatic recurrence after curative resection of hepatocellular carcinoma (HCC), and evaluated MRE as a predictor of intrahepatic recurrence. METHODS We retrospectively evaluated 80 patients who underwent preoperative contrast-enhanced magnetic resonance imaging (MRI) with two-dimensional MRE and curative resection for treatment-naïve HCC between May 2019 and December 2021. Liver stiffness (LS) was measured on the elastograms, and the optimal cutoff of LS for predicting intrahepatic recurrence was obtained using receiver operating characteristic (ROC) analysis. An LS above this cutoff was defined as MRE-recurrence. Preoperative imaging features of the tumor were assessed on MRI, including features in the Liver Imaging Reporting and Data System and microvascular invasion (MVI). Recurrence-free survival (RFS) rates were estimated using the Kaplan-Meier method, and differences were compared using the log-rank test. Using a Cox proportional hazards model, we conducted a multivariable analysis to investigate the factors affecting recurrence-free survival. RESULTS During a median follow-up period of 32 months (range, 4-52 months), thirteen patients (16.3%) developed intrahepatic recurrence. ROC analysis determined an LS cutoff of ≥4.35 kPa to define MRE-recurrence. The 4-year RFS rate was significantly higher in patients without MRE-recurrence than in those with MRE-recurrence (93.4% vs. 48.9%; p = 0.001). In multivariable analysis, MRE-recurrence (Hazard ratio [HR], 5.9; 95% confidence interval [CI], 1.5-23.1) and MVI (HR, 3.4; 95% CI, 1.0-11.3) were independent predictors of intrahepatic recurrence. CONCLUSIONS Patients without MRE-recurrence had significantly higher RFS rates than those with MRE-recurrence. MRE-recurrence and MVI were independent predictors of intrahepatic recurrence in patients after curative resection for HCC.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kyowon Gu
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungchul Han
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Deng X, Liao Z. A machine-learning model based on dynamic contrast-enhanced MRI for preoperative differentiation between hepatocellular carcinoma and combined hepatocellular-cholangiocarcinoma. Clin Radiol 2024; 79:e817-e825. [PMID: 38413354 DOI: 10.1016/j.crad.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024]
Abstract
AIM To establish a machine-learning model based on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) to differentiate combined hepatocellular-cholangiocarcinoma (cHCC-CC) from hepatocellular carcinoma (HCC) before surgery. MATERIALS AND METHODS Clinical and MRI data of 194 patients with histopathologically diagnosed cHCC-CC (n=52) or HCC (n=142) were analysed retrospectively. ITK-SNAP software was used to delineate three-dimensional (3D) lesions and extract high-throughput features. Feature selection was carried out based on Pearson's correlation coefficient and least absolute shrinkage and selection operator (LASSO) regression analysis. A radiomics model (radiomics features), a clinical model (i.e., clinical-image features), and a fusion model (i.e., radiomics features + clinical-image features) were established using six machine-learning classifiers. The performance of each model in distinguishing between cHCC-CC and HCC was evaluated with the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), sensitivity, and specificity. RESULTS Significant differences in liver cirrhosis, tumour number, shape, edge, peritumoural enhancement in the arterial phase, and lipid were identified between cHCC-CC and HCC patients (p<0.05). The AUC of the fusion model based on logistic regression was 0.878 (95% CI: 0.766-0.949) in the arterial phase in the test set, and the sensitivity/specificity was 0.844/0.714; however, the AUC of the clinical and radiomics models was 0.759 (95% CI: 0.663-0.861) and 0.838 (95% CI: 0.719-0.921) in the test set, respectively. CONCLUSION The fusion model based on DCE-MRI in the arterial phase can significantly improve the diagnostic rate of cHCC-CC and HCC as compared with conventional approaches.
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Affiliation(s)
- X Deng
- Medical Imaging Center, Ganzhou People's Hospital, 16th Meiguan Avenue, Ganzhou 341000, China; Ganzhou Institute of Medical Imaging, Ganzhou 341000, China; Ganzhou Key Laboratory of Medical Imaging and Artificial Intelligence, Ganzhou 341000, China
| | - Z Liao
- Medical Imaging Center, Ganzhou People's Hospital, 16th Meiguan Avenue, Ganzhou 341000, China; Ganzhou Institute of Medical Imaging, Ganzhou 341000, China; Ganzhou Key Laboratory of Medical Imaging and Artificial Intelligence, Ganzhou 341000, China.
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Heo S, Park HJ, Lee SS. Prognostication of Hepatocellular Carcinoma Using Artificial Intelligence. Korean J Radiol 2024; 25:550-558. [PMID: 38807336 PMCID: PMC11136947 DOI: 10.3348/kjr.2024.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/13/2024] [Accepted: 03/31/2024] [Indexed: 05/30/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a biologically heterogeneous tumor characterized by varying degrees of aggressiveness. The current treatment strategy for HCC is predominantly determined by the overall tumor burden, and does not address the diverse prognoses of patients with HCC owing to its heterogeneity. Therefore, the prognostication of HCC using imaging data is crucial for optimizing patient management. Although some radiologic features have been demonstrated to be indicative of the biologic behavior of HCC, traditional radiologic methods for HCC prognostication are based on visually-assessed prognostic findings, and are limited by subjectivity and inter-observer variability. Consequently, artificial intelligence has emerged as a promising method for image-based prognostication of HCC. Unlike traditional radiologic image analysis, artificial intelligence based on radiomics or deep learning utilizes numerous image-derived quantitative features, potentially offering an objective, detailed, and comprehensive analysis of the tumor phenotypes. Artificial intelligence, particularly radiomics has displayed potential in a variety of applications, including the prediction of microvascular invasion, recurrence risk after locoregional treatment, and response to systemic therapy. This review highlights the potential value of artificial intelligence in the prognostication of HCC as well as its limitations and future prospects.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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11
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Lee S, Kim YY, Shin J, Shin H, Sirlin CB, Chernyak V. Performance of LI-RADS category 5 vs combined categories 4 and 5: a systemic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10813-5. [PMID: 38809263 DOI: 10.1007/s00330-024-10813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 has high specificity and modest sensitivity for diagnosis of hepatocellular carcinoma (HCC). The purpose of this study was to compare the diagnostic performance of LR-5 vs combined LR-4 and LR-5 (LR-4/5) for HCC diagnosis. METHODS MEDLINE and EMBASE databases through January 03, 2023 were searched for studies reporting the performance of LR-5 and combined LR-4/5 for HCC diagnosis, using CT/MRI LI-RADS version 2014, 2017, or 2018. A bivariate random-effects model was used to calculate the pooled per-observation diagnostic performance. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Sixty-nine studies (15,108 observations, 9928 (65.7%) HCCs) were included. Compared to LR-5, combined LR-4/5 showed significantly higher pooled sensitivity (83.0% (95% CI [80.3-85.8%]) vs 65.7% (95% CI [62.4-69.1%]); p < 0.001), lower pooled specificity (75.0% (95% CI [70.5-79.6%]) vs 91.7% (95% CI [90.2-93.1%]); p < 0.001), lower pooled positive likelihood ratio (3.60 (95% CI [3.06-4.23]) vs 6.18 (95% CI [5.35-7.14]); p < 0.001), and lower pooled negative likelihood ratio (0.22 (95% CI [0.19-0.25]) vs 0.38 (95% CI [0.35-0.41]) vs; p < 0.001). Similar results were seen in all subgroups. CONCLUSIONS Our meta-analysis showed that combining LR-4 and LR-5 would increase sensitivity but decrease specificity, positive likelihood ratio, and negative likelihood ratio. These findings may inform management guidelines and individualized management. CLINICAL RELEVANCE STATEMENT This meta-analysis estimated the magnitude of changes in the sensitivity and specificity of imaging criteria when LI-RADS categories 4 and 5 were combined; these findings can inform management guidelines and individualized management. KEY POINTS There is no single worldwide reporting system for liver imaging, partly due to regional needs. Combining LI-RADS categories 4 and 5 increased sensitivity and decreased specificity and positive and negative likelihood ratios. Changes in the sensitivity and specificity of imaging criteria can inform management guidelines and individualized management.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Heo S, Kang HJ, Choi SH, Kim S, Yoo Y, Choi WM, Kim SY, Lee SS. Proliferative hepatocellular carcinomas in cirrhosis: patient outcomes of LI-RADS category 4/5 and category M. Eur Radiol 2024; 34:2974-2985. [PMID: 37848775 DOI: 10.1007/s00330-023-10305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES We aimed to compare Liver Imaging Reporting and Data System (LI-RADS) category 4/5 and category M (LR-M) of proliferative hepatocellular carcinomas (HCCs) in cirrhotic patients and evaluate their impacts on prognosis. METHODS This retrospective multi-reader study included cirrhotic patients with single treatment-naïve HCC ≤ 5.0 cm who underwent contrast-enhanced CT, MRI, and subsequent hepatic resection within 2 months. The percentages of CT/MRI LR-4/5 and LR-M in proliferative and non-proliferative HCCs were compared. Univariable and multivariable Cox proportional hazards regression analyses were performed to assess the association of LI-RADS categories (LR-4/5 vs. LR-M) and pathologic classification (proliferative vs. non-proliferative) with overall survival (OS) and recurrence-free survival (RFS). Subgroups of patients with proliferative and non-proliferative HCCs were analyzed to compare OS and RFS between LR-4/5 and LR-M. RESULTS Of the 204 included patients, 38 were classified as having proliferative HCC. The percentages of LR-M were higher in proliferative than non-proliferative HCC on both CT (15.8% vs. 3.0%, p = 0.007) and MRI (26.3% vs. 9.6%, p = 0.016). Independent of pathologic classification, CT and MRI LR-M were significantly associated with poorer OS (hazard ratio (HR) = 4.58, p = 0.013, and HR = 6.45, p < 0.001) and RFS (HR = 3.66, p = 0.005, and HR = 6.44, p < 0.001) than LR-4/5. MRI LR-M was associated with significantly poorer OS (p ≤ 0.003) and RFS (p < 0.001) than MRI LR-4/5 in both proliferative and non-proliferative HCCs. CONCLUSIONS This multi-reader study showed that the percentages of LR-M were significantly higher in proliferative than non-proliferative HCCs. CT/MRI LR-M was significantly associated with poor OS and RFS, independent of the pathologic classification of proliferative versus non-proliferative HCCs. CLINICAL RELEVANCE STATEMENT CT and MRI LI-RADS category M can be clinically useful in predicting poor outcomes in patients with proliferative and non-proliferative hepatocellular carcinomas. KEY POINTS • The percentages of LR-M tumors on both CT and MRI were significantly higher in proliferative than non-proliferative hepatocellular carcinomas. • Independent of pathologic classification, CT/MRI LR-M categories were correlated with poor overall survival and recurrence-free survival. • Patients with both proliferative and non-proliferative hepatocellular carcinomas categorized as MRI LR-M had significantly poorer overall survival and recurrence-free survival than those categorized as MRI LR-4/5.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Hyo Jeong Kang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Youngeun Yoo
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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Sheng R, Wang H, Zhang Y, Sun W, Jin K, Dai Y, Zhang W, Zeng M, Zhou J. MRI for Hepatitis B-Associated Intrahepatic Cholangiocarcinoma: A Multicenter Comparative Study. J Magn Reson Imaging 2024; 59:1093-1104. [PMID: 37309823 DOI: 10.1002/jmri.28855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The diagnosis of intrahepatic cholangiocarcinoma (iCCA) is challenging in hepatitis B virus (HBV)-infected patients, due to the overlapping clinical manifestations and atypical imaging patterns compared to patients without HBV. PURPOSE To investigate the preoperative imaging characteristics of iCCA in patients with HBV in comparison to those without HBV. STUDY TYPE Retrospective. SUBJECTS 431 patients with histopathologically confirmed iCCA (143 HBV-positive and 288 HBV-negative patients) were retrospectively enrolled from three institutes, and patients were allocated to the training (n = 302) and validation (n = 129) cohorts from different institutes or time period; 100 matching HBV-positive hepatocellular carcinoma (HCC) patients were also enrolled. FIELD STRENGTH/SEQUENCE 1.5-T and 3-T, including T1- and T2-weighted, diffusion-weighted and dynamic gadopentetate dimeglumine-enhanced imaging. ASSESSMENT Clinical and MRI features were analyzed and compared between HBV-positive and HBV-negative patients with iCCA, and between HBV-positive patients with iCCA and HCC. STATISTICAL TESTS Univariate and multivariate logistic regression analyses with odds ratio (OR) to identify independent features for discriminating HBV-associated iCCA. Diagnostic model generation by incorporating independent features, and the performance for discrimination was evaluated by receiver operating characteristics with the area under the curve (AUC) and 95% confidence interval (CI). AUCs were compared by the DeLong's method. A P-value <0.05 was considered statistically significant. RESULTS Compared to patients without HBV, washout or degressive enhancement pattern (OR = 51.837), well-defined tumor margin (OR = 8.758) and no peritumoral bile duct dilation (OR = 4.651) were independent significant features for discriminating HBV-associated iCCAs. All these features were also the predominant MRI manifestations for HBV-associated HCC. The combined index showed an AUC of 0.798 (95% CI 0.748-0.842) in the training cohort and an AUC of 0.789 (95% CI 0.708-0.856) in the validation cohort for discrimination. The sensitivity, specificity, and accuracy were all >70%, which was superior to each single feature alone in both cohorts. [Correction added after first online publication on 29 June 2023. The Field Strength/Sequence has been updated from 5-T to 1.5-T.] DATA CONCLUSION: Preoperative MRI may help to discriminate HBV-associated iCCA. EVIDENCE LEVEL 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Heqing Wang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Yunfei Zhang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Kaipu Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Weiguo Zhang
- Department of Radiology, Dushu Lake Public Hospital, Affiliated to Soochow University, Suzhou, 215028, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
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Kartalis N, Grigoriadis A. LI-RADS in Patients with Solitary Resected Hepatocellular Carcinoma: Glancing beyond Diagnosis. Radiology 2024; 310:e240161. [PMID: 38411516 DOI: 10.1148/radiol.240161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Nikolaos Kartalis
- From the Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186 Stockholm, Sweden
| | - Aristeidis Grigoriadis
- From the Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186 Stockholm, Sweden
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15
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Cannella R, Matteini F, Dioguardi Burgio M, Sartoris R, Beaufrère A, Calderaro J, Mulé S, Reizine E, Luciani A, Laurent A, Seror O, Ganne-Carrié N, Wagner M, Scatton O, Vilgrain V, Cauchy F, Hobeika C, Ronot M. Association of LI-RADS and Histopathologic Features with Survival in Patients with Solitary Resected Hepatocellular Carcinoma. Radiology 2024; 310:e231160. [PMID: 38411519 DOI: 10.1148/radiol.231160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Both Liver Imaging Reporting and Data System (LI-RADS) and histopathologic features provide prognostic information in patients with hepatocellular carcinoma (HCC), but whether LI-RADS is independently associated with survival is uncertain. Purpose To assess the association of LI-RADS categories and features with survival outcomes in patients with solitary resected HCC. Materials and Methods This retrospective study included patients with solitary resected HCC from three institutions examined with preoperative contrast-enhanced CT and/or MRI between January 2008 and December 2019. Three independent readers evaluated the LI-RADS version 2018 categories and features. Histopathologic features including World Health Organization tumor grade, microvascular and macrovascular invasion, satellite nodules, and tumor capsule were recorded. Overall survival and disease-free survival were assessed with Cox regression models. Marginal effects of nontargetoid features on survival were estimated using propensity score matching. Results A total of 360 patients (median age, 64 years [IQR, 56-70 years]; 280 male patients) were included. At CT and MRI, the LI-RADS LR-M category was associated with increased risk of recurrence (CT: hazard ratio [HR] = 1.83 [95% CI: 1.26, 2.66], P = .001; MRI: HR = 2.22 [95% CI: 1.56, 3.16], P < .001) and death (CT: HR = 2.47 [95% CI: 1.72, 3.55], P < .001; MRI: HR = 1.80 [95% CI: 1.32, 2.46], P < .001) independently of histopathologic features. The presence of at least one nontargetoid feature was associated with an increased risk of recurrence (CT: HR = 1.80 [95% CI: 1.36, 2.38], P < .001; MRI: HR = 1.93 [95% CI: 1.81, 2.06], P < .001) and death (CT: HR = 1.51 [95% CI: 1.10, 2.07], P < .010) independently of histopathologic features. In matched samples, recurrence was associated with the presence of at least one nontargetoid feature at CT (HR = 2.06 [95% CI: 1.15, 3.66]; P = .02) or MRI (HR = 1.79 [95% CI: 1.01, 3.20]; P = .048). Conclusion In patients with solitary resected HCC, LR-M category and nontargetoid features were negatively associated with survival independently of histopathologic characteristics. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kartalis and Grigoriadis in this issue.
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Affiliation(s)
- Roberto Cannella
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Francesco Matteini
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Marco Dioguardi Burgio
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Riccardo Sartoris
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Aurélie Beaufrère
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Julien Calderaro
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Sébastien Mulé
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Edouard Reizine
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Alain Luciani
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Alexis Laurent
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Olivier Seror
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Nathalie Ganne-Carrié
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Mathilde Wagner
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Olivier Scatton
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Valérie Vilgrain
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - François Cauchy
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Christian Hobeika
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
| | - Maxime Ronot
- From the Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy (R.C., F.M.); Departments of Radiology (F.M., M.D.B., R.S., V.V., M.R.), Pathology (A.B.), and Hepatobiliary Surgery (F.C., C.H.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France; Université Paris Cité, Paris, France (A.B., V.V., M.R.); Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France (A.B.); Departments of Pathology (J.C.), Medical Imaging (S.M., E.R., A. Luciani), and Hepatobiliary and Digestive Surgery (A. Laurent), Hôpitaux Universitaires Henri-Mondor, AP-HP, Université Paris Est Créteil, Faculté de Santé, Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," Créteil, France (A. Laurent); Department of Radiology (O. Seror) and Liver Unit (N.G.C.), Avicenne Hospital, AP-HP, Bobigny, France; Sorbonne Paris Nord University, UFR SMBH, Bobigny, France (N.G.C.); INSERM UMR 1138, Team "Functional Genomic of Solid Tumors," Paris, France (N.G.C.); and Departments of Imaging (M.W.) and HPB and Liver Transplantation (O. Scatton), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Sorbonne Université, Centre de Recherche Saint-Antoine INSERM, Paris, France
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Min JH, Lee MW, Rhim H, Han S, Song KD, Kang TW, Jeong WK, Cha DI, Kim JM, Choi GS, Kim K. LI-RADS category is associated with treatment outcomes of small single HCC: surgical resection vs. radiofrequency ablation. Eur Radiol 2024; 34:525-537. [PMID: 37526668 DOI: 10.1007/s00330-023-09998-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To assess whether the Liver Imaging Reporting and Data System (LI-RADS) category is associated with the treatment outcomes of small single hepatocellular carcinoma (HCC) after surgical resection (SR) and radiofrequency ablation (RFA). METHODS This retrospective study included 357 patients who underwent SR (n = 209) or RFA (n = 148) for a single HCC of ≤ 3 cm between 2014 and 2016. LI-RADS categories were assigned. Overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP) rates after treatment were compared according to the LI-RADS category (LR-4/5 vs. LR-M) before and after propensity score matching (PSM). Prognostic factors for treatment outcomes were assessed. RESULTS In total, 357 patients (mean age, 59 years; men, 272) with 357 HCCs (294 LR-4/5 and 63 LR-M) were included. After PSM (n = 78 in each treatment group), there were 10 and 11 LR-M HCCs in the SR and RFA group, respectively. There were no significant differences in OS or RFS. However, SR provided a lower 5-year LTP rate than RFA (1.4% vs. 14.9%, p = 0.001). SR provided a lower 5-year LTP rate than RFA for LR-M HCCs (0% vs. 34.4%, p = 0.062) and LR-4/5 HCCs (1.5% vs. 12.0%, p = 0.008). The LI-RADS category was the sole risk factor associated with poor OS (hazard ratio [HR] 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032). CONCLUSION LI-RADS classification is associated with the treatment outcome of HCC, supporting favorable outcomes of SR over RFA for LTP, especially for HCCs categorized as LR-M. CLINICAL RELEVANCE STATEMENT Liver Imaging Reporting and Data System category has a potential prognostic role, supporting favorable outcomes of surgical resection over radiofrequency ablation for local tumor progression, especially for hepatocellular carcinoma categorized as LR-M. KEY POINTS • SR provided a lower 5-year LTP rate than RFA for HCCs categorized as LR-M (0% vs. 34.4%, p = 0.062) and HCCs categorized as LR-4/5 (1.5% vs. 12.0%, p = 0.008). • There is a steeply increased risk of LTP within 1 year after RFA for LR-M HCCs, compared to SR. • The LI-RADS category was the sole risk factor associated with poor OS (HR 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032) in patients with HCC of ≤ 3 cm treated with SR or RFA.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seungchul Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Sheng R, Zhang Y, Wang H, Zhang W, Jin K, Sun W, Dai Y, Zhou J, Zeng M. A multi-center diagnostic system for intrahepatic mass-forming cholangiocarcinoma based on preoperative MRI and clinical features. Eur Radiol 2024; 34:548-559. [PMID: 37552257 DOI: 10.1007/s00330-023-10002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To establish a non-invasive diagnostic system for intrahepatic mass-forming cholangiocarcinoma (IMCC) via decision tree analysis. METHODS Totally 1008 patients with 504 pathologically confirmed IMCCs and proportional hepatocellular carcinomas (HCC) and combined hepatocellular cholangiocarcinomas (cHCC-CC) from multi-centers were retrospectively included (internal cohort n = 700, external cohort n = 308). Univariate and multivariate logistic regression analyses were applied to evaluate the independent clinical and MRI predictors for IMCC, and the selected features were used to develop a decision tree-based diagnostic system. Diagnostic efficacy of the established system was calculated by the receiver operating characteristic curve analysis in the internal training-testing and external validation cohorts, and also in small lesions ≤ 3 cm. RESULTS Multivariate analysis revealed that female, no chronic liver disease or cirrhosis, elevated carbohydrate antigen 19-9 (CA19-9) level, normal alpha-fetoprotein (AFP) level, lobulated tumor shape, progressive or persistent enhancement pattern, no enhancing tumor capsule, targetoid appearance, and liver surface retraction were independent characteristics favoring the diagnosis of IMCC over HCC or cHCC-CC (odds ratio = 3.273-25.00, p < 0.001 to p = 0.021). Among which enhancement pattern had the highest weight of 0.816. The diagnostic system incorporating significant characteristics above showed excellent performance in the internal training (area under the curve (AUC) 0.971), internal testing (AUC 0.956), and external validation (AUC 0.945) cohorts, as well as in small lesions ≤ 3 cm (AUC 0.956). CONCLUSIONS In consideration of the great generalizability and clinical efficacy in multi-centers, the proposed diagnostic system may serve as a non-invasive, reliable, and easy-to-operate tool in IMCC diagnosis, providing an efficient approach to discriminate IMCC from other HCC-containing primary liver cancers. CLINICAL RELEVANCE STATEMENT This study established a non-invasive, easy-to-operate, and explainable decision tree-based diagnostic system for intrahepatic mass-forming cholangiocarcinoma, which may provide essential information for clinical decision-making. KEY POINTS • Distinguishing intrahepatic mass-forming cholangiocarcinoma (IMCC) from other primary liver cancers is important for both treatment planning and outcome prediction. • The MRI-based diagnostic system showed great performance with satisfying generalization ability in the diagnosis and discrimination of IMCC. • The diagnostic system may serve as a non-invasive, easy-to-operate, and explainable tool in the diagnosis and risk stratification for IMCC.
