Introduction: Small duct (SD) and large duct (LD) subtypes of cholangiocarcinoma have been investigated for their prognostic factors. This study aimed to evaluate the diagnostic value of liver magnetic resonance imaging (MRI) in differentiating SD- and LD-types of intrahepatic cholangiocarcinoma (iCCA) and its prognostic value in predicting survival outcomes. Methods: One-hundred forty patients with surgically confirmed iCCAs (93 SD-type and 47 LD-type) who had available preoperative gadoxetic acid-enhanced liver MR images were retrospectively included. MRI features suggestive of LD-type over SD-type were analyzed using multivariate logistic analyses. Postoperative recurrence-free survival (RFS) and overall survival (OS) for 107 patients with available survival data were compared according to MRI features. Results: MRI features suggestive of LD-type included infiltrative contour (odds ratio [OR] 14.2, 95% confidence interval [CI]: 2.5 – 81.7, p = 0.003), diffuse biliary dilatation (OR 9.7, 95% CI: 1.2 – 76.9, p = 0.032), no arterial phase hyperenhancement (OR 17.8, 95% CI: 2.7 – 118.6, p = 0.003), and vascular invasion (OR 4.5, 95% CI: 1.3 – 15.4, p = 0.018). When two or more features were combined, sensitivity was 59.6% (28/47) and specificity was 95.7% (89/93) in discriminating the LD-type. RFS/OS was significantly shorter in patients with two or more MRI features, compared to those with none or one (310 days versus 529 days, p = 0.011/964 days versus 2023 days, p=0.010). Conclusions: Preoperative liver MRI may help predict the pathologic subtype of iCCAs as either the SD-type or LD-type, allowing preoperative identification of patients with poorer survival outcomes.


中文翻译：

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利用肝脏磁共振成像特征对肝内胆管癌进行亚型分类及其预后价值

简介：已研究了胆管癌的小导管 (SD) 和大导管 (LD) 亚型的预后因素。本研究旨在评估肝脏磁共振成像 (MRI) 在区分肝内胆管癌 (iCCA) 的 SD 型和 LD 型中的诊断价值及其在预测生存结果中的预后价值。方法：回顾性纳入 140 例手术确诊 iCCA（93 例 SD 型和 47 例 LD 型）且术前可获得钆塞酸增强肝脏 MR 图像的患者。使用多变量逻辑分析分析提示 LD 型优于 SD 型的 MRI 特征。根据 MRI 特征比较了 107 名具有可用生存数据的患者的术后无复发生存期 (RFS) 和总生存期 (OS)。结果：提示 LD 型的 MRI 特征包括浸润轮廓（优势比 [OR] 14.2，95% 置信区间 [CI]：2.5 – 81.7，p = 0.003），弥漫性胆道扩张（OR 9.7，95% CI：1.2 – 76.9， p = 0.032），无动脉期高强化（OR 17.8, 95% CI: 2.7 – 118.6, p = 0.003）和血管侵犯（OR 4.5, 95% CI: 1.3 – 15.4, p = 0.018）。当结合两个或多个特征时，区分 LD 类型的敏感性为 59.6% (28/47)，特异性为 95.7% (89/93)。与没有或没有一项的患者相比，具有两项或多项 MRI 特征的患者的 RFS/OS 显着缩短（310 天对 529 天，p = 0.011/964 天对 2023 天，p=0.010）。结论：术前肝脏 MRI 可能有助于预测 iCCA 的病理亚型为 SD 型或 LD 型，