Abstract
We aim to gain further insight into identifying differential perfusion parameters and corresponding histogram parameters of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinomas (HCCs) on triphasic computed tomography (CT) scans. 90 patients with pathologically confirmed HCCs (n = 54) and IMCCs (n = 36) who underwent triple-phase enhanced CT imaging were included. Quantitative analysis of CT images derived from triphasic CT scans were evaluated to generate liver perfusion and histogram parameters. The differential performances, including the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity were assessed. The mean value, and all thepercentiles of the arterial enhancement fraction (AEF) were significantly higher in HCCs than in IMCCs. The difference in hepatic arterial blood supply perfusion (HAP) and AEF (ΔHAP = HAPtumor − HAPliver, ΔAEF = AEFtumor − AEFliver) for the mean perfusion parameters and all percentile parameters between tumor and peripheral normal liver were significantly higher in HCCs than in IMCCs. The relative AEF (rAEF = ΔAEF/AEFliver), including the mean value and all corresponding percentile parameters were statistically significant between HCCs and IMCCs. The 10th percentiles of the ΔAEF and rAEF had the highest AUC of 0.788 for differentiating IMCC from HCC, with sensitivities and specificities of 87.0%, 83.3%, and 61.8%, 64.7%, respectively. Among all parameters, the mean value of ∆AEF, the 75th percentiles of ∆AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivities of 94.4%, while the 50th percentile of rAEF had the highest specificity of 82.4%. AEF (including ΔAEF and rAEF) and the corresponding histogram parameters derived from triphasic CT scans provided useful value and facilitated the accurate discrimination between IMCCs and HCCs.
Highlights
Intrahepatic cholangiocarcinoma (ICC), originating from the epithelial cells of the bile duct, is the second most common primary cancer of the liver after hepatocellular carcinoma (HCC), and its incidence and mortality have been increasing in recent decades[1,2]
36 patients diagnosed with intrahepatic mass-forming cholangiocarcinoma (IMCC) and 54 patients diagnosed with HCCs were included
There was no significant difference in the age, sex, or tumor size between HCC and IMCC patients
Summary
Intrahepatic cholangiocarcinoma (ICC), originating from the epithelial cells of the bile duct, is the second most common primary cancer of the liver after hepatocellular carcinoma (HCC), and its incidence and mortality have been increasing in recent decades[1,2]. HCC typically shows intense hyper enhancement on the arterial phase, followed by washout during dynamic imaging. IMCC in cirrhotic patients may be hypervascular on the arterial phase images due to the increasing density of the arteries and microvessels in cirrhosis and precirrhotic liver, exhibiting overlapping phenotypes with the appearance of typical H CC15,16. For patients with hepatic tumors, accurate evaluation of the hemodynamic blood status, especially in the area of hepatic perfusion, could provide vital information for prognosis assessments and appropriate clinical treatment options. The proportion of hepatic artery and portal vein blood supply varies according to the pathological changes of the liver. Liver cancers differ in their type of vascularization[18] and in principle, HCC is hyper-vascular and initially vascularized by the hepatic artery. IMCC contains a large amount of fibrous stroma, less blood supply, and a slower clearance rate of contrast agents than HCC
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