Objective This study aimed to evaluate the predictive value of quantitative gadobenate dimeglumine-enhanced MRI parameters in aggressiveness and prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). Materials and methods A total of 158 patients with IMCC who underwent preoperative MRI at three centers were included, and their clinical and imaging data were analyzed retrospectively. Multimodal quantitative parameters were measured in various tumor areas, including relative intensity ratio (RIR) and relative enhancement ratio (RER) of the central and rim areas of the tumor to the liver in the hepatobiliary phase, and the center area-tumor volume ratio. Patients were classified into low-aggressiveness (Ki-67 LI < 25%) and high-aggressiveness (Ki-67 LI ≥ 25%) groups based on the Ki-67 labeling index (LI). Potential risk factors of aggressiveness were determined using multivariate logistic regression analysis. The prediction efficacy of factors was assessed using receiver operating characteristic (ROC) curves. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Cox proportional-hazards regression model. Results The volume ratio (VR) and RIRrim were independent risk factors for aggressiveness (p < 0.05). The area under the ROC curve was 0.803 [95% confidence interval (CI), 0.728–0.878] and 0.799 (95% CI, 0.727–0.872), both higher than that of CA19-9 ≥ 34 U/mL and intratumoral necrosis (all, p < 0.05). VR and RIRrim were identified as independent predictors of OS and DFS in patients with IMCC (p < 0.05). Conclusion The multimodal quantitative MRI parameters, VR and RIRrim, were effective risk factors for predicting both aggressiveness and prognoses in patients with IMCC. Critical relevance statement Noninvasive MRI hepatobiliary-phase quantification stratified aggressiveness and prognosis in intrahepatic mass-forming cholangiocarcinoma. It might provide important clinical information for treatment strategies. Key Points <UnorderedList Mark="Bullet"> <ItemContent> The volume ratio (VR), relative intensity ratio (RIRrim), CA19-9 ≥ 34 U/mL, and necrosis were independent predictors of high aggressiveness. </ItemContent> <ItemContent> The VR, RIRrim, CA19-9 ≥ 34 U/mL, and tumor boundary were independent predictors of poorer overall survival. </ItemContent> <ItemContent> The VR, RIRrim, CA19-9 ≥ 34 U/mL, tumor boundary, and tumor maximum size ≥ 3 cm were independent predictors of shorter disease-free survival. </ItemContent> </UnorderedList> Graphical Abstract

The value of gadobenate dimeglumine-enhanced MRI quantification in predicting aggressiveness and prognosis of typical intrahepatic mass-forming cholangiocarcinoma: a multicenter retrospective study

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2026年3月3日

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Shuo Zhang,
Bing Kang,
Chenyang Qiu,
Kai Deng,
Haitao Sun,
Yicong Nie,
Ximing Wang,
Cong Sun

摘要

Objective

This study aimed to evaluate the predictive value of quantitative gadobenate dimeglumine-enhanced MRI parameters in aggressiveness and prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).

Materials and methods

A total of 158 patients with IMCC who underwent preoperative MRI at three centers were included, and their clinical and imaging data were analyzed retrospectively. Multimodal quantitative parameters were measured in various tumor areas, including relative intensity ratio (RIR) and relative enhancement ratio (RER) of the central and rim areas of the tumor to the liver in the hepatobiliary phase, and the center area-tumor volume ratio. Patients were classified into low-aggressiveness (Ki-67 LI < 25%) and high-aggressiveness (Ki-67 LI ≥ 25%) groups based on the Ki-67 labeling index (LI). Potential risk factors of aggressiveness were determined using multivariate logistic regression analysis. The prediction efficacy of factors was assessed using receiver operating characteristic (ROC) curves. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Cox proportional-hazards regression model.

Results

The volume ratio (VR) and RIR_rim were independent risk factors for aggressiveness (p < 0.05). The area under the ROC curve was 0.803 [95% confidence interval (CI), 0.728–0.878] and 0.799 (95% CI, 0.727–0.872), both higher than that of CA19-9 ≥ 34 U/mL and intratumoral necrosis (all, p < 0.05). VR and RIR_rim were identified as independent predictors of OS and DFS in patients with IMCC (p < 0.05).

Conclusion

The multimodal quantitative MRI parameters, VR and RIR_rim, were effective risk factors for predicting both aggressiveness and prognoses in patients with IMCC.

Critical relevance statement

Noninvasive MRI hepatobiliary-phase quantification stratified aggressiveness and prognosis in intrahepatic mass-forming cholangiocarcinoma. It might provide important clinical information for treatment strategies.

Key Points

The volume ratio (VR), relative intensity ratio (RIR_rim), CA19-9 ≥ 34 U/mL, and necrosis were independent predictors of high aggressiveness.

The VR, RIR_rim, CA19-9 ≥ 34 U/mL, and tumor boundary were independent predictors of poorer overall survival.

The VR, RIR_rim, CA19-9 ≥ 34 U/mL, tumor boundary, and tumor maximum size ≥ 3 cm were independent predictors of shorter disease-free survival.

Graphical Abstract