Researchers found that tumor characteristics seen in diffusion-weighted magnetic resonance imaging (MRI) may predict early progression of intrahepatic cholangiocarcinoma (iCCA), as published in the Journal of Magnetic Resonance Imaging.

The retrospective research conducted by Sheng et al included 43 patients with unresectable iCCA who had received combined targeted immunotherapy with lenvatinib and PD1 antibody.

The authors analyzed MRI obtained prior to initiating treatment and observed lower apparent diffusion coefficient (ADC), higher tumor number, ill-defined tumor margins, greater arterial peritumoral enhancement, and the presence of lymphatic invasion were significantly more frequent in patients who had early progression defined as 12 months or less after treatment.

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“We used 12 months as the prognostic prediction endpoint for [early progression], instead of 6 months,” the authors said. “Thus, a 12-month cut-off was considered of more clinical prognostic value, but further investigation with larger sample size is valuable for validation.”

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After performing a multivariate logistic regression analysis, ADC was the only feature independently associated with early progression with an odds ratio of 0.012 and an area under the curve of 0.774. Furthermore, a Cox regression model detected only ADC and tumor margins poorly defined as risk factors for early progression.

Patients with higher ADC values (>1.028 x 10^3 mm2/sec) had a median progression-free survival (PFS) of 16 months vs those with lower ADC values who had 5 months of PFS. In iCCA tumors, lower ADC values often suggest the presence of a high tumor grade, poor differentiation, and hence, worse prognosis and higher likelihood of tumor aggressiveness.

“There are good reasons to believe that ADC might convey prognostic information and play a role in patient selection for systemic therapy. Our study in [iCCA] may also provide a train of thought for other tumors receiving targeted-immunotherapy,” the authors wrote.

These findings confirm the important role of MRI in iCCA and further suggest that some variables could be useful to determine risk-stratified treatment optimization for these patients.


Sheng R, Sun W, Huang X, et al. Apparent diffusion coefficient MRI shows association with early progression of unresectable intrahepatic cholangiocarcinoma with combined targeted‐immunotherapy. J Magn Reson Imaging. Published online April 30, 2022. doi:10.1002/jmri.28214