Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI.

PURPOSE: To examine the differential features of combined hepatocellular and cholangiocarcinoma (HCC-CC) from mass-forming intrahepatic cholangiocarcinoma (ICC) on gadoxetic acid-enhanced MRI. MATERIALS AND METHODS: Forty patients with pathologically proven combined HCC-CC (n = 20) and ICCs (n = 20) who had undergone gadoxetic acid-enhanced MRI were enrolled in this study. MR images were analyzed for the shape of lesions, hypo- or hyperintense areas on the T2-weighted image (T2WI), rim enhancement during early dynamic phases, and central enhancement with hypointense rim (target appearance) on the 10-min and 20-min hepatobiliary phase (HBP). The significance of these findings was determined by the χ(2) test. RESULTS: Irregular shape and strong rim enhancement during early dynamic phases, and absence of target appearance on HBP favored combined HCC-CCs (P < 0.05). Lobulated shape, weak peripheral rim enhancement, and the presence of complete target appearance on the 10-min and 20-min HBP favored ICCs (P < 0.05). However, 10 CC-predominant type of combined HCC-CC showed complete or partial target appearance on 10-min HBP. CONCLUSION: The shape of tumors, degree of rim enhancement during early dynamic phases, and target appearance on HBP were valuable for differentiating between combined HCC-CC and mass-forming ICC on gadoxetic acid-enhanced MRI.

Superior long-term outcomes after surgery in child-pugh class a patients with single small hepatocellular carcinoma compared to radiofrequency ablation.

BACKGROUND AND AIMS: There are insufficient data comparing long-term prognoses after radiofrequency ablation (RFA) and surgery. METHODS: We compared the baseline characteristics and survival rates of patients (single, ≤3 cm, and Child-Pugh class A) treated surgically (n = 215) and with RFA (n = 255) from January 2000 to December 2007 at our institution. RESULTS: The surgery group was characterized by younger age, higher prevalence of HBsAg, less cirrhosis, and an increased chance of Child-Pugh score of 5 and CLIP score of 1, compared to the RFA group. During the median follow-up period of 42 months (range 1-109), the 3-, 5- and 7-year overall survival rates in the surgery group were 98, 94, and 94%, respectively, which were significantly higher than those in the RFA group (92, 87, and 76%, respectively, P = 0.002). The 3- and 5-year recurrence-free survival rates were 72 and 66%, respectively, in the surgery group, which were significantly higher than those in the RFA group (34 and 24%, respectively, P < 0.001). The superiority of the survival rates in the surgery group persisted in most patients throughout the subgroup analysis, based on the Child-Pugh score and CLIP score. Multivariate analysis showed that age and surgery as a procedure type were the significant predictive factors for both overall survival [HR = 1.04 (CI 1.001-1.08), P = 0.047 for age; HR = 2.97 (CI 1.19-7.45), P = 0.02 for surgery] and recurrence-free survival [HR = 1.02 (CI 1.01-1.04), P = 0.01 for age; HR = 2.44 (CI 1.76-3.37), P < 0.001 for surgery]. CONCLUSIONS: The long-term outcome after surgery for Child-Pugh class A and single small HCC is superior to that after RFA.

Sonography guided percutaneous radiofrequency ablation of hepatocellular carcinoma: effect of cooperative training on the pretreatment assessment of the operation's feasibility.

OBJECTIVE: The aim of this study is to investigate the effects of cooperative training on the pretreatment assessment of the feasibility to perform Ultrasonography (US) guided percutaneous radiofrequency ablation for patients afflicted with hepatocellular carcinoma. MATERIALS AND METHODS: In our prospective study, 146 patients with 200 hepatocellular carcinomas were referred for radiofrequency ablation after triage by hepatologists. Three radiologists with different levels of experience performed the planning US before (group I) and after (group II) cooperative training, to evaluate whether radiofrequency ablation was feasible. The feasibility rates considered eligible according to our criteria were evaluated. In addition, we analyzed the reasons for the lack of feasibility were analyzed. The interobserver agreement for the assessment of feasibility before and after training was also calculated. RESULTS: The overall feasibility rates for both groups was 73%. No significant difference in the feasibility rates was observed. The feasibility rates of each observer for group I were 71% (observer 1), 77% (observer 2) and 70% (observer 3) and those for group II were 73%, 76% and 69%, respectively. In the tumors (n = 164) considered ineligible, the two most common causes for refraining from performing radiofrequency ablation included non-visualization of the tumor (62%) and the absence of a safe route for the percutaneous approach (38%). We found moderate interobserver agreement for all observers before cooperative training and a good agreement after training. CONCLUSION: Although the cooperative training did not affect the feasibility rate of each observer, it improved the interobserver agreement for assessing the feasibility of performing US guided radiofrequency ablation, which may reduce unnecessary admission or delayed treatment.