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Affiliation(s)
- Ruofan Sheng
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No. 668 Jinhu Road, Huli District, Xiamen, 361015, Fujian, China
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yunfei Zhang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Heqing Wang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No. 668 Jinhu Road, Huli District, Xiamen, 361015, Fujian, China
| | - Weiguo Zhang
- Dushu Lake Public Hospital Affiliated to Soochow University, Suzhou, 215028, China
| | - Kaipu Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No. 668 Jinhu Road, Huli District, Xiamen, 361015, Fujian, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Xiamen Municipal Clinical Research Center for Medical Imaging, and Xiamen Key Clinical Specialty for Radiology, Xiamen, 361015, China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Chen S, Wan L, Zhao R, Peng W, Liu X, Li L, Zhang H. Risk stratification for overall survival and recurrence-free survival after R0 resection for solitary intrahepatic mass-forming cholangiocarcinoma based on preoperative MRI and clinical features. Eur J Radiol 2023; 169:111190. [PMID: 37979460 DOI: 10.1016/j.ejrad.2023.111190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/09/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE This study aimed to establish two nomograms for predicting overall survival (OS) and recurrence-free survival (RFS) in patients with solitary intrahepatic mass-forming cholangiocarcinoma (IMCC) based on preoperative magnetic resonance imaging (MRI) features. METHODS This retrospective study included 120 consecutive patients who were diagnosed with solitary IMCC. Preoperative MRI and clinical features were collected. Based on the univariate and multivariate Cox regression analyses, two nomograms were constructed to predict OS and RFS, respectively. The effective performance of the nomograms was evaluated using concordance index (C-index). The prognostic stratification systems for OS and RFS were developed and used to classify patients into high- and low-risk groups. RESULTS Suspicious lymph nodes, arterial phase (AP) enhancement patterns, and bile duct dilatation were independent predictors of OS, while suspicious lymph nodes, AP enhancement patterns, and necrosis were independent predictors of RFS. The nomograms achieved the C-index values of 0.705/0.710 for OS and 0.721/0.759 for RFS in the development/validation cohorts, which were significantly higher than those of the T and TNM stages (P < 0.05). Patients were stratified into high- and low-risk groups, the 1-year OS and RFS rates of high-risk patients were poorer than those of patients with low-risk in the development cohort (OS: 93.5% vs 76.3%, P < 0.001; RFS: 74.5% vs 22.4%, P < 0.001). Similar results were observed in the validation cohort. CONCLUSIONS Two nomograms were constructed based on preoperative MRI features in patients with solitary IMCC for predicting the OS and RFS and facilitate further prognostic stratification.
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Affiliation(s)
- Shuang Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Lijuan Wan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Rui Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Wenjing Peng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Xiangchun Liu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Lin Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Zheng C, Gu XT, Huang XL, Wei YC, Chen L, Luo NB, Lin HS, Jin-Yuan L. Nomogram based on clinical and preoperative CT features for predicting the early recurrence of combined hepatocellular-cholangiocarcinoma: a multicenter study. LA RADIOLOGIA MEDICA 2023; 128:1460-1471. [PMID: 37747668 PMCID: PMC10700214 DOI: 10.1007/s11547-023-01726-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To establish and validate a multiparameter prediction model for early recurrence after radical resection in patients diagnosed with combined hepatocellular-cholangiocarcinoma (cHCC-CC). MATERIALS AND METHODS This study reviewed the clinical characteristics and preoperative CT images of 143 cHCC-CC patients who underwent radical resection from three institutions. A total of 110 patients from institution 1 were randomly divided into training set (n = 78) and testing set (n = 32) in the ratio of 7-3. Univariate and multivariate logistic regression analysis were used to construct a nomogram prediction model in the training set, which was internally and externally validated in the testing set and the validation set (n = 33) from institutions 2 and 3. The area under the curve (AUC) of receiver operating characteristics (ROC), decision curve analysis (DCA), and calibration analysis were used to evaluate the model's performance. RESULTS The combined model demonstrated superior predictive performance compared to the clinical model, the CT model, the pathological model and the clinic-CT model in predicting the early postoperative recurrence. The nomogram based on the combined model included AST, ALP, tumor size, tumor margin, arterial phase peritumoral enhancement, and MVI (Microvascular invasion). The model had AUCs of 0.89 (95% CI 0.81-0.96), 0.85 (95% CI 0.70-0.99), and 0.86 (95% CI 0.72-1.00) in the training, testing, and validation sets, respectively, indicating high predictive power. DCA showed that the combined model had good clinical value and correction effect. CONCLUSION A nomogram incorporating clinical characteristics and preoperative CT features can be utilized to effectively predict the early postoperative recurrence in patients with cHCC-CC.
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Affiliation(s)
- Chao Zheng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No. 6 Taoyuan Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Xin-Tao Gu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Xiao-Li Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Yu-Chen Wei
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Ning-Bin Luo
- Department of Radiology, Guangxi Medical University Affiliated Cancer Hospital, No. 71 Hedi Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Hua-Shan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha, 410005, People's Republic of China
| | - Liao Jin-Yuan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Wang L, Liang M, Feng B, Li D, Cong R, Chen Z, Wang S, Ma X, Zhao X. Microvascular invasion-negative hepatocellular carcinoma: Prognostic value of qualitative and quantitative Gd-EOB-DTPA MRI analysis. Eur J Radiol 2023; 168:111146. [PMID: 37832198 DOI: 10.1016/j.ejrad.2023.111146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES The purpose of this study was to establish a model for predicting the prognosis of patients with microvascular invasion (MVI)-negative hepatocellular carcinoma (HCC) based on qualitative and quantitative analyses of Gd-EOB-DTPA magnetic resonance imaging (MRI). MATERIALS AND METHODS Consecutive patients with MVI-negative HCC who underwent preoperative Gd-EOB-DTPA MRI between January 2015 and December 2019 were retrospectively enrolled.In total, 122 patients were randomly assigned to the training and validation groups at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify significant clinical parameters and MRI features, including quantitative and qualitative parameters associated with prognosis, which were incorporated into a predictive nomogram. The end-point of this study was recurrence-free survival. Outcomes were compared between groups using the Kaplan-Meier method with the log-rank test. RESULTS During a median follow-up period of 58.86 months, 38 patients (31.15 %) experienced recurrence. Multivariate analysis revealed that lower relative enhancement ratio (RER), hepatobiliary phase hypointensity without arterial phase hyperenhancement, Liver Imaging Reporting and Data System category, mild-moderate T2 hyperintensity, and higher aspartate aminotransferase levels were risk factors associated with prognosis and then incorporated into the prognostic model. C-indices for training and validation groups were 0.732 and 0.692, respectively. The most appropriate cut-off value for RER was 1.197. Patients with RER ≤ 1.197 had significantly higher postoperative recurrence rates than those with RER > 1.197 (p = 0.004). CONCLUSION The model integrating qualitative and quantitative imaging parameters and clinical parameters satisfactorily predicted the prognosis of patients with MVI-negative HCC.
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Affiliation(s)
- Leyao Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Meng Liang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bing Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dengfeng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rong Cong
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhaowei Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Sicong Wang
- Sicong Wang, Magnetic Resonance Imaging Research, General Electric Healthcare (China), Beijing 100176, China
| | - Xiaohong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Kwon JY, Nietert PJ, Rockey DC. Hyperbilirubinemia in hospitalized patients: Etiology and outcomes. J Investig Med 2023; 71:773-781. [PMID: 37386866 PMCID: PMC10824167 DOI: 10.1177/10815589231180498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
There is little information on the differential diagnosis and prognosis of hospitalized patients with hyperbilirubinemia. Here, we hypothesized that hyperbilirubinemia in hospitalized patients is associated with specific diseases and outcomes. This retrospective cohort analysis included patients admitted to the Medical University of South Carolina with a total bilirubin >3 mg/dL from January 9, 2015 to August 25, 2017. Collected clinical data included demographics, primary diagnosis, Charlson Comorbidity Index (CCI), laboratory data, and clinical outcomes. We separated and analyzed the cohort into seven primary diagnostic groups. We identified 1693 patients with a bilirubin level >3 mg/dL. The cohort was 42% female, had an average age of 54, average CCI of 4.8, and average length of stay of 13 days. The causes of hyperbilirubinemia included the following: primary liver disease (868/1693; 51%) with cirrhosis being most common (385/1693; 23%), benign biliary obstruction (252/1693; 15%), hemolytic anemia (149/1693; 9%), malignant biliary obstruction (121/1693; 7%), unknown etiology (108/1693; 6%), primary liver cancer (74/1693; 4%), and metastatic cancer to the liver (57/1693; 3%). Overall, the mortality/discharge to hospice rate in patients with a bilirubin >3 mg/dL was 30%, and was proportional to the severity of hyperbilirubinemia, including when controlling for the underlying severity of illness. Mortality was highest in patients with primary liver disease and malignancy and was lowest in patients with non-cancerous obstruction or hemolytic jaundice. Hyperbilirubinemia in hospitalized patients is most often due to primary liver disease, and identifies patients with a poor prognosis, particularly when caused by primary liver disease or cancer.
