Magnetic resonance imaging (MRI) before surgery may help identify intrahepatic cholangiocarcinoma (iCCA) associated with the hepatitis B virus, according to a new study published in the Journal of Magnetic Resonance Imaging

The diagnosis of iCCA in patients infected with hepatitis B is challenging. 

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In the present study, a team of researchers led by Jianjun Zhou MD, from the Department of Radiology, Zhongshan Hospital, Fudan University, China assessed the preoperative imaging characteristics of patients with iCCA with and without hepatitis B infection.

They retrospectively enrolled 431 patients with histopathologically confirmed iCCA. Of these, 143 were positive for hepatitis B infection and 288 were negative.

They then allocated 302 patients to a training group and the remaining 129 patients to a validation group. They also enrolled an additional 100 patients with hepatocellular carcinoma who were also positive for hepatitis B infection.

The team analyzed the clinical and MRI characteristics of the participants and compared those with patients with iCCA who were hepatitis B-positive and hepatitis B-negative. 

They also compared the features of patients who were positive for hepatitis B and who had iCCA and hepatocellular carcinoma.

They found that a washout or degressive enhancement pattern, a well-defined tumor margin, and no peritumoral bile duct dilation were independent factors for discriminating iCCA associated with hepatitis B compared to iCCA with no hepatitis B. 

These features were also the predominant MRI manifestations for hepatocellular carcinoma associated with hepatitis B. 

The combined index showed an area under the curve (AUC) of 0.798 in the training group and an AUC of 0.789 in the validation group. 

The sensitivity, specificity, and accuracy were all above 70%. This was higher than each single feature alone in both groups.

The researchers concluded that preoperative MRI can help identify patients who have hepatitis B-associated iCCA.


Sheng R, Wang H, Zhang Y, et al. MRI for hepatitis B-associated intrahepatic cholangiocarcinoma: A multicenter comparative study. J Magn Reson Imaging. Published online June 13, 2023. doi:10.1002/jmri.28855