Objective: To investigate the prognostic value of enhancement patterns of intrahepatic mass-forming cholangiocarcinomas (IMCCs) during the hepatobiliary phase (HBP) in gadoxetic acid (Gd-EOB)-enhanced MRI. Methods: We retrospectively identified 66 consecutive patients with histopathologically proven IMCCs (reference standard: resection) and preoperative Gd-EOB-enhanced MRI. Gd-EOB retention area was subjectively rated based on areas of intermediate signal intensity. Lesions were classified as either hypointense (0–25% retention area) or significantly-retaining (>25% retention area). Clinical, radiological, and prognostic features were compared between these groups. The primary endpoints were recurrence-free survival (RFS) and overall survival (OS) after primary surgical resection. Results: 73% (48/66) of lesions were rated as hypointense and 29% (19/66) as significantly-retaining. While the hypointense subgroup more frequently featured local and distant intrahepatic metastases (p= 0.039 andp= 0.022) and an infiltrative growth pattern (p= 0.005), RFS, OS, and clinical features did not differ significantly with estimated Gd-EOB retention area or quantitatively measured HBP enhancement ratios. Lymph node metastasis was an independent predictor of poor RFS (p= 0.001). Conclusions: Gd-EOB-enhanced MRI revealed two subtypes of IMCC in the HBP: hypointense and signal-retaining. The hypointense subtype is associated with more frequent intrahepatic metastases and an infiltrative growth pattern, indicating potential tumor aggressiveness. However, this did not result in a significant difference in survival after the primary resection of IMCC.
目的：探讨钆塞酸二钠（Gd-EOB）增强磁共振成像肝胆期（HBP）中肝内肿块型胆管癌（IMCC）强化模式的预后价值。方法：回顾性纳入66例经组织病理学证实（金标准：手术切除）且术前接受Gd-EOB增强MRI检查的连续IMCC患者。基于中等信号强度区域主观评估Gd-EOB滞留区域，将病灶分为低信号型（滞留区域0–25%）与显著滞留型（滞留区域>25%）。比较两组患者的临床、影像学及预后特征。主要终点指标为首次手术切除后的无复发生存期（RFS）与总生存期（OS）。结果：73%（48/66）的病灶被评估为低信号型，29%（19/66）为显著滞留型。低信号亚组更常出现局部及远处肝内转移（p=0.039和p=0.022）以及浸润性生长模式（p=0.005），但RFS、OS及临床特征与估计的Gd-EOB滞留区域或定量测量的HBP强化比值均无显著差异。淋巴结转移是RFS不良的独立预测因素（p=0.001）。结论：Gd-EOB增强MRI在HBP期揭示了IMCC的两种亚型：低信号型与信号滞留型。低信号亚型与更频繁的肝内转移及浸润性生长模式相关，提示潜在的肿瘤侵袭性，但这并未导致IMCC首次切除后的生存率存在显著差异。
肿瘤(癌症)患者之家