Kai-Pu Jin1,2,3, Rou-Fan Sheng1,2,3, Chun Yang4,5,6, Meng-Su Zeng7,8,9. 1. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China. 2. Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China. 3. Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China. 4. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China. yang.chun1@zs-hospital.sh.cn. 5. Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China. yang.chun1@zs-hospital.sh.cn. 6. Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China. yang.chun1@zs-hospital.sh.cn. 7. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China. zengmengsu@outlook.com. 8. Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China. zengmengsu@outlook.com. 9. Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China. zengmengsu@outlook.com.
Abstract
OBJECTIVES: This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). METHODS: From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. RESULTS: Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors. CONCLUSIONS: The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.
OBJECTIVES: This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). METHODS: From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. RESULTS: Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors. CONCLUSIONS: The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.
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