Study Population
The database of the Department of Pathology from December 2004 to January 2012 was cross-referenced with the database of Departement of Radiology to identify all patients with pathology-confirmed diagnosis of cHCC-CC who had undergone MRI and CT.
This retrospective study includes nine patients (eight male,
one female,
mean age 54.8 years,
range 42–70 years) who had either an hepatectomy (n=3) or a core biopsy (n=1) for HCC and CC,
either a liver transplantation (LT) (n=5) for HCC.
All the patients were evaluated with presurgical imaging study MRI (n=4) and CT (n=9); 5/9 were treated with presurgical Transarterial Chemoembolization (TACE).
All the patients had a clinical history of chronic liver disease: 8 cirrhosis (5 alcoholic,
1 HCV/HIV,
1 glycogenosis type III,
1 hemochromatosis) and 1 non alcoholic steatohepatitis (NASH).
A serum alphafetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) test was available in 9 and 3 patients,
respectively.
The body mass index (BMI) ’s mean is 24.6 (range 34-15,4).
Pathological Analysis
Lesions were confirmed histopathologically as hepatic tumors comprising unequivocal elements of both HCC and CC according to the tumor classification of the World Health Organization.
The bidirectional differentiation was further supported by immunohistochemical stain.
For each specimen,
biliary differentiation was confirmed with immunohistochemical stains characteristic of bile duct differentiation (cytokeratin 7,
cytokeratin 19) whereas hepatocellular differentiation was confirmed with immunohistochemical stains characteristic of hepatocyte differentiation (anti-glypican,
anti-hepatocyte and anti-AFP).
MRI Technique
All MRI examinations were performed on a Achieva 1.5T (Philips Healthcare, Best,
The Netherlands),
MRI system using a phased-array torso coil.
In all patients a standard upper abdominal protocol was performed. The parameters are displayed in Table 1.
Postcontrast sequences were acquired at 18 seconds,
approximately (early phase),
40 seconds (venous phase),
120 seconds (interstitial phase) and 5 minutes (delayed phase) after gadolinium administration.
Gadoteric acid,
0,5 mmol/mL (Dotarem; Guerbet France) was administered intra venous in all patients by a power injector as a bolus of 0.2 mL/kg gadolinium chelate at 2 mL/sec.
CT Techinique
All CT examinations were performed on a Brilliance 64-slice (Philips Healthcare, Best,
The Netherlands).
In all patients a standard abdominal protocol was performed.
The parameters are displayed in Table 2.
The protocol is based on 4 dynamique CT phases: a precontrast phase and three postcontrast phases that were acquired at 20-25 seconds (early phase),
40 seconds (venous phase),
5 minutes (delayed phase) after iodine based contrast administration.
Iomeprol,
350 mgI/mL (Bracco Imaging s.p.a.; Milano,
Italy) was administered intra venous in all patients by a power injector as a bolus of 1,5 mL/kg iodine based contrast at 3-5 mL/sec.
Images Analysis
MR/CT images were retrospectively reviewed in consensus by two abdominal radiologists,
with knowledge of the diagnosis of cHCC-CC.
Images were reviewed on a picture archiving and communication system PACS (Carestream Health,
New York,
U.S.A.) in all patients.
The following characteristics were evaluated: tumor location; the number and size of lesions; margins (well-defined or ill-defined); MR signal intensity of tumor on non contrast-enhanced T1-weighted and T2-weighted (hypointense/hyperintense) and caracteristic of tumor signal (homogeneous/heterogeneous); enhancement pattern was analyzed on gadolinium-enhanced T1-weighted images and iodine contrast–enhanced CT images on arterial,
portal and delayed phase; the presence of necrosis; the presence of a tumoral capsule,
biliary dilatation directly related to the mass,
vascular invasion and satellite tumors; imaging findings consistent with cirrhosis (lobulated liver contours and hypertrophy of the left lobe and/or caudate lobe and/or hypotrophy of the quadrate lobe and/or right liver) and signs of portal hypertension (ascites,
splenomegaly and porto-systemique shunts); lymph node involvement (short axis more than 1.0 cm) and metastasis.