MRI for Hepatitis B-Associated Intrahepatic Cholangiocarcinoma: A Multicenter Comparative Study

Background The diagnosis of intrahepatic cholangiocarcinoma (iCCA) is challenging in hepatitis B virus (HBV)-infected patients, due to the overlapping clinical manifestations and atypical imaging patterns compared to patients without HBV.Purpose To investigate the preoperative imaging characteristics of iCCA in patients with HBV in comparison to those without HBV.Study Type Retrospective.Subjects 431 patients with histopathologically confirmed iCCA (143 HBV-positive and 288 HBV-negative patients) were retrospectively enrolled from three institutes, and patients were allocated to the training (n = 302) and validation (n = 129) cohorts from different institutes or time period; 100 matching HBV-positive hepatocellular carcinoma (HCC) patients were also enrolled.Field Strength/Sequence 5-T and 3-T, including T1- and T2-weighted, diffusion-weighted and dynamic gadopentetate dimeglumine-enhanced imaging.Assessment Clinical and MRI features were analyzed and compared between HBV-positive and HBV-negative patients with iCCA, and between HBV-positive patients with iCCA and HCC.Statistical Tests Univariate and multivariate logistic regression analyses with odds ratio (OR) to identify independent features for discriminating HBV-associated iCCA. Diagnostic model generation by incorporating independent features, and the performance for discrimination was evaluated by receiver operating characteristics with the area under the curve (AUC) and 95% confidence interval (CI). AUCs were compared by the DeLong's method. A P-valueCompared to patients without HBV, washout or degressive enhancement pattern (OR = 51.837), well-defined tumor margin (OR = 8.758) and no peritumoral bile duct dilation (OR = 4.651) were independent significant features for discriminating HBV-associated iCCAs. All these features were also the predominant MRI manifestations for HBV-associated HCC. The combined index showed an AUC of 0.798 (95% CI 0.748-0.842) in the training cohort and an AUC of 0.789 (95% CI 0.708-0.856) in the validation cohort for discrimination. The sensitivity, specificity, and accuracy were all >70%, which was superior to each single feature alone in both cohorts.