The value of MRI enhancement in the differential diagnosis of hepatocellular carcinoma and combined hepatocellular-cholangiocarinoma

Abstract Background Combined hepatocellular-cholangicarcinoma ( cHCC-CC) is a rare primary liver malignant tumor, the distinction between cHCC-CC and HCC before operation has important clinical significance for optimizing the treatment plan and predicting the prognosis of patients. This study intends to study the value of preoperative clinical date and enhanced MRI in the differential diagnosis of HCC and cHCC-CC and to obtain independent risk factors for predicting cHCC-CC. Methods The clinical and imaging data of 157 HCC and 59 cHCC-CC patients confirmed by pathology were collected, and the differences between the two groups of patients were compared by t test, chi-square test, and logistic regression analysis.Results CHCC-CC was more likely to show multiple lesions than HCC (28.81% Vs 10.83%，P=0.001) and more prone to microvascular invasion (MVI) (36.31%Vs 61.02%，P＜0.001). However, HCC had a higher incidence of liver cirrhosis than cHCC-CC (50.85% Vs72.61% ，P=0.003). The incidence of non-smooth margin was higher in cHCC-CC group (84.75% Vs52.23%，P＜0.001). The incidence of peritumor enhancement in arterial phase was higher in cHCC-CC group (11.46%Vs 62.71%，P＜0.001) Multivariate analysis showed that liver cirrhosis and arterial peritumor enhancement were independent risk factors for predicting cHCC-CC. In addition, the imaging sign of arterial phase peritumor enhancement had high sensitivity (62.71%) and specificity (88.54%) in the diagnosis of cHCC-CC.Conclusions Liver cirrhosis and the imaging findings of GD-DTPA-enhanced MRI are helpful for the differential diagnosis of HCC and cHCC-CC. In addition, the imaging sign of peritumoral enhancement in the arterial phase has high sensitivity and specificity for the diagnosis of cHCC-CC.