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Diagnostic Image Feature and Performance of CT and Gadoxetic Acid Disodium-Enhanced MRI in Distinction of Combined Hepatocellular-Cholangiocarcinoma from Hepatocellular Carcinoma

 Hyunghu Kim  ;  Seung-seob Kim  ;  Sunyoung Lee  ;  Myeongjee Lee  ;  Myeong-Jin Kim 
 Investigative Magnetic Resonance Imaging, Vol.25(4) : 313-322, 2021-12 
Journal Title
Investigative Magnetic Resonance Imaging
Issue Date
Liver neoplasms ; Combined hepatocellular-cholangiocarcinoma ; Differential diagnosis ; Sensitivity and specificity ; Contrast media
Purpose: To find diagnostic image features, to compare diagnostic performance of
multiphase CT versus gadoxetic acid disodium-enhanced MRI (GAD-MRI), and to
evaluate the impact of analyzing Liver Imaging Reporting and Data System (LI-RADS)
imaging features, for distinguishing combined hepatocellular-cholangiocarcinoma
(CHC) from hepatocellular carcinoma (HCC).
Materials and Methods: Ninety-six patients with pathologically proven CHC (n =
48) or HCC (n = 48), diagnosed June 2008 to May 2018 were retrospectively analyzed
in random order by three radiologists with different experience levels. In the first
analysis, the readers independently determined the probability of CHC based on their
own knowledge and experiences. In the second analysis, they evaluated imaging
features defined in LI-RADS 2018. Area under the curve (AUC) values for CHC
diagnosis were compared between CT and MRI, and between the first and second
analyses. Interobserver agreement was assessed using Cohen’s weighted κ values.
Results: Targetoid LR-M image features showed better specificities and
positive predictive values (PPV) than the others. Among them, rim arterial phase
hyperenhancement had the highest specificity and PPV. Average sensitivity, specificity,
and AUC values were higher for MRI than for CT in both the first (P = 0.008, 0.005, 0.002,
respectively) and second (P = 0.017, 0.026, 0.036) analyses. Interobserver agreements
were higher for MRI in both analyses (κ = 0.307 for CT, κ = 0.332 for MRI in the first
analysis; κ = 0.467 for CT, κ = 0.531 for MRI in the second analysis), with greater
agreement in the second analysis for both CT (P = 0.001) and MRI (P < 0.001).
Conclusion: Rim arterial phase hyperenhancement on GAD-MRI can be a good
indicator suggesting CHC more than HCC. GAD-MRI may provide greater accuracy
than CT for distinguishing CHC from HCC. Interobserver agreement can be improved
for both CT and MRI by analyzing LI-RADS imaging features
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Lee, Myeongjee(이명지)
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
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