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Affiliation(s)
- Joshua Y Kwon
- Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, USA
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Pan YJ, Liu W, Qiu QX, Miao SL, Zeng MS, Shan Y, Lin J, Xu PJ. Prognostic value of LI-RADS category on MRI in patients with primary hepatic lymphoepithelioma-like carcinoma. Eur Radiol 2023; 33:5993-6000. [PMID: 37014407 DOI: 10.1007/s00330-023-09598-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/18/2023] [Accepted: 02/10/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To compare the clinical and MRI features of primary hepatic lymphoepithelioma-like carcinoma (LELC) categorized as LR-M or LR-4/5 using the Liver Imaging Reporting and Data System (LI-RADS) version 2018 and to determine the prognostic factors for recurrence-free survival (RFS). METHODS In this retrospective study, 37 patients with surgically confirmed LELC were included. Two independent observers evaluated preoperative MRI features according to the LI-RADS version 2018. Clinical and imaging features were compared between two groups. RFS and the associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan-Meier analysis, and log-rank test. RESULTS In total, 37 patients (mean age, 58.5 ± 10.3 years) were evaluated. Sixteen (43.2%) LELCs were categorized as LR-M and twenty-one (56.8%) LELCs were categorized as LR-4/5. In the multivariate analysis, the LR-M category was an independent factor for RFS (HR 7.908, 95% CI 1.170-53.437; p = 0.033). RFS rates were significantly lower in patients with LR-M LELCs than in patients with LR-4/5 LELCs (5-year RFS rate, 43.8% vs.85.7%; p = 0.002). CONCLUSION The LI-RADS category was significantly associated with postsurgical prognosis of LELC, with tumor categorized as LR-M having a worse RFS than those categorized as LR-4/5. KEY POINTS • Lymphoepithelioma-like carcinoma patients categorized as LR-M have worse recurrence-free survival than those categorized as LR-4/5. • MRI-based LI-RADS categorization was an independent factor for postoperative prognosis of primary hepatic lymphoepithelioma-like carcinoma.
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Affiliation(s)
- Yi-Jun Pan
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wei Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Qi-Xuan Qiu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Peng-Ju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
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Sheng R, Yang C, Zhang Y, Wang H, Zheng B, Han J, Sun W, Zeng M. The significance of the predominant component in combined hepatocellular-cholangiocarcinoma: MRI manifestation and prognostic value. LA RADIOLOGIA MEDICA 2023; 128:1047-1060. [PMID: 37474663 DOI: 10.1007/s11547-023-01682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To investigate the significance of the predominant component of combined hepatocellular-cholangiocarcinoma (cHCC-CC) in terms of MRI manifestation and its potential prognostic value compared to hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS A total of 300 patients with chronic liver disease from two centers were retrospectively enrolled, including 100 surgically proven cases of cHCC-CC, HCC, and ICC each. Univariate and multivariate regression analyses were performed to identify independent predictors for distinguishing HCC-predominant cHCC-CC and ICC-predominant cHCC-CC from HCC and ICC, respectively. Diagnostic models were constructed based on the independent features. Recurrence-free survival (RFS) was estimated and compared between groups. RESULTS The predominant component was an independent predictor for RFS in cHCC-CC (hazard ratio = 1.957, P = 0.044). The presence of targetoid appearance (odds ratio(OR) = 10.907, P = 0.001), lack of enhancing capsule (OR = 0.072, P = 0.001) and arterial peritumoral enhancement (OR = 0.091, P = 0.003) were independent predictors suggestive of HCC-predominant cHCC-CC over HCC; their combination yielded an area under the curve of 0.756. No significant differences were observed in RFS between HCC-predominant cHCC-CC and HCC (P = 0.864). Male gender (OR = 4.049, P = 0.015), higher alpha fetoprotein (OR = 16.789, P < 0.001) and normal carbohydrate antigen 19-9 (OR = 0.343, P = 0.036) levels, presence of enhancing capsule (OR = 7.819, P < 0.001) and hemorrhage (OR = 23.526, P = 0.004), and lack of targetoid appearance (OR = 0.129, P = 0.005) and liver surface retraction (OR = 0.190, P = 0.021) were independent predictors suggestive of ICC-predominant cHCC-CC over ICC; their combination yielded an area under the curve value of 0.898. ICC-predominant cHCC-CC exhibited poorer survival with shorter RFS than ICC (P = 0.009). CONCLUSION The predominant histopathological component is closely related to the imaging manifestation of cHCC-CC; and more importantly, it plays a significant prognostic role, which may alter the RFS prognosis of cHCC-CC.
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Affiliation(s)
- Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Shanghai , 361006, Fujian, China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yunfei Zhang
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Heqing Wang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Shanghai , 361006, Fujian, China
| | - Beixuan Zheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing Han
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
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Zhang C, Yang R, Wang X, Tao Y, Tang S, Tian Z, Zhou Y. LI-RADS Morphological Type Predicts Prognosis of Patients with Hepatocellular Carcinoma After Radical Resection. Ann Surg Oncol 2023; 30:4876-4885. [PMID: 37133569 DOI: 10.1245/s10434-023-13494-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/27/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE This study aimed to explore the association of preoperative magnetic resonance imaging (MRI) tumor morphological classification with early recurrence (ER) and overall survival (OS) after radical surgery of hepatocellular carcinoma (HCC). PATIENTS AND METHODS A retrospective analysis of 296 patients with HCC who underwent radical resection was performed. On the basis of LI-RADS, tumor imaging morphology was classified into three types. The clinical imaging features, ER, and survival rates of three types were compared. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors associated with OS and ER after hepatectomy for HCC. RESULTS There were 167 tumors of type 1, 95 of type 2, and 34 of type 3. In patients with type 3 HCC, postoperative mortality and ER were significantly higher than in patients with type 1 and type 2 (55.9% versus 32.6% versus 27.5% and 52.9% versus 33.7% versus 28.7%). In multivariate analysis, the LI-RADS morphological type was a stronger risk factor for predicting poor OS [hazard ratio (HR) 2.77, 95% confidence interval (CI) 1.59-4.85, P < 0.001] and ER (HR 2.14, 95% CI 1.24-3.70, P = 0.007). A subgroup analysis revealed that type 3 was associated with poor OS and ER in > 5 cm cases but not in < 5 cm cases. CONCLUSIONS ER and OS of patients with HCC undergoing radical surgery can be predicted using the preoperative tumor LI-RADS morphological type, which could help to select personalized treatment plans for patients with HCC in the future.
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Affiliation(s)
- Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Rui Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Yuqing Tao
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Shuli Tang
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Zhennan Tian
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China.
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Hu YX, Yan CJ, Yun M, Zheng W, Zou XB, Zhang YF, Mao RS, Li LL, Zhou JH. Contrast-enhanced ultrasound liver imaging reporting and data system v2017: patient outcomes after treatment for early-stage hepatocellular carcinoma nodules with category 3-5 and category M. Br J Radiol 2023; 96:20220492. [PMID: 37066834 PMCID: PMC10321252 DOI: 10.1259/bjr.20220492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVE To evaluate correlation between contrast-enhanced ultrasonography Liver Imaging Reporting and Data System (CEUS LI-RADS; v. 2017) categories (LR 3-5 vs LR-M) and outcomes in patients with early-stage hepatocellular carcinoma (HCC) after initial therapy. METHODS In this retrospective study, 272 patients with high risks for HCC and solitary clinically or pathologically confirmed HCC were identified between January 2010 and December 2015. Patients were initially treated by resection and radiofrequency ablation (RFA) according to the Barcelona Clinic Liver Cancer staging system and were followed up until December 31, 2018. Recurrence-free survival (RFS) and overall survival (OS) were compared between nodules assigned as LR 3-5 or LR M according to CEUS LI-RADS v. 2017 by using the Kaplan-Meier curve, log-rank test, and Cox proportional hazard model. RESULTS Early washout is the key determinating whether a nodule is classed as LR-M. Treatment procedures and LI-RADS category showed an independent correlation with OS and RFS (p < 0.05). LR 3-5 category were more correlated with better OS (88.6 months and 74.2 months, respectively; p = 0.017) compared with LR-M. Surgical resection demonstrated longer OS and RFS than RFA in LR-M patients and longer OS in LR 3-5 patients (p < 0.05). Besides, there was no significantly difference in OS and RFS between two categories in resection (p > 0.05), while for patients treated with RFA, LR 3-5 patients showed significant longer OS and RFS than LR-M patients (p < 0.05). CONCLUSION Patients with HCC assigned as LR-M showed worse RFS and OS and surgical resection tended to be a more effective treatment for these patients. ADVANCES IN KNOWLEDGE Putting forward a theory that CEUS LI-RADS categories could independently predict the outcome for patients with solitary HCC at early-stage after initial treatment.
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Affiliation(s)
- Yi-xin Hu
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Cui-ju Yan
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Miao Yun
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Zheng
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue-bin Zou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ya-fang Zhang
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ru-shuang Mao
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ling-ling Li
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jian-hua Zhou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Guo L, Li X, Zhang C, Xu Y, Han L, Zhang L. Radiomics Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Preoperative Differentiation of Combined Hepatocellular-Cholangiocarcinoma from Hepatocellular Carcinoma: A Multi-Center Study. J Hepatocell Carcinoma 2023; 10:795-806. [PMID: 37288140 PMCID: PMC10243611 DOI: 10.2147/jhc.s406648] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose To explore whether texture features based on magnetic resonance can distinguish diseases combined hepatocellular-cholangiocarcinoma (cHCC-CC) from hepatocellular carcinoma (HCC) before operation. Methods The clinical baseline data and MRI information of 342 patients with pathologically diagnosed cHCC-CC and HCC in two medical centers were collected. The data were divided into the training set and the test set at a ratio of 7:3. MRI images of tumors were segmented with ITK-SNAP software, and python open-source platform was used for texture analysis. Logistic regression as the base model, mutual information (MI) and Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to select the most favorable features. The clinical, radiomics, and clinic-radiomics model were constructed based on logistic regression. The model's effectiveness was comprehensively evaluated by the receiver operating characteristic (ROC) curve, area under the curve (AUC), sensitivity, specificity, and Youden index which is the main, and the model results were exported by SHapley Additive exPlanations (SHAP). Results A total of 23 features were included. Among all models, the arterial phase-based clinic-radiomics model showed the best performance in differentiating cHCC-CC from HCC before an operation, with the AUC of the test set being 0.863 (95% CI: 0.782 to 0.923), the specificity and sensitivity being 0.918 (95% CI: 0.819 to 0.973) and 0.738 (95% CI: 0.580 to 0.861), respectively. SHAP value results showed that the RMS was the most important feature affecting the model. Conclusion Clinic-radiomics model based on DCE-MRI may be useful to distinguish cHCC-CC from HCC in a preoperative setting, especially in the arterial phase, and RMS has the greatest impact.
