ArticleEuropean radiology2026
Differentiating combined hepatocellular-cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma with MRI and tumor markers: a multi-center study.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo establish a diagnostic regimen based on gadoxetate acid disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) integrated with tumor markers in differentiating combined hepatocellular-cholangiocarcinoma (cHCC-CCA) from mass-forming intrahepatic cholangiocarcinoma (iCCA) in high-risk patients. MATERIALS AND
methodsThis multi-center study enrolled 137 patients with pathologically proven cHCC-CCAs (n = 52) and iCCAs (n = 85) who underwent Gd-EOB-DTPA enhanced MRI. The differences in clinical data and imaging features between cHCC-CCA and iCCA were compared. The diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, and the area under the ROC curve (AUC) of all independent predictors was calculated and compared.
resultsUnivariate and multivariable regression analysis revealed that progressive enhancement (OR = 0.283, p = 0.013), targetoid appearance on HBP (OR = 0.196, p = 0.001), and targetoid diffusion restriction (OR = 0.157, p < 0.001) were independent predictors of iCCA. However, only elevated alpha-fetoprotein (AFP) (> 100 ng/mL) (OR = 3.416, p = 0.012) was an independent predictor of cHCC-CCA. Moreover, elevated AFP (> 100 ng/mL) with progressive enhancement (Z = 2.343, p = 0.019), elevated AFP (> 100 ng/mL) with targetoid appearance on HBP (Z = 2.402, p = 0.016), and elevated AFP (> 100 ng/mL) with targetoid diffusion restriction (Z = 3.196, p = 0.001) can significantly improve the AUC value in the diagnosis of cHCC-CCA. Among them, the AUC value of elevated AFP (> 100 ng/mL) with targetoid diffusion restriction was higher than elevated AFP (> 100 ng/mL) with progressive enhancement (Z = 2.092, p = 0.036).
conclusionsA diagnostic regimen combining tumor markers and imaging features could help differentiation of cHCC-CCA from mass-forming iCCAs. When elevated AFP (> 100 ng/mL) in discordance with progressive enhancement, or targetoid diffusion restriction, or targetoid appearance on HBP, the lesion might be highly suspicious of cHCC-CCA. KEY POINTS: Question Can contrast-enhanced MRI and tumor markers improve preoperative differentiation of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) from mass-forming intrahepatic cholangiocarcinoma (iCCA) with rim arterial phase hyperenhancement (APHE)? Findings Elevated alpha-fetoprotein > 100 ng/mL in discordance with progressive enhancement, targetoid appearance on hepatobiliary phase (HBP), or targetoid diffusion restriction can improve differentiation of cHCC-CCA from iCCA. Clinical relevance This diagnostic regimen improves preoperative accuracy in distinguishing cHCC-CCA from iCCA by integrating tumor marker with specific MRI imaging features, guiding appropriate treatment strategies while minimizing unnecessary biopsy.
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