Comparative Accuracy of Qualitative and Quantitative Contrast-Enhanced CT Analysis in Differentiating Intrahepatic Mass-Forming Cholangiocarcinoma from Colorectal Liver Metastasis
Abstract
Objective: To compare the diagnostic performance of qualitative and quantitative computed tomography in differentiating intrahepatic mass-forming cholangiocarcinoma (IHMCC) from colorectal liver metastasis (CRLM).
Material and Methods: A retrospective study analyzed 79 patients (IHMCC n=41, CRLM n=38). Two abdominal radiologists separately reviewed the following parameters: size, location, number, margin, calcification, hepatic capsular retraction, peripheral bile duct dilatation, proximal bile duct enhancement, extrahepatic spreading, regional lymph node enlargement, vascular and adjacent organ invasion, arterial and delayed enhancement. For the quantitative study, regions of interest were placed on lesions and adjacent liver in the non-contrast, portovenous and delayed phases. The percentage attenuation ratio, absolute percentage delayed enhancement, and the enhancement ratio on the portal venous and delayed phases (ERPV and ERD) were calculated. Multivariate logistic regression was used to determine the significant factors.
Results: Ten qualitative features showed statistically significant differences. Satellite lesions (p-value<0.001), right hepatic lobe location (p-value=0.009), irregular margin (p-value=0.028), hepatic capsular retraction (p-value<0.001), peripheral bile duct dilatation (p-value<0.001), proximal bile duct enhancement (p-value=0.002), extrahepatic spreading (p-value=0.002), regional lymph node enlargement (p-value<0.001), vascular invasion (p-value<0.001), and adjacent organ invasion (p-value=0.01) were found more often in IHMCC versus CRLM. For quantitative analysis, size, ERPV, and ERD showed statistically significant differences (p-value=0.003 and p-value=0.001). Peripheral duct dilatation (OR 21.1,95% CI 5.07,77.7), regional node enlargement (OR 5.8, 95% CI 1.32, 26.085) and ERD (OR 4.4, 95% CI 1.02, 6.54) were significant predictors on multivariate analysis. From the ROC curve, an optimal cut-off of ERD was 0.79 (AUC0.704, 95% CI 0.59, 0.818).
Conclusion: Peripheral bile duct dilatation, regional lymph node enlargement, and ERD greater than 0.79 can be useful in differentiating IHMCC from CRLM.
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Banales JM, Marin JJG, Lamarca A, Rodrigues PM, Khan SA, Roberts LR, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol 2020;17:557–88.
Gopal P, Robert ME, Zhang X. Cholangiocarcinoma: pathologic and molecular classification in the era of precision medicine. Arch Pathol Lab Med 2023;148:359–70.
Florio AA, Ferlay J, Znaor A, Ruggieri D, Alvarez CS, Laversanne M, et al. Global trends in intrahepatic and extrahepatic cholangiocarcinoma incidence from 1993 to 2012. Cancer 2020;126:2666–78.
Kirstein MM, Vogel A. Epidemiology and risk factors of cholangiocarcinoma. Visc Med 2016;32:395–400.
Sripa B, Pairojkul C. Cholangiocarcinoma: lessons from Thailand. Curr Opin Gastroenterol 2008;24:349–56.
Chansitthichok S, Chamnan P, Sarkhampee P, Lertsawatvicha N, Voravisutthikul P, Wattanarath P. Survival of patients with cholangiocarcinoma receiving surgical treatment in an o. viverrini endemic area in Thailand: a retrospective cohort study. Asian Pac J Cancer Prev 2020;21:903–9.
Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, et al. Management of incidental liver lesions on CT: a white paper of the ACR incidental findings committee. J Am Coll Radiol 2017;14:1429–37.
Fábrega-Foster K, Ghasabeh MA, Pawlik TM, Kamel IR. Multimodality imaging of intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr 2017;6:67–78.
Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M. Imaging of Cholangiocarcinoma. Visc Med 2016;32:402–10.
Venkatesh SK, Chandan V, Roberts LR. Liver masses: a clinical, radiologic, and pathologic perspective. Clin Gastroenterol Hepatol 2014;12:1414–29.
Mendiratta-Lala M, Park H, Kolicaj N, Mendiratta V, Bassi D. Small intrahepatic peripheral cholangiocarcinomas as mimics of hepatocellular carcinoma in multiphasic CT. Abdom Radiol (NY) 2017;42:171–8.
Kow AWC. Hepatic metastasis from colorectal cancer. J Gastrointest Oncol 2019;10:1274–98.
Schima W, Kulinna C, Langenberger H, Ba-Ssalamah A. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging 2005;5:S149–56.
Valderrama-Treviño AI, Barrera-Mera B, Ceballos-Villalva JC, Montalvo-Javé EE. Hepatic Metastasis from Colorectal Cancer. Euroasian J Hepatogastroenterol 2017;7:166–75.
Apisarnthanarak P, Pansri C, Maungsomboon K, Thamtorawat S. The CT appearances for differentiating of peripheral, mass-forming cholangiocarcinoma and liver meatastases from colorectal adenocarcinoma. J Med Assoc Thai 2014;97:415–22.
Paulatto L, Dioguardi Burgio M, Sartoris R, Beaufrère A, Cauchy F, Paradis V, et al. Colorectal liver metastases: radiopathological correlation. Insights Imaging 2020;11:99.
Li S, Qian H, Peng Y, Jia H, Lin G. Differentiating peripheral cholangiocarcinoma in stages T1N0M0 and T2N0M0 from hepatic hypovascular nodules using dynamic contrast-enhanced MRI. Sci Rep 2017;7:8084.
King MJ, Hectors S, Lee KM, Omidele O, Babb JS, Schwartz M, et al. Outcomes assessment in intrahepatic cholangiocarcinoma using qualitative and quantitative imaging features. Cancer Imaging 2020;20:43.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74.
Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 1994;6:284–90.
Seo N, Kim DY, Choi JY. Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis. AJR Am J Roentgenol 2017;209:W64–75.22.
Chen Y, Pan Y, Shen KR, Zhu XL, Lu CY, Li QH, et al. Contrast-enhanced multiple-phase imaging features of intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma with cirrhosis: a comparative study. Oncol Lett 2017;14:4213–9.
Vijgen S, Terris B, Rubbia-Brandt L. Pathology of intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr 2017;6:22–34.
Chung YE, Kim MJ, Park YN, Choi JY, Pyo JY, Kim YC, et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 2009;29:683–700.
El-Diwany R, Pawlik TM, Ejaz A. Intrahepatic Cholangiocarcinoma. Surg Oncol Clin N Am 2019;28:587–99.
Kovač JD, Galun D, Đurić-Stefanović A, Lilić G, Vasin D, Lazić L, et al. Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible? Acta Radiol 2017;58:1417–26.
Shen K, Mo W, Wang X, Shi D, Qian W, Sun J, et al. A convenient scoring system to distinguish intrahepatic mass-forming cholangiocarcinoma from solitary colorectal liver metastasis based on magnetic resonance imaging features. Eur Radiol 2023;33:8986–98.
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