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Affiliation(s)
- Le Guo
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xijun Li
- Key Laboratory of Hunan Province for Internet of Things and Information Security, Xiangtan University, Xiangtan, Hunan Province, People’s Republic of China
| | - Chao Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Yang Xu
- Department of Interventional, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Lujun Han
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Ling Zhang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
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Shen YT, Yue WW, Xu HX. Non-invasive imaging in the diagnosis of combined hepatocellular carcinoma and cholangiocarcinoma. Abdom Radiol (NY) 2023; 48:2019-2037. [PMID: 36961531 DOI: 10.1007/s00261-023-03879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023]
Abstract
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare type of primary liver cancer. It is a complex "biphenotypic" tumor type consisting of bipotential hepatic progenitor cells that can differentiate into cholangiocytes subtype and hepatocytes subtype. The prognosis of patients with cHCC-CC is quite poor with its specific and more aggressive nature. Furthermore, there are no definite demographic or clinical features of cHCC-CC, thus a clear preoperative identification and accurate non-invasive imaging diagnostic analysis of cHCC-CC are of great value. In this review, we first summarized the epidemiological features, pathological findings, molecular biological information and serological indicators of cHCC-CC disease. Then we reviewed the important applications of non-invasive imaging modalities-particularly ultrasound (US)-in cHCC-CC, covering both diagnostic and prognostic assessment of patients with cHCC-CC. Finally, we presented the shortcomings and potential outlooks for imaging studies in cHCC-CC.
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Affiliation(s)
- Yu-Ting Shen
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, 200072, China.
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China.
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Park SH, Heo S, Kim B, Lee J, Choi HJ, Sung PS, Choi JI. Targetoid Primary Liver Malignancy in Chronic Liver Disease: Prediction of Postoperative Survival Using Preoperative MRI Findings and Clinical Factors. Korean J Radiol 2023; 24:190-203. [PMID: 36788766 PMCID: PMC9971837 DOI: 10.3348/kjr.2022.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We aimed to assess and validate the radiologic and clinical factors that were associated with recurrence and survival after curative surgery for heterogeneous targetoid primary liver malignancies in patients with chronic liver disease and to develop scoring systems for risk stratification. MATERIALS AND METHODS This multicenter retrospective study included 197 consecutive patients with chronic liver disease who had a single targetoid primary liver malignancy (142 hepatocellular carcinomas, 37 cholangiocarcinomas, 17 combined hepatocellular carcinoma-cholangiocarcinomas, and one neuroendocrine carcinoma) identified on preoperative gadoxetic acid-enhanced MRI and subsequently surgically removed between 2010 and 2017. Of these, 120 patients constituted the development cohort, and 77 patients from separate institution served as an external validation cohort. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were identified using a Cox proportional hazards analysis, and risk scores were developed. The discriminatory power of the risk scores in the external validation cohort was evaluated using the Harrell C-index. The Kaplan-Meier curves were used to estimate RFS and OS for the different risk-score groups. RESULTS In RFS model 1, which eliminated features exclusively accessible on the hepatobiliary phase (HBP), tumor size of 2-5 cm or > 5 cm, and thin-rim arterial phase hyperenhancement (APHE) were included. In RFS model 2, tumors with a size of > 5 cm, tumor in vein (TIV), and HBP hypointense nodules without APHE were included. The OS model included a tumor size of > 5 cm, thin-rim APHE, TIV, and tumor vascular involvement other than TIV. The risk scores of the models showed good discriminatory performance in the external validation set (C-index, 0.62-0.76). The scoring system categorized the patients into three risk groups: favorable, intermediate, and poor, each with a distinct survival outcome (all log-rank p < 0.05). CONCLUSION Risk scores based on rim arterial enhancement pattern, tumor size, HBP findings, and radiologic vascular invasion status may help predict postoperative RFS and OS in patients with targetoid primary liver malignancies.
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Affiliation(s)
- So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Subin Heo
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jungbok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hwang SH, Rhee H. Radiologic features of hepatocellular carcinoma related to prognosis. JOURNAL OF LIVER CANCER 2023; 23:143-156. [PMID: 37384030 PMCID: PMC10202237 DOI: 10.17998/jlc.2023.02.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 06/30/2023]
Abstract
The cross-sectional imaging findings play a crucial role in the diagnosis of hepatocellular carcinoma (HCC). Recent studies have shown that imaging findings of HCC are not only relevant for the diagnosis of HCC, but also for identifying genetic and pathologic characteristics and determining prognosis. Imaging findings such as rim arterial phase hyperenhancement, arterial phase peritumoral hyperenhancement, hepatobiliary phase peritumoral hypointensity, non-smooth tumor margin, low apparent diffusion coefficient, and the LR-M category of the Liver Imaging-Reporting and Data System have been reported to be associated with poor prognosis. In contrast, imaging findings such as enhancing capsule appearance, hepatobiliary phase hyperintensity, and fat in mass have been reported to be associated with a favorable prognosis. Most of these imaging findings were examined in retrospective, single-center studies that were not adequately validated. However, the imaging findings can be applied for deciding the treatment strategy for HCC, if their significance can be confirmed by a large multicenter study. In this literature, we would like to review imaging findings related to the prognosis of HCC as well as their associated clinicopathological characteristics.
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Affiliation(s)
- Shin Hye Hwang
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hyungjin Rhee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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30
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Liu X, Shan Q, Wang Z. Editorial for "LI-RADS Category on MRI Is Associated With Recurrence of Intrahepatic Cholangiocarcinoma After Surgery: A Multicenter Study". J Magn Reson Imaging 2023; 57:939-940. [PMID: 35986651 DOI: 10.1002/jmri.28398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xiaoyu Liu
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Huangpu District, Shanghai, China
| | - Qungang Shan
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Huangpu District, Shanghai, China
| | - Zhongmin Wang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Huangpu District, Shanghai, China
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Wu H, Liang Y, Wang Z, Tan C, Yang R, Wei X, Jiang X. Optimizing CT and MRI criteria for differentiating intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma. Acta Radiol 2023; 64:926-935. [PMID: 35898164 DOI: 10.1177/02841851221113265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate diagnosis of intrahepatic mass-forming cholangiocarcinoma (IMCC) is crucial with regard to the choice of patient management and treatment options. PURPOSE To evaluate the feasibility and diagnostic performance of the LI-RADS M (LR-M) targetoid criteria on computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in differentiating IMCC from hepatocellular carcinoma (HCC). MATERIAL AND METHODS A total of 118 patients with IMCC and HCC were included who underwent CT and EOB-MRI examinations. Multivariate analysis was used to determine the strongest predictors differentiating IMCC from HCC. Using these predictors, a predictive model for differentiating IMCC from HCC was constructed and the performance of the model was confirmed using the receiver operating characteristic curve. RESULTS Multivariate analyses revealed rim-like arterial phase hyperenhancement (rim APHE) on CT and rim APHE, delayed central enhancement (DCE), and targetoid hepatobiliary phase (HBP) on MRI as independent variables significantly differentiating IMCC from HCC. The multivariate logistic regression model incorporating the three variables on EOB-MRI was constructed with an area under the curve (AUC) of 0.946, sensitivity of 87.80%, specificity of 92.21%, and accuracy of 94.60%. Per the DeLong test, the multivariate logistic regression model showed significantly higher AUC than rim APHE on CT (0.946 vs. 0.871; P = 0.008) and MRI (0.946 vs. 0.876; P = 0.003), whereas rim APHE on CT and MRI did not differ significantly (P = 0.809). CONCLUSION The multivariate logistic regression model based on rim APHE, DCE, and targetoid HBP on EOB-MRI can effectively distinguish IMCC from HCC and is superior to any other targetoid appearance criterion of LI-RADS on CT and EOB-MRI.
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Affiliation(s)
- Hongzhen Wu
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Yingying Liang
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Zihua Wang
- Department of Radiology, 593063Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, PR China
| | - Caihong Tan
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Ruimeng Yang
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Xinhua Wei
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Xinqing Jiang
- Department of Radiology, 74668Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
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Hwang JA, Lee S, Lee JE, Yoon J, Choi SY, Shin J. LI-RADS Category on MRI Is Associated With Recurrence of Intrahepatic Cholangiocarcinoma After Surgery: A Multicenter Study. J Magn Reson Imaging 2023; 57:930-938. [PMID: 35833798 DOI: 10.1002/jmri.28354] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing the terminology and interpretation of liver imaging. The association between the LI-RADS category and tumor recurrence in patients with intrahepatic cholangiocarcinomas (iCCAs) has not yet been evaluated in a multicenter study. PURPOSE To retrospectively investigate the preoperative clinical and imaging features associated with recurrence-free survival (RFS) after curative resection of iCCAs and to identify the role of the LI-RADS category in at-risk patients. STUDY TYPE Retrospective, multicenter. SUBJECTS A total of 113 patients (mean age: 61.1 years; 74 men, 39 women) who underwent preoperative contrast-enhanced MRI and curative surgical resection for a single treatment-naive iCCA between 2008 and 2021. FILED STRENGTH/SEQUENCE A 3 T dual gradient-echo T1 WI with in- and opposed-phase, turbo spin-echo T2 WI, diffusion-weighted echo-planar images, and three-dimensional gradient-echo T1 WI before and after administration of contrast agent. ASSESSMENT MR imaging features were evaluated and assigned for each lesion using LI-RADS version 2018. RFS was calculated from the date of surgery to tumor recurrence or the last imaging date without evidence of recurrence. Factors affecting RFS were evaluated using clinical and imaging features. STATISTICAL TESTS Cox proportional hazards model, Kaplan-Meier method, and log-rank test. A P-value of <0.05 was considered statistically significant. RESULTS A total of 93 (82.3%) were categorized as LR-M and 20 (17.7%) were categorized as LR-4 or 5. In the multivariable analysis, LR-M category (hazard ratio [HR], 8.035; 95% confidence interval [CI], 1.096-58.931) and a tumor size >3 cm on MRI (HR, 2.690; 95% CI, 1.319-5.487) were independent factors for poor RFS. The 5-year RFS rate was significantly higher in patients with iCCA categorized as LR-4 or 5 than in those categorized as LR-M (94.4% vs. 51.9%, respectively). DATA CONCLUSION Patients with iCCA categorized as LR-4 or 5 may have a better RFS than those categorized as LR-M. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jongjin Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo-Yeon Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Wang R, Xu H, Chen W, Jin L, Ma Z, Wen L, Wang H, Cao K, Du X, Li M. Gadoxetic acid-enhanced MRI with a focus on LI-RADS v2018 imaging features predicts the prognosis after radiofrequency ablation in small hepatocellular carcinoma. Front Oncol 2023; 13:975216. [PMID: 36816925 PMCID: PMC9932892 DOI: 10.3389/fonc.2023.975216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Gadoxetic acid-enhanced magnetic resonance imaging (MRI) contributes to evaluating the prognosis of small hepatocellular carcinoma (sHCC) following treatment. We have investigated the potential role of gadoxetic acid-enhanced MRI based on LI-RADS (Liver Imaging Reporting and Data System) v2018 imaging features in the prognosis prediction of patients with sHCC treated with radiofrequency ablation (RFA) as the first-line treatment and formulated a predictive nomogram. Methods A total of 204 patients with sHCC who all received RFA as the first-line therapy were enrolled. All patients had undergone gadoxetic acid-enhanced MRI examinations before RFA. Uni- and multivariable analyses for RFS were assessing using a Cox proportional hazards model. A novel nomogram was further constructed for predicting RFS. The clinical capacity of the model was validated according to calibration curves, the concordance index (C-index), and decision curve analyses. Results Alpha fetoprotein (AFP) > 100 ng/ml (HR, 2.006; 95% CI, 1.111-3.621; P = 0.021), rim arterial phase hyperenhancement (APHE) (HR, 2.751; 95% CI, 1.511-5.011; P = 0.001), and targetoid restriction on diffusion-weighted imaging (DWI) (HR, 3.289; 95% CI, 1.832-5.906; P < 0.001) were considered as the independent risk features for recurrence in patients with sHCC treated with RFA. The calibration curves and C-indexes (C-index values of 0.758 and 0.807) showed the superior predictive performance of the integrated nomogram in both the training and validation groups. Discussion The gadoxetic acid-enhanced MRI features based on LI-RADS v2018, including rim APHE, targetoid restriction on DWI, and the AFP level, are the independent risk factors of recurrence in patients with sHCC treated with RFA as the first-line therapy. The predictive clinical-radiological nomogram model was constructed for clinicians to develop individualized treatment and surveillance strategies.
