Magnetic resonance imaging (MRI) and computed tomography (CT) predictors such as rim-like arterial phase hyperenhancement (rim APHE), delayed central enhancement (DCE), and targetoid hepatobiliary phase (HBP) could reliably distinguish intrahepatic cholangiocarcinoma (CCA) from hepatocellular carcinoma (HCC), according to a recently published article in Acta Radiologica.

HCC and intrahepatic CCA are the first and second most common liver malignancies, respectively. While a liver transplant is the mainstay of treatment for HCC in many countries, it is contraindicated in CCA due to the high rate of recurrence, thus making an accurate diagnosis between these tumors crucial.

LR-M is a special category of the Liver Imaging Reporting and Data System (LI-RADS), defined as findings that are possibly or definitely malignant but are not specific to HCC. According to several studies, the 2018 LR-M criteria could reliably distinguish CCA from HCC; however, the criteria have not been fully validated.

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The authors aimed to assess the diagnostic performance of LR-M to differentiate between HCC and intrahepatic CCA through a retrospective study that included 118 patients with HCC and intrahepatic CCA who underwent examination with CT and gadoxetic acid-enhanced MRI (EOB-MRI) between 2017 and 2021. Biopsy results were used to determine the type of tumor based on the World Health Organization (WHO) classification system.

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Researchers used multivariate analysis to identify predictive parameters with the potential to detect intrahepatic CCA and evaluated the diagnostic performance of LR-M using a receiver operating characteristic (ROC) curve.

The multivariate analysis revealed that DCE (P =.007), rim APHE (P <.001), and targetoid HBP (P =.02) were independent predictors of intrahepatic mass-forming CCA. The ROC curve demonstrated that, of the 3 variables, rim APHE had the most diagnostic value, with a sensitivity of over 80% and a specificity of more than 90%. The 3 variables in EOB-MRI had a combined sensitivity of 92% and specificity of 87% according to the multivariate logistic regression model.

“The multivariate logistic regression model based on rim APHE, DCE, and targetoid HBP on EOB-MRI can effectively distinguish [intrahepatic mass-forming CCA] from HCC and is superior to any other targetoid appearance criterion of LI-RADS on CT and EOB-MRI,” the authors concluded.


Wu H, Liang Y, Wang Z, et al. Optimizing CT and MRI criteria for differentiating intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma. Acta Radiol. Published online July 27, 2022. doi:10.1177/02841851221113265