Abstract
BackgroundThe presence of microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICC) is a significant adverse prognostic factor. This study sought to investigate the correlation between preoperative imaging parameters and MVI in ICC.MethodsA total of 108 patients with surgically resected single ICC tumors (34 MVI-positive and 74 MVI-negative lesions) who underwent MRI examination, including T1WI, T2WI, DWI, and dynamic enhancement imaging, were enrolled in this retrospective study. The following qualitative and quantitative characteristics were evaluated: tumor morphology, signal features on T1WI and T2WI, intrahepatic duct dilatation, hepatic capsule retraction, target sign on DWI, dynamic enhancement pattern, arterial phase enhancement pattern, dot−/band-like enhancement inside the tumor, visible vessel penetration inside the tumor (hepatic artery, portal vein, or hepatic vein), integrity of the enhancement edge of the arterial phase, peripheral hepatic enhancement, tumor size, maximum enhancement edge thickness, arterial edge enhancement ratio, and delayed phase enhancement ratio. Other clinicopathological features were also used to predict and evaluate MVI in ICC. Chi-square test, Fisher’s exact test, and independent t-test were used for univariate analysis to determine the relationships among the presence of MVI and these MR parameters. Logistic regression analysis was used to identify predictors of MVI among these MR parameters.ResultsAmong MRI characteristics, tumor morphology, intrahepatic duct dilatation, arterial phase enhancement pattern, visible hepatic artery penetration sign, maximum diameter of the tumor and the arterial phase edge enhancement ratio were correlated with MVI (P = 0.007, 0.003, 0.008, 0.000, 0.003, and 0.002, respectively). Furthermore, higher CA19–9 levels (≥37 U/ml) and pathological tumor grade III were also related to MVI (P = 0.014 and 0.004, respectively). However, multivariate logistic regression analysis demonstrated that none of the parameters were independent risk factors for the diagnosis of MVI in ICCs.ConclusionFor the preoperative prediction of MVI in ICC, six qualitative and quantitative data obtained on preoperative MRI, as well as one tumorigenic marker and the pathological tumor grade, were statistically significant. More research is needed to identify MR characteristics that can be used as independent risk factors.
Highlights
Intrahepatic cholangiocarcinoma (ICC), the second most common primary malignancy of the liver, is a subtype of cholangiocarcinoma that originates from the epitheliocytes of bile ductules [1]
Compared with previous studies, which focused on the measurement of diffusionweighted imaging (DWI) and ADC quantitative values by one magnetic resonance (MR) model, our research focuses on morphological data and a small amount of quantitative data from six different MR models in order to determine whether a correlation exists between MR imaging features and microvascular invasion (MVI)
The results of our study indicate that six MR characteristics—four qualitative features and two quantitative parameters—are associated with MVI of intrahepatic cholangiocarcinoma (ICC)
Summary
Intrahepatic cholangiocarcinoma (ICC), the second most common primary malignancy of the liver, is a subtype of cholangiocarcinoma that originates from the epitheliocytes of bile ductules [1]. ICC accounts for 20–25% of all cholangiocarcinomas and 10–15% of all primary hepatic malignancies, and its incidence is rising worldwide [2,3,4]. Research has revealed that microvascular invasion (MVI), tumor size, tumor grade, multiple tumors and lymph node positivity are associated with postoperative survival in patients with ICC [10]. As a single-center study, the primary objective of this study was to retrospectively analyze the clinicopathologic features and preoperative magnetic resonance (MR) imaging findings of 108 ICC patients undergoing primary surgery for a single tumor with the hope of discovering new MR imaging indicators for the preoperative prediction of MVI in ICC. This study is focused on mass-forming ICCs. The presence of microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICC) is a significant adverse prognostic factor. This study sought to investigate the correlation between preoperative imaging parameters and MVI in ICC
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