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Affiliation(s)
- Ruizhi Wang
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Hengtian Xu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wufei Chen
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhuangxuan Ma
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Lei Wen
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hongwei Wang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Kun Cao
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xia Du
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China,*Correspondence: Xia Du, ; Ming Li,
| | - Ming Li
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China,*Correspondence: Xia Du, ; Ming Li,
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Xiao Y, Zheng X, Zhou C, Huang P, Wu F, Yang C, Zeng M. Combined hepatocellular carcinoma-cholangiocarcinoma with a predominant HCC component: better survival and MRI-based prediction. Eur Radiol 2023; 33:1412-1421. [PMID: 36112193 DOI: 10.1007/s00330-022-09131-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/22/2022] [Accepted: 08/29/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the optimal cutoff value of HCC% for predicting the outcome of patients with combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) and to investigate how preoperative MR features based on the Liver Imaging Reporting and Data System (LI-RADS ver. 2018) are related to the HCC% in cHCC-CCA. METHODS The study enrolled 107 patients pathologically confirmed to have single cHCC-CCA according to the 2019 WHO classification. A receiver operating characteristic (ROC) curve was used to find the optimal cutoff value of HCC% based on overall survival (OS). The preoperative MR imaging features and clinicopathological findings were retrospectively evaluated and compared between the high HCC% and low HCC% groups. RESULTS In total, 107 patients (mean age, males vs. females: 56.6 ± 10.7 years vs. 54.2 ± 12.8 years) were evaluated. Analysis of the relationship between HCC% and OS by ROC curve suggested that the optimal cutoff value was 65%, by which 51 (47.7%) patients were assigned to the high HCC% group. LI-RADS categorization (OR = 3.657, p = 0.006 vs. OR = 4.075, p = 0.004) and serum carcinoembryonic antigen (CEA) >5 ng/mL (OR = 0.348, p = 0.089 vs. OR = 0.298, p = 0.040) were significant predictors for HCC% in cHCC-CCA in both univariate and multivariate analysis. CONCLUSIONS cHCC-CCA patients with HCC components higher than 65% tend to exhibit better overall survival, and MRI-based LI-RADS categorization and serum CEA level are valuable for identifying HCC% in cHCC-CCA preoperatively. KEY POINTS • cHCC-CCA patients with HCC components higher than 65% tend to exhibit better overall survival. • MRI-based LI-RADS categorization and serum CEA level were significant predictors for HCC% in cHCC-CCA in both univariate and multivariate analyses and valuable for identifying HCC% in cHCC-CCA preoperatively.
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Affiliation(s)
- Yuyao Xiao
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xinde Zheng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Changwu Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng Huang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Fei Wu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, China. .,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Yang X, Chang J, Li R, Qi Y, Zeng X, Wang W, Li H. Quantitative Assessment of Hypovascular Component in Arterial Phase to Help the Discrimination of Combined Hepatocellular-Cholangiocarcinoma and Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:113-122. [PMID: 36727035 PMCID: PMC9885771 DOI: 10.2147/jhc.s390820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/10/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose To explore the imaging performance for discrimination of combined hepatocellular- cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC). Methods In total, 35 patients with cHCC-CCA and a matched control group of HCC patients (n = 35) were included retrospectively. We quantitatively evaluated the hypovascular component in tumor and qualitatively assessed LI-RADS features and other aggressive features to develop model for cHCC-CCA diagnose. Subgroup analyses were performed by tumor size and LI-RADS category. Results cHCC-CCA frequently showed a larger proportion (≥50%) of hypovascular areas followed by HCC (P = 0.000). Among those patients with ≥50% hypovascular areas, 8 patients did not present rim enhancement in atrial phase. The LI-RADS major features were more commonly observed in HCC (82.9-45.7%,), than cHCC-CCA (P = 0.003-0.022). The targetoid appearances and non-smooth margin frequently appeared in cHCC-CCA (34.3-63.9%), compared with HCC (P = 0.000-0.023). We developed a radiologic model based on ≥50% hypovascular component and delayed enhancement, which presented AUC of 0.821, accuracy of 80%. We also obtained good performance by radiologic model in LR-M group and tumor size <50mm group (AUC: 0.841 and 0.866, respectively). Combined group which included CA 19-9 and ≥50% hypovascular component and delayed enhancement did not improve the distinction performance between cHCC-CCA and HCC, which presented good performance of identifying cHCC-CCA in the LR-4/5 subgroup and tumor size ≥50 mm subgroup (AUC: 0.717, 0.730, respectively). cHCC-CCA group presented heterogeneous dominant pathology involving 15 of HCC, 7 of intrahepatic cholangiocarcinoma (iCCA) or cholangiolocellular carcinoma (CLC), 13 of intermediate cells component. Macrotrabecular appearances were higher in cHCC-CCA than that in HCC. The proportion of Hepa-1 was significantly higher in true negative (TN) patients (29 [93.5%]) and false negative (FN) patients (10 [100%]) than in true positive (TP) patients (16 [64%]; P = 0.036). Conclusion Quantitative assessment of hypovascular component could help the discrimination of cHCC-CCA. Macrotrabecular appearances were more exhibited in cHCC-CCA than that in HCC.
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Affiliation(s)
- Xue Yang
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Jing Chang
- Department of Pathology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Ruili Li
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, 100073, People’s Republic of China
| | - Yu Qi
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Xufen Zeng
- Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Wei Wang
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China,Correspondence: Hongjun Li, Department of Radiology, Beijing YouAn Hospital, Capital Medical University, No. 8 Xi Tou Tiao, Youanmen Wai, Fengtai District, Beijing, 100069, People’s Republic of China, Email
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Lee S, Kim YY, Shin J, Son WJ, Roh YH, Choi JY, Sirlin CB, Chernyak V. Percentages of Hepatocellular Carcinoma in LI-RADS Categories with CT and MRI: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e220646. [PMID: 36625748 DOI: 10.1148/radiol.220646] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) CT and MRI algorithm applies equally to CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with gadoxetate (Gx-MRI). Purpose To estimate pooled percentages of hepatocellular carcinoma (HCC) and overall malignancy for each LI-RADS category with CT and MRI. Materials and Methods MEDLINE and EMBASE databases were searched for research articles (January 2014-April 2021) reporting the percentages of observations in each LI-RADS category with use of versions 2014, 2017, or 2018. Study design, population characteristics, imaging modality, reference standard, and numbers of HCC and non-HCC malignancies in each category were recorded. A random-effects model evaluated the pooled percentage of HCC and overall malignancy for each category. Results There were 49 studies with 9620 patients and a total 11 562 observations, comprising 7921 HCCs, 1132 non-HCC malignancies, and 2509 benign entities. No HCC or non-HCC malignancies were reported with any modality in the LR-1 category. The pooled percentages of HCC for CT, ECA-MRI, and Gx-MRI, respectively, were 10%, 6%, and 1% for LR-2 (P = .16); 48%, 31%, and 38% for LR-3 (P = .42); 76%, 64%, and 77% for LR-4 (P = .62); 96%, 95%, and 96% for LR-5 (P = .76); 88%, 76%, and 78% for LR-5V or LR-TIV (tumor in vein) (P = .42); and 20%, 30%, and 35% for LR-M (P = .32). Most LR-M (93%-100%) and LR-5V or LR-TIV (99%-100%) observations were malignant, regardless of modality. Conclusion There was no difference in percentages of hepatocellular carcinoma and overall malignancy between CT, MRI with extracellular contrast agents, and MRI with gadoxetate for any Liver Imaging Reporting and Data System categories. © RSNA, 2023 Supplemental material is available for this article See also the editorial by Ronot in this issue.
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Affiliation(s)
- Sunyoung Lee
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yeun-Yoon Kim
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jaeseung Shin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Won Jeong Son
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yun Ho Roh
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jin-Young Choi
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Claude B Sirlin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Victoria Chernyak
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
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Li Y, Ni X, Liu X, Yang C, Wang Y, Lu X, Zhou C. Prognosis of Primary Liver Cancer Based on LI-RADS Classification with Extracellular Agent-Enhanced MRI. J Hepatocell Carcinoma 2023; 10:399-411. [PMID: 36926054 PMCID: PMC10010934 DOI: 10.2147/jhc.s394840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Objective The prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) 2018 in differentiating hepatocellular carcinoma (HCC) from other primary liver cancers (PLC) with cirrhosis is unclear. We aim to evaluate the value of LI-RADS 2018 with agent-enhanced MRI in the postoperative prognosis of PLC patients with cirrhosis. Methods Between 2016 and 2021, 432 patients with cirrhosis and surgically proven single primary liver cancer were retrospectively evaluated. Two radiologists evaluated the preoperative MRI features independently and assigned each lesion a LI-RADS category. Overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated by using the Kaplan-Meier method, Log rank test, and Cox proportional hazards model. Results The mean age of 432 patients (239 HCCs, 93 ICCs, and 100 cHCC-CCAs) was 57.27±10.92 years. The LR-M category showed poorer OS and RFS than the LR-4 or LR-5 category did for all primary liver cancers (P <0.001 for both), and so did HCCs with tumor size less than 30mm (P =0.003 and P =0.04, respectively). In the multivariable analysis, the LI-RADS category and tumor size > 30 mm had independent correlations with OS and RFS (all P < 0.05). Multivariable Cox analysis identified rim arterial phase hyperenhancement (APHE) as independent determinants of poor OS and RFS in primary liver cancers (all P < 0.05). Conclusion The LI-RADS categories can predict the postsurgical prognosis of primary liver cancers independently.
