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Background <p>The precise impact of LI-RADS-defined risk factors on the diagnosis and prognosis of intrahepatic cholangiocarcinoma (iCCA) remains unclear.</p> Objective <p>To assess the value of LI-RADS categories and features for iCCA diagnosis, focusing on the diagnostic and prognostic implications of LI-RADS-defined risk factors.</p> Methods <p>Totally 214 high risk patients, including 107 surgically-confirmed solitary iCCAs and 107 hepatocellular carcinomas (HCC) from two centers were retrospectively enrolled. Clinical and MRI features based on LI-RADS v2018 were compared, and the performance of targetoid features for discriminating iCCA was evaluated. Recurrence-free survival (RFS) was compared across different pathologic diagnoses and LI-RADS categories. Multivariate Cox analysis was performed to identify the independent risk factors for RFS.</p> Results <p>In the LI-RADS defined high-risk patients, iCCAs differed from HCCs in MRI manifestation. The LR-M category enabled the accurate classification of most iCCAs (89/107, 83.2%), achieving high sensitivity (83.2%), specificity (85.1%), and accuracy (84.1%). The optimal diagnostic performance for iCCA was achieved when at least one targetoid appearance was required for LR-M categorization (AUC = 0.828). Although 26.2% iCCAs presented at least one major feature and 15.0% iCCAs were miscategorized as probably or definitely HCC, only one iCCA case was categorized as LR-5. RFS varied according to both pathologic diagnosis (<i>P</i> = 0.030) and LI-RADS category (<i>P</i> = 0.028), with LI-RADS category demonstrating an independent association with RFS (HR = 1.736, <i>P</i> = 0.033).</p> Conclusions <p>In high-risk patients, iCCAs frequently exhibit HCC major features, leading to miscategorization as probable HCC. However, the LR-5 category remains highly specific for ruling out iCCA. Furthermore, in high-risk patients with solitary resected iCCA or HCC, LI-RADS category enables the prediction of postsurgical prognosis independently from pathological diagnosis.</p>

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Assessment of intrahepatic cholangiocarcinoma with LI-RADS in the high-risk population: MRI diagnosis and postoperative survival

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月26日

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  • Ruofan Sheng,
  • Beixuan Zheng,
  • Yunfei Zhang,
  • Chun Yang,
  • Dong Wu,
  • Jianjun Zhou,
  • Mengsu Zeng

摘要

Background

The precise impact of LI-RADS-defined risk factors on the diagnosis and prognosis of intrahepatic cholangiocarcinoma (iCCA) remains unclear.

Objective

To assess the value of LI-RADS categories and features for iCCA diagnosis, focusing on the diagnostic and prognostic implications of LI-RADS-defined risk factors.

Methods

Totally 214 high risk patients, including 107 surgically-confirmed solitary iCCAs and 107 hepatocellular carcinomas (HCC) from two centers were retrospectively enrolled. Clinical and MRI features based on LI-RADS v2018 were compared, and the performance of targetoid features for discriminating iCCA was evaluated. Recurrence-free survival (RFS) was compared across different pathologic diagnoses and LI-RADS categories. Multivariate Cox analysis was performed to identify the independent risk factors for RFS.

Results

In the LI-RADS defined high-risk patients, iCCAs differed from HCCs in MRI manifestation. The LR-M category enabled the accurate classification of most iCCAs (89/107, 83.2%), achieving high sensitivity (83.2%), specificity (85.1%), and accuracy (84.1%). The optimal diagnostic performance for iCCA was achieved when at least one targetoid appearance was required for LR-M categorization (AUC = 0.828). Although 26.2% iCCAs presented at least one major feature and 15.0% iCCAs were miscategorized as probably or definitely HCC, only one iCCA case was categorized as LR-5. RFS varied according to both pathologic diagnosis (P = 0.030) and LI-RADS category (P = 0.028), with LI-RADS category demonstrating an independent association with RFS (HR = 1.736, P = 0.033).

Conclusions

In high-risk patients, iCCAs frequently exhibit HCC major features, leading to miscategorization as probable HCC. However, the LR-5 category remains highly specific for ruling out iCCA. Furthermore, in high-risk patients with solitary resected iCCA or HCC, LI-RADS category enables the prediction of postsurgical prognosis independently from pathological diagnosis.