Imaging Features of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Multicenter Study
Jun-Yi Wu1,2, Li-Ming Huang1, Yan-Nan Bai1,2
1Department of Hepatobiliary Surgery, the Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Insights
Diagnosing hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is challenging. Intrahepatic bile duct dilation on CT or MRI scans can help detect B1-B3 BDTT in HCC patients, improving early diagnosis.
Area of Science:
- Radiology
- Oncology
- Hepatology
Background:
- Accurate pre-operative diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) remains a clinical challenge.
- Identifying imaging features associated with BDTT is crucial for treatment planning and patient management.
Purpose of the Study:
- To analyze and identify specific imaging features of HCC with B1-B3 BDTT.
- To evaluate the diagnostic utility of intrahepatic bile duct dilation as a biomarker for BDTT in HCC patients.
Main Methods:
- Retrospective review of clinicopathological data and imaging findings from 30 HCC patients with B1-B3 BDTT.
- Comparison with a control group of 631 HCC patients without BDTT.
- Validation using a blinded reading test on 453 HCC patients.
Main Results:
- HCC patients with B1-B3 BDTT exhibited more advanced tumor stages and adverse clinicopathological features.
- Intrahepatic bile duct dilation was significantly more prevalent in HCC patients with B1-B3 BDTT (93.3%) compared to those without (1.43%).
- Intrahepatic bile duct dilation demonstrated high sensitivity (93.33%) and specificity (98.57%) for BDTT diagnosis, effectively differentiating patients in a blinded test.
Conclusions:
- Hepatocellular carcinoma lesions and intrahepatic bile duct dilation are key imaging indicators of BDTT.
- These imaging features, particularly bile duct dilation, can facilitate the early and accurate diagnosis of B1-B3 BDTT in HCC patients.
Objectives:
There are still challenging problems in diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before operation. This study aimed to analyze the imaging features of HCC with B1-B3 BDTT.
Materials And Methods:
The clinicopathological data and imaging findings of 30 HCC patients with B1-B3 BDTT from three high-volume institutions were retrospectively reviewed. A total of 631 patients without BDTT who were randomly collected from each of the enrolled centers were recorded as the control group to analyze the differences in clinicopathological characteristics and imaging features between the two groups. A total of 453 HCC patients who underwent surgical treatment in the three institutions from January 2020 to December 2020 were collected for a blinded reading test as the validation group.
Results:
HCC patients with B1-B3 BDTT had more advanced tumor stages and adverse clinicopathological features. HCC lesions were detected in all patients, and intrahepatic bile duct dilation was observed in 28 (93.3%) patients with B1-B3 BDTT and 9 (1.43%) patients in HCC without BDTT. The intrahepatic bile duct dilation showed no enhancement at hepatic arterial phase (HAP) and no progressively delayed enhancement at portal venous phase (PVP), but it was more obvious at PVP on CT. In the reports of the 30 HCC patients with B1-B3 BDTT generated for the image when the scan was done, BDTT was observed in all 13 B3 patients and 3 of 12 B2 patients, but none of the 5 B1 patients. Fourteen patients were misdiagnosed before surgery. However, when using intrahepatic bile duct dilation in HCC patients as a potential biomarker for BDTT diagnosis, the sensitivity and specificity for BDTT diagnosis were 93.33% and 98.57%, respectively. The blinded reading test showed that intrahepatic bile duct dilation in CT and MRI scans could be for separating HCC patients with B1-B3 BDTT from HCC patients without BDTT.
Conclusions:
The HCC lesions and intrahepatic bile duct dilation on CT or MRI scans are imaging features of HCC with BDTT, which might facilitate the early diagnosis of B1-B3 BDTT.