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Affiliation(s)
- Yubo Li
- Department of MRI, Henan Provincial Hospital of Traditional Chinese Medicine (the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, People's Republic of China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaoyan Ni
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xinai Liu
- Department of MRI, Henan Provincial Hospital of Traditional Chinese Medicine (the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, People's Republic of China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yi Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xin Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Changwu Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Kierans AS, Lafata KJ, Ludwig DR, Burke LMB, Chernyak V, Fowler KJ, Fraum TJ, McGinty KA, McInnes MDF, Mendiratta-Lala M, Cunha GM, Allen BC, Hecht EM, Jaffe TA, Kalisz KR, Ranathunga DS, Wildman-Tobriner B, Cardona DM, Aslam A, Gaur S, Bashir MR. Comparing Survival Outcomes of Patients With LI-RADS-M Hepatocellular Carcinomas and Intrahepatic Cholangiocarcinomas. J Magn Reson Imaging 2023; 57:308-317. [PMID: 35512243 DOI: 10.1002/jmri.28218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There is a sparsity of data evaluating outcomes of patients with Liver Imaging Reporting and Data System (LI-RADS) (LR)-M lesions. PURPOSE To compare overall survival (OS) and progression free survival (PFS) between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) meeting LR-M criteria and to evaluate factors associated with prognosis. STUDY TYPE Retrospective. SUBJECTS Patients at risk for HCC with at least one LR-M lesion with histologic diagnosis, from 8 academic centers, yielding 120 patients with 120 LR-M lesions (84 men [mean age 62 years] and 36 women [mean age 66 years]). FIELD STRENGTH/SEQUENCE A 1.5 and 3.0 T/3D T1 -weighted gradient echo, T2 -weighted fast spin-echo. ASSESSMENT The imaging categorization of each lesion as LR-M was made clinically by a single radiologist at each site and patient outcome measures were collected. STATISTICAL TESTS OS, PFS, and potential independent predictors were evaluated by Kaplan-Meier method, log-rank test, and Cox proportional hazard model. A P value of <0.05 was considered significant. RESULTS A total of 120 patients with 120 LR-M lesions were included; on histology 65 were HCC and 55 were iCCA. There was similar median OS for patients with LR-M HCC compared to patients with iCCA (738 days vs. 769 days, P = 0.576). There were no significant differences between patients with HCC and iCCA in terms of sex (47:18 vs. 37:18, P = 0.549), age (63.0 ± 8.4 vs. 63.4 ± 7.8, P = 0.847), etiology of liver disease (P = 0.202), presence of cirrhosis (100% vs. 100%, P = 1.000), tumor size (4.73 ± 3.28 vs. 4.75 ± 2.58, P = 0.980), method of lesion histologic diagnosis (P = 0.646), and proportion of patients who underwent locoregional therapy (60.0% vs. 38.2%, P = 0.100) or surgery (134.8 ± 165.5 vs. 142.5 ± 205.6, P = 0.913). Using multivariable analysis, nonsurgical compared to surgical management (HR, 4.58), larger tumor size (HR, 1.19), and higher MELD score (HR, 1.12) were independently associated with worse OS. DATA CONCLUSION There was similar OS in patients with LR-M HCC and LR-M iCCA, suggesting that LR-M imaging features may more closely reflect patient outcomes than histology. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Andrea S Kierans
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Kyle J Lafata
- Department of Radiology, Duke University, Durham, NC, USA.,Department of Radiation Oncology, Duke University, Durham, NC, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren M B Burke
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center and Montefiore Medical Center, New York, NY, USA
| | - Kathryn J Fowler
- Department of Radiology, University California San Diego, San Diego, CA, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katrina A McGinty
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew D F McInnes
- Department of Radiology, the Ottawa Hospital Research Institute Clinical Epidemiology Program, University of Ottawa, Ottawa, Canada
| | | | | | - Brian C Allen
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University, Durham, NC, USA
| | - Kevin R Kalisz
- Department of Radiology, Duke University, Durham, NC, USA
| | | | | | | | - Anum Aslam
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Sonia Gaur
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University, Durham, NC, USA.,Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Radiology, Center for Advanced Magnetic Resonance Development, Duke University, Durham, NC, USA
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Yoon JH. Editorial for "Comparing Survival Outcomes of Patients With LI-RADS-M Hepatocellular Carcinomas and Intrahepatic Cholangiocarcinomas". J Magn Reson Imaging 2023; 57:318-319. [PMID: 35604010 DOI: 10.1002/jmri.28222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
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Kim YY, Choi JY. [CT/MRI Liver Imaging Reporting and Data System (LI-RADS): Standardization, Evidence, and Future Direction]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:15-33. [PMID: 36818714 PMCID: PMC9935963 DOI: 10.3348/jksr.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
The liver imaging reporting and data system (LI-RADS) has been developed with the support of the American College of Radiology to standardize the diagnosis and evaluation of treatment response of hepatocellular carcinoma (HCC). The CT/MRI LI-RADS version 2018 has been incorporated in the American Association for the Study of Liver Diseases guidance. This review examines the effect of CT/MRI LI-RADS on the standardized reporting of liver imaging, and the evidence in diagnosing HCC and evaluating treatment response after locoregional treatment using CT/MRI LI-RADS. The results are compared with other HCC diagnosis guidelines, and future directions are described.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Yang X, Shao G, Liu J, Liu B, Cai C, Zeng D, Li H. Predictive machine learning model for microvascular invasion identification in hepatocellular carcinoma based on the LI-RADS system. Front Oncol 2022; 12:1021570. [DOI: 10.3389/fonc.2022.1021570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
PurposesThis study aimed to establish a predictive model of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) by contrast-enhanced computed tomography (CT), which relied on a combination of machine learning approach and imaging features covering Liver Imaging and Reporting and Data System (LI-RADS) features.MethodsThe retrospective study included 279 patients with surgery who underwent preoperative enhanced CT. They were randomly allocated to training set, validation set, and test set (167 patients vs. 56 patients vs. 56 patients, respectively). Significant imaging findings for predicting MVI were identified through the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression method. Predictive models were performed by machine learning algorithm, support vector machine (SVM), in the training set and validation set, and evaluated in the test set. Further, a combined model adding clinical findings to the radiologic model was developed. Based on the LI-RADS category, subgroup analyses were conducted.ResultsWe included 116 patients with MVI which were diagnosed through pathological confirmation. Six imaging features were selected about MVI prediction: four LI-RADS features (corona enhancement, enhancing capsule, non-rim aterial phase hyperehancement, tumor size) and two non-LI-RADS features (internal arteries, non-smooth tumor margin). The radiological feature with the best accuracy was corona enhancement followed by internal arteries and tumor size. The accuracies of the radiological model and combined model were 0.725–0.714 and 0.802–0.732 in the training set, validation set, and test set, respectively. In the LR-4/5 subgroup, a sensitivity of 100% and an NPV of 100% were obtained by the high-sensitivity threshold. A specificity of 100% and a PPV of 100% were acquired through the high specificity threshold in the LR-M subgroup.ConclusionA combination of LI-RADS features and non-LI-RADS features and serum alpha-fetoprotein value could be applied as a preoperative biomarker for predicting MVI by the machine learning approach. Furthermore, its good performance in the subgroup by LI-RADS category may help optimize the management of HCC patients.
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Identification of the origin of tumor in vein: comparison between CEUS LI-RADS v2017 and v2016 for patients at high risk. BMC Med Imaging 2022; 22:186. [PMID: 36309665 PMCID: PMC9617430 DOI: 10.1186/s12880-022-00912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To compare the diagnostic performance of the Contrast-Enhanced Ultrasound (CEUS) Liver Imaging Report and Data System (LI-RADS) v2016 and v2017 in identifying the origin of tumor in vein (TIV). Methods From April 2014 to December 2018, focal liver lesions (FLLs) accompanied by TIV formation in patients at high risk for hepatocellular carcinoma (HCC) were enrolled. Histologic evaluation or composite imaging reference standard were served as the reference standard. Each case was categorized according to the CEUS LI-RADS v2016 and v2017, respectively. Diagnostic performance of CEUS LI-RADS v2016 and v2017 in identifying the originated tumor of TIV was validated via sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value. Results A total of 273 FLLs with TIV were analyzed finally, including 266 HCCs and 7 non-HCCs. In v2016, when adopting all TIV as LR-5V, the accuracy and PPV in identifying the originated tumor were both 97.4%. In v2017, when assigning TIV according to contiguous FLLs CEUS LI-RADS category, the accuracy and PPV were 61.9% and 99.4% in subclass of LR-5 as the diagnostic criteria of HCC, and 64.1% and 99.4% in subclass of LR-4/5 as the criteria of HCC diagnosis. There were significant differences in diagnostic accuracy between CEUS LI-RADS v2016 and v2017 in identifying the originated tumor of TIV (p < 0.001). Conclusions CEUS LI-RADS v2016 could be better than v2017 in identifying the originated tumor of TIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00912-4.
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Zhang L, Cheng C, Li B, Chen J, Peng J, Cao Y, Yue Y, Mai X, Yu D. Combined clinical features and MRI parameters for the prediction of VEGFR2 in hepatocellular carcinoma patients. Front Oncol 2022; 12:961530. [PMID: 36313714 PMCID: PMC9608502 DOI: 10.3389/fonc.2022.961530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/03/2022] [Indexed: 01/17/2023] Open
Abstract
Purpose To develop a prediction model for estimating the expression of vascular endothelial growth factor receptor 2 (VEGFR2) in hepatocellular carcinoma (HCC) patients using clinical features and the contrast-enhanced MRI Liver Imaging Reporting and Data System (LI-RADS). Methods A total of 206 HCC patients were subjected to preoperative contrast-enhanced MRI, radical resection, and VEGFR2 immunohistochemistry labeling. The intensity of VEGFR2 expression was used to split patients into either the positive group or the negative group. For continuous data, the Mann-Whitney U test was employed, and for categorical variables, the χ2 test was utilized. Results VEGFR2-positivity was identified in 41.7% (86/206) of the patients. VEGFR2-positive HCCs were confirmed by higher serum alpha-fetoprotein (AFP) levels, larger tumor dimensions (either on MRI or upon final pathology), and a higher LI-RADS score (all p < 0.001). LI-RADS scores and AFP levels were independent predictors for high VEGFR2 expression. These two parameters were used to establish a VEGFR2-positive risk nomogram, which was validated to possess both good discrimination and calibration. The area under the curve was 0.830 (sensitivity 83.6%, specificity 72.5%) and the mean absolute error was 0.021. The threshold probabilities ranged between 0.07 and 0.95, and usage of the model contributed net benefits. Conclusion A nomogram including clinical features and contrast-enhanced MRI parameters was developed and was demonstrably effective at predicting VEGFR2 expression in HCC patients.
