European radiology · 2026
Differentiating scirrhous hepatocellular carcinoma from intrahepatic mass-forming cholangiocarcinoma based on Gd-EOB-DTPA-enhanced MRI and serum biomarkers in an HBV-positive high-risk cohort: a multi-center study.
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He Haoran, Qiu Leixin, Song Mingyue, Tao Yuhao, Zhang Hanjun, Hu Xin, Du Mingzhan, Guo Lingchuan, Hu Chunhong, Shen Jingxian, Zhang Weiguo
Аннотация
PURPOSE: This study aimed to differentiate scirrhous hepatocellular carcinoma (SHCC) from intrahepatic mass-forming cholangiocarcinoma (IMCC) in HBV-infected patients using Gd-EOB-DTPA-enhanced MR imaging features combined with clinical variables.
MATERIALS AND METHODS: Sixty-three pathologically confirmed SHCC and 120 IMCC were analyzed retrospectively in HBV-infected patients admitted to three centers (118 patients from Center 1 for training and 65 patients from the other two centers for external validation). Clinicopathological characteristics and Gd-EOB-DTPA-enhanced MR imaging features were evaluated. Independent diagnostic factors for SHCC were identified using multivariate logistic regression. A preoperative diagnostic model combining these features with clinical variables was constructed, and its performance was assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).
RESULTS: Compared to IMCC, SHCC demonstrated a significantly lower incidence of necrosis (training: p = 0.03; validation: p = 0.002). A multivariable diagnostic model incorporating non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging, and relevant serum biomarkers achieved an area under the curve (AUC) of 0.951 (sensitivity 85.9%, specificity 88.4%). External validation yielded an AUC of 0.939 (sensitivity 85.0%, specificity 88.9%). DCA further confirmed its clinical utility, demonstrating positive net benefit across a range of threshold probabilities.
CONCLUSION: Non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging on Gd-EOB-DTPA-enhanced MRI, combined with related serum biomarkers, may differentiate SHCC from IMCC in HBV-infected patients with high accuracy.
KEY POINTS: Question A reliable diagnostic approach that integrates Gd-EOB-DTPA-enhanced MRI features with serum biomarkers for differentiating SHCC from IMCC in HBV-infected patients has not been clearly defined. Findings A model integrating non-thin rim enhancement, enhancing capsule, opposed-phase signal loss, and related serum biomarkers effectively differentiated SHCC from IMCC in HBV-infected patients. Clinical relevance This study provides clinicians with a high-accuracy diagnostic model for differentiating SHCC from IMCC in the specific high-risk cohort, which may facilitate the development of personalized treatment plans and improvement of prognosis.
MATERIALS AND METHODS: Sixty-three pathologically confirmed SHCC and 120 IMCC were analyzed retrospectively in HBV-infected patients admitted to three centers (118 patients from Center 1 for training and 65 patients from the other two centers for external validation). Clinicopathological characteristics and Gd-EOB-DTPA-enhanced MR imaging features were evaluated. Independent diagnostic factors for SHCC were identified using multivariate logistic regression. A preoperative diagnostic model combining these features with clinical variables was constructed, and its performance was assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).
RESULTS: Compared to IMCC, SHCC demonstrated a significantly lower incidence of necrosis (training: p = 0.03; validation: p = 0.002). A multivariable diagnostic model incorporating non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging, and relevant serum biomarkers achieved an area under the curve (AUC) of 0.951 (sensitivity 85.9%, specificity 88.4%). External validation yielded an AUC of 0.939 (sensitivity 85.0%, specificity 88.9%). DCA further confirmed its clinical utility, demonstrating positive net benefit across a range of threshold probabilities.
CONCLUSION: Non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging on Gd-EOB-DTPA-enhanced MRI, combined with related serum biomarkers, may differentiate SHCC from IMCC in HBV-infected patients with high accuracy.
KEY POINTS: Question A reliable diagnostic approach that integrates Gd-EOB-DTPA-enhanced MRI features with serum biomarkers for differentiating SHCC from IMCC in HBV-infected patients has not been clearly defined. Findings A model integrating non-thin rim enhancement, enhancing capsule, opposed-phase signal loss, and related serum biomarkers effectively differentiated SHCC from IMCC in HBV-infected patients. Clinical relevance This study provides clinicians with a high-accuracy diagnostic model for differentiating SHCC from IMCC in the specific high-risk cohort, which may facilitate the development of personalized treatment plans and improvement of prognosis.