Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker.
Purpose To assess the value of diffusion-weighted (DW) imaging as a prognostic marker in preoperative evaluation of patients with mass-forming intrahepatic cholangiocarcinoma (ICC). Materials and Methods This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 91 patients who underwent hepatic resection and DW imaging for mass-forming ICC were included. Two radiologists evaluated the degree of diffusion restriction of the tumors by using qualitative (visual) interpretation combined with quantitative analysis by volumetric evaluation of the whole tumor on DW images. Patients were classified into two groups: those in whom less than one-third of the tumor showed diffusion restriction (group 1) and those in whom more than one-third of the tumor showed diffusion restriction (group 2). Imaging findings in tumors were compared with pathology findings. Disease-free and overall survival rates were compared between the two groups by using the Kaplan-Meier method with the log-rank test. Results There were 43 patients in group 1 and 48 patients in group 2. The 1- and 3-year disease-free survival rates were 30% and 16%, respectively, in group 1 and 75% and 64%, respectively, in group 2 (P < .001). The 1- and 3-year overall survival rates were 77% and 26%, respectively, in group 1 and 92% and 67%, respectively, in group 2 (P = .001). Multivariate analysis revealed that diffusion restriction (P = .024), differentiation (P = .030), and intrahepatic metastasis (P = .001) were independent prognostic factors for overall survival. Conclusion The degree of diffusion restriction on DW images may be a prognostic marker in preoperative evaluation of patients with mass-forming ICC. (©) RSNA, 2016 Online supplemental material is available for this article.
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Jisun
J
Lee
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Seong Hyun
SH
Kim
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Tae Wook
TW
Kang
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Kyoung Doo
KD
Song
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Dongil
D
Choi
From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea.
Kee Taek
KT
Jang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome