A NEW MRI diagnostic model combining serum biomarkers with magnetic resonance imaging features accurately distinguished scirrhous hepatocellular carcinoma (SHCC) from intrahepatic mass-forming cholangiocarcinoma (IMCC) in patients with hepatitis B virus (HBV) infection, achieving high diagnostic accuracy in both the training and external validation cohorts.
SHCC is a rare form of hepatocellular carcinoma, whereas IMCC is a primary bile duct cancer that develops within the liver. Differentiating the two cancers before treatment can be challenging, but accurate diagnosis is important because management strategies differ.
The retrospective multicentre study analysed 183 cases from HBV-infected patients across three centres, including 63 pathologically confirmed SHCC and 120 IMCC cases.
MRI Features Strengthened Diagnostic Accuracy
Researchers assessed clinicopathological characteristics alongside gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI findings to identify factors that distinguished SHCC from IMCC. Compared with IMCC, SHCC showed a significantly lower incidence of necrosis in both the training and validation cohorts (training: p= 0.03; validation: p=0.002).
Multivariable analysis identified three imaging features as independent diagnostic indicators: non-thin rim enhancement during the arterial phase, an enhancing capsule, and signal loss on opposed-phase T1-weighted imaging. When combined with relevant serum biomarkers, these imaging features produced a diagnostic model with an area under the curve (AUC) of 0.951, alongside a sensitivity of 85.9% and specificity of 88.4% in the training cohort.
Validation Supported Clinical Utility
External validation demonstrated similarly strong performance, with an AUC of 0.939, sensitivity of 85.0%, and specificity of 88.9%. Decision curve analysis also indicated a positive net benefit across a range of threshold probabilities, supporting the model’s potential clinical utility.
Potential to Inform Personalised Treatment
The findings suggested that combining Gd-EOB-DTPA-enhanced MRI characteristics with serum biomarkers could provide clinicians with a reliable preoperative approach for distinguishing SHCC from IMCC in HBV-infected patients. Improved diagnostic confidence in this high-risk population could help inform personalised treatment planning. However, because the study only included patients with HBV infection, the findings should be interpreted within that clinical setting.
Reference
He H et al. 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. Eur Radiol. 2026;DOI:10.1007/s00330-026-12749-4.
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