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Affiliation(s)
- Laizhu Zhang
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chunxiao Cheng
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Binghua Li
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jun Chen
- Department of Pathology, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jin Peng
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yajuan Cao
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Yue
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoli Mai
- Department of Radiology, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Xiaoli Mai, ; Decai Yu,
| | - Decai Yu
- Hepatobiliary and Pancreatic Center & Liver Transplantation Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Xiaoli Mai, ; Decai Yu,
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Zulfiqar M, Chatterjee D, Yoneda N, Hoegger MJ, Ronot M, Hecht EM, Bastati N, Ba-Ssalamah A, Bashir MR, Fowler K. Imaging Features of Premalignant Biliary Lesions and Predisposing Conditions with Pathologic Correlation. Radiographics 2022; 42:1320-1337. [PMID: 35930475 DOI: 10.1148/rg.210194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Biliary malignancies include those arising from the intrahepatic and extrahepatic bile ducts as well as the gallbladder and hepatopancreatic ampulla of Vater. The majority of intrahepatic and extrahepatic malignancies are cholangiocarcinomas (CCAs). They arise owing to a complex interplay between the patient-specific genetic background and multiple risk factors and may occur in the liver (intrahepatic CCA), hilum (perihilar CCA), or extrahepatic bile ducts (distal CCA). Biliary-type adenocarcinoma constitutes the most common histologic type of ampullary and gallbladder malignancies. Its prognosis is poor and surgical resection is considered curative, so early detection is key, with multimodality imaging playing a central role in making the diagnosis. There are several risk factors for biliary malignancy as well as predisposing conditions that increase the risk; this review highlights the pertinent imaging features of these entities with histopathologic correlation. The predisposing factors are broken down into three major categories: (a) congenital malformations such as choledochal cyst and pancreaticobiliary maljunction; (b) infectious or inflammatory conditions such as parasitic infections, hepatolithiasis, primary sclerosing cholangitis, and porcelain gallbladder; and (c) preinvasive epithelial neoplasms such as biliary intraepithelial neoplasm, intraductal papillary neoplasm of the bile duct, intra-ampullary papillary tubular neoplasm, and intracholecystic papillary neoplasm of the gallbladder. Recognizing the baseline features of these premalignant biliary entities and changes in their appearance over time that indicate the advent of malignancy in high-risk patients can lead to early diagnosis and potentially curative management. An invited commentary by Volpacchio is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Deyali Chatterjee
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Norihide Yoneda
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Maxime Ronot
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Elizabeth M Hecht
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Nina Bastati
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Ahmed Ba-Ssalamah
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Mustafa R Bashir
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
| | - Kathryn Fowler
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.)
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Zhou C, Lu X, Wang Y, Qian X, Yang C, Zeng M. Histopathological components correlated with MRI features and prognosis in combined hepatocellular carcinoma-cholangiocarcinoma. Eur Radiol 2022; 32:6702-6711. [PMID: 35976399 DOI: 10.1007/s00330-022-09065-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To distinguish MR features according to different proportions of the histopathological hepatocellular carcinoma (HCC) component and to investigate whether the proportion of the HCC component can predict the prognosis of patients with cHCC-CCA. METHODS The study enrolled 106 cHCC-CCA patients confirmed by histopathology. The MR imaging features and clinicopathological findings were retrospectively evaluated and compared between two subgroups with different proportions of the HCC component. The recurrence-free survival (RFS) and overall survival (OS) were evaluated using Kaplan-Meier survival curves and compared using the log-rank test. Moreover, whether the proportion of the HCC component was a predictor of RFS and OS was investigated using Cox regression analyses. RESULTS The Liver Imaging Reporting and Data System (LI-RADS) category 4/5 was more prevalent in cHCC-CCAs with an HCC component > 50% (odds ratio (OR) = 5.559, p = 0.018), 70% (OR = 4.031, p = 0.008), and 90% (OR = 6.282, p = 0.012) than in those with an HCC component ≤ 50%, 70%, and 90%, respectively. In addition, cHCC-CCAs with an HCC component > 70% (HR: 0.241, p = 0.023) had a better OS prognosis than those with an HCC component ≤ 70%. CONCLUSIONS cHCC-CCAs categorized as LR-4/5 are mainly composed of HCC component, and cHCC-CCAs with an HCC component > 70% are associated with better OS than those with an HCC component ≤ 70%. These findings suggest that the proportion of HCC or CCA component can predict the prognosis of cHCC-CCA patients. KEY POINTS • cHCC-CCAs categorized as LR-4/5 are mainly composed of HCC component. • cHCC-CCAs with an HCC component > 70% are associated with better OS than those with an HCC component ≤ 70%.
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Affiliation(s)
- Changwu Zhou
- Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianling Qian
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China. .,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, China. .,Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China. .,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Guo HL, Lu XZ, Hu HT, Ruan SM, Zheng X, Xie XY, Lu MD, Kuang M, Shen SL, Chen LD, Wang W. Contrast-Enhanced Ultrasound-Based Nomogram: A Potential Predictor of Individually Postoperative Early Recurrence for Patients With Combined Hepatocellular-Cholangiocarcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1925-1938. [PMID: 34751450 DOI: 10.1002/jum.15869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
PURPOSES To evaluate the postsurgical prognostic implication of contrast-enhanced ultrasound (CEUS) for combined hepatocellular-cholangiocarcinoma (CHC). To build a CEUS-based early recurrence prediction classifier for CHC, in comparison with tumor-node-metastasis (TNM) staging. METHODS The CEUS features and clinicopathological findings of each case were analyzed, and the Liver Imaging Reporting and Data System categories were assigned. The recurrence-free survival associated factors were evaluated by Cox proportional hazard model. Incorporating the independent factors, nomograms were built to estimate the possibilities of 3-month, 6-month, and 1-year recurrence and whose prognostic value was determined by time-dependent receiver operating characteristics, calibration curves, and hazard layering efficiency validation, comparing with TNM staging system. RESULTS In the multivariable analysis, the levels of carbohydrate antigen 19-9, prothrombin time and total bilirubin, and tumor shape, the Liver Imaging Reporting and Data System category were independent factors for recurrence-free survival. The LR-M category showed longer recurrence-free survival than did the LR-4/5 category. The 3-month, 6-month, and 1-year area under the curves of the CEUS-clinical nomogram, clinical nomogram, and TNM staging system were 0.518, 0.552, and 0.843 versus 0.354, 0.240, and 0.624 (P = .048, .049, and .471) vs. 0.562, 0.545, and 0.843 (P = .630, .564, and .007), respectively. The calibration curves of the CEUS-clinical model at different prediction time pionts were all close to the ideal line. The CEUS-clinical model effectively stratified patients into groups of high and low risk of recurrence in both training and validation set, while the TNM staging system only works on the training set. CONCLUSIONS Our CEUS-clinical nomogram is a reliable early recurrence prediction tool for hepatocellular-cholangiocarcinoma and helps postoperative risk stratification.
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Affiliation(s)
- Huan-Ling Guo
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Zhou Lu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Zheng
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shun-Li Shen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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De Muzio F, Grassi F, Dell’Aversana F, Fusco R, Danti G, Flammia F, Chiti G, Valeri T, Agostini A, Palumbo P, Bruno F, Cutolo C, Grassi R, Simonetti I, Giovagnoni A, Miele V, Barile A, Granata V. A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12071655. [PMID: 35885561 PMCID: PMC9319674 DOI: 10.3390/diagnostics12071655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.
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Affiliation(s)
- Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Federica Dell’Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Ginevra Danti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Federica Flammia
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Giuditta Chiti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Tommaso Valeri
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Andrea Agostini
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Area of Cardiovascular and Interventional Imaging, Department of Diagnostic Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
| | - Andrea Giovagnoni
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Antonio Barile
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
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Liu X, Ni X, Li Y, Yang C, Wang Y, Ma C, Zhou C, Lu X. Diagnostic Performance of LI-RADS Version 2018 for Primary Liver Cancer in Patients With Liver Cirrhosis on Enhanced MRI. Front Oncol 2022; 12:934045. [PMID: 35847955 PMCID: PMC9284034 DOI: 10.3389/fonc.2022.934045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The study evaluated the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 for differentiating hepatocellular carcinoma (HCC) from primary liver cancer in patients with liver cirrhosis based on the updated 2019 WHO classification. Materials and Methods From 2016 to 2021, 300 patients with surgically confirmed primary liver cancer (PLC) and liver cirrhosis based on the updated 2019 WHO classification were eligible for this retrospective study (100 cases in each of three groups including HCC, ICC, and cHCC-CCA). Two radiologists were blinded to the final diagnosis and independently assigned an LI-RADS category to each liver nodule. The diagnostic performances of the LR-5 category (definitely HCC), and the LR-M category (probably or definitely malignant, but not specific for HCC) were calculated in overall and small observations (<20 mm). Comparisons between groups of categorical variables were performed by one-way analysis of variance and the Chi-squared or Fisher’s exact test. Results The mean age of 300 patients (226 men and 74 women) was 57.40 ± 11.05 years. The sensitivity and specificity of the LR-5 category for differentiating HCCs from other primary liver cancers were 81% (81 of 100) and 82% (164 of 200), respectively. The LR-M category had a sensitivity of 63% (126 of 200) for diagnosing non-HCCs (ICCs and cHCC-CCAs), with a specificity of 90% (90 of 100). The LR-5 category had a sensitivity of 82.5% (33 of 40) for diagnosing HCCs in small observations (<20 mm) with a specificity of 76.6% (59 of 77). On the contrary, LR-M demonstrated slightly higher specificity (93.8%) and sensitivity (73.8%) for diagnosing non-HCCs with tumor size <20 mm. Conclusion The LR-5 category as well as the LR-M category of Liver Imaging Reporting and Data System (LI-RADS) version 2018 can effectively distinguish hepatocellular carcinoma from other primary hepatic malignancies in patients with liver cirrhosis, especially for small observations (<20 mm).
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Affiliation(s)
- Xinai Liu
- Department of Magnetic Resonance Imaging (MRI), Henan Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Ni
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yubo Li
- Department of Magnetic Resonance Imaging (MRI), Henan Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunzheng Ma
- Department of Oncology, Henan Provincial Hospital of Traditional Chinese Medicine, Zhengzhou, China
- *Correspondence: Xin Lu, ; Changwu Zhou, ; Chunzheng Ma,
| | - Changwu Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xin Lu, ; Changwu Zhou, ; Chunzheng Ma,
| | - Xin Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xin Lu, ; Changwu Zhou, ; Chunzheng Ma,
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Yoon J, Park SH, Ahn SJ, Shim YS. Atypical Manifestation of Primary Hepatocellular Carcinoma and Hepatic Malignancy Mimicking Lesions. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:808-829. [PMID: 36238905 PMCID: PMC9514587 DOI: 10.3348/jksr.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.
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50
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Yang J, Jiang H, Xie K, Bashir MR, Wan H, Huang J, Qin Y, Chen J, Lu Q, Song B. Profiling hepatocellular carcinoma aggressiveness with contrast-enhanced ultrasound and gadoxetate disodium-enhanced MRI: an intra-individual comparative study based on the Liver Imaging Reporting and Data System. Eur J Radiol 2022; 154:110397. [PMID: 35696735 DOI: 10.1016/j.ejrad.2022.110397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 02/07/2023]
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