Abstract
ObjectivesThere are still challenging problems in diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before operation. This study aimed to analyze the imaging features of HCC with B1–B3 BDTT.Materials and MethodsThe clinicopathological data and imaging findings of 30 HCC patients with B1–B3 BDTT from three high-volume institutions were retrospectively reviewed. A total of 631 patients without BDTT who were randomly collected from each of the enrolled centers were recorded as the control group to analyze the differences in clinicopathological characteristics and imaging features between the two groups. A total of 453 HCC patients who underwent surgical treatment in the three institutions from January 2020 to December 2020 were collected for a blinded reading test as the validation group.ResultsHCC patients with B1–B3 BDTT had more advanced tumor stages and adverse clinicopathological features. HCC lesions were detected in all patients, and intrahepatic bile duct dilation was observed in 28 (93.3%) patients with B1–B3 BDTT and 9 (1.43%) patients in HCC without BDTT. The intrahepatic bile duct dilation showed no enhancement at hepatic arterial phase (HAP) and no progressively delayed enhancement at portal venous phase (PVP), but it was more obvious at PVP on CT. In the reports of the 30 HCC patients with B1–B3 BDTT generated for the image when the scan was done, BDTT was observed in all 13 B3 patients and 3 of 12 B2 patients, but none of the 5 B1 patients. Fourteen patients were misdiagnosed before surgery. However, when using intrahepatic bile duct dilation in HCC patients as a potential biomarker for BDTT diagnosis, the sensitivity and specificity for BDTT diagnosis were 93.33% and 98.57%, respectively. The blinded reading test showed that intrahepatic bile duct dilation in CT and MRI scans could be for separating HCC patients with B1–B3 BDTT from HCC patients without BDTT.ConclusionsThe HCC lesions and intrahepatic bile duct dilation on CT or MRI scans are imaging features of HCC with BDTT, which might facilitate the early diagnosis of B1–B3 BDTT.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide [1]
The incidence of HCC with bile duct tumor thrombus (BDTT) was 3.3% (112/ 3,371), and B1–B3 BDTT accounted for 26.8% (30/112)
When using intrahepatic bile duct dilation in HCC patients as a potential biomarker for BDTT diagnosis by blinded radiologists in all 453 HCC patients (Figure 2B), 14 patients were classified as HCC with BDTT (7 as B1–B3 and 7 as B4, respectively)
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide [1]. HCC with bile duct tumor thrombus (BDTT) is uncommon, with an incidence between 0.53% and 12.9% [2,3,4,5]. Previous studies have attempted to explore the clinicopathological characteristics and surgical treatment of HCC with BDTT [6,7,8,9,10]. Hepatectomy is generally considered the preferred treatment for HCC with BDTT. Accurate diagnosis and surgical treatment are important to improve survival. Both computed tomography (CT) and magnetic resonance imaging (MRI) have diagnostic value for HCC with BDTT. There remain challenges in the diagnosis of HCC with BDTT before operation. Several reports focusing on the CT or MRI features of HCC with B4 BDTT have been described [12,13,14,15,16,17]
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