Differentiating scirrhous hepatocellular carcinoma from intrahepatic mass-forming cholangiocarcinoma based on Gd-EOB-DTPA-enhanced MRI and serum biomarkers in an HBV-positive high-risk cohort: a multi-center study.

Abstract

This study aimed to differentiate scirrhous hepatocellular carcinoma (SHCC) from intrahepatic mass-forming cholangiocarcinoma (IMCC) in HBV-infected patients using Gd-EOB-DTPA-enhanced MR imaging features combined with clinical variables. Sixty-three pathologically confirmed SHCC and 120 IMCC were analyzed retrospectively in HBV-infected patients admitted to three centers (118 patients from Center 1 for training and 65 patients from the other two centers for external validation). Clinicopathological characteristics and Gd-EOB-DTPA-enhanced MR imaging features were evaluated. Independent diagnostic factors for SHCC were identified using multivariate logistic regression. A preoperative diagnostic model combining these features with clinical variables was constructed, and its performance was assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). Compared to IMCC, SHCC demonstrated a significantly lower incidence of necrosis (training: p = 0.03; validation: p = 0.002). A multivariable diagnostic model incorporating non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging, and relevant serum biomarkers achieved an area under the curve (AUC) of 0.951 (sensitivity 85.9%, specificity 88.4%). External validation yielded an AUC of 0.939 (sensitivity 85.0%, specificity 88.9%). DCA further confirmed its clinical utility, demonstrating positive net benefit across a range of threshold probabilities. Non-thin rim enhancement in the arterial phase, enhancing capsule, and signal loss on opposed-phase T1-weighted imaging on Gd-EOB-DTPA-enhanced MRI, combined with related serum biomarkers, may differentiate SHCC from IMCC in HBV-infected patients with high accuracy. Question A reliable diagnostic approach that integrates Gd-EOB-DTPA-enhanced MRI features with serum biomarkers for differentiating SHCC from IMCC in HBV-infected patients has not been clearly defined. Findings A model integrating non-thin rim enhancement, enhancing capsule, opposed-phase signal loss, and related serum biomarkers effectively differentiated SHCC from IMCC in HBV-infected patients. Clinical relevance This study provides clinicians with a high-accuracy diagnostic model for differentiating SHCC from IMCC in the specific high-risk cohort, which may facilitate the development of personalized treatment plans and improvement of prognosis.