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Major and ancillary features according to LI-RADS in the assessment of combined hepatocellular-cholangiocarcinoma

Vincenza Granata; Roberta Fusco; Sergio Venanzio Setola; Fabio Sandomenico; Maria Luisa Barretta; Andrea Belli; Raffaele Palaia; Fabiana Tatangelo; Roberta Grassi; Francesco Izzo; Antonella Petrillo

We uploaded the Figures of the manuscript: Granata V, Fusco R, Venanzio Setola S, Sandomenico F, Luisa Barretta M, Belli A, Palaia R, Tatangelo F, Grassi R, Izzo F, Petrillo A. Major and ancillary features according to LI-RADS in the assessment of combined hepatocellular-cholangiocarcinoma. Radiol Oncol. 2020 May 28;54(2):149-158. doi: 10.2478/raon-2020-0029. PMID: 32463393; PMCID: PMC7276649.


Background. The aim of the study was to investigate the performance of the Liver Imaging Reporting and Data
System (LI-RADS) v2018 for combined hepatocellular-cholangiocarcinoma (cHCC-CCA) identifying the features that
allow an accurate characterization.
Patients and methods. Sixty-two patients (median age, 63 years; range, 38–80 years), with pre-surgical biopsy
diagnosis of hepatocellular carcinoma (HCC) that underwent hepatic resection, comprised our retrospective study.
All patients were subject to multidetector computed tomography (MDCT); 23 patients underwent to magnetic
resonance (MR) study. The radiologist reported the presence of the HCC by using LIRADS v2018 assessing major and
ancillary features.
Results. Final histological diagnosis was HCC for 51 patients and cHCC-CCA for 11 patients. The median nodule size
was 46.0 mm (range 10–190 mm). For cHCC-CCA the median size was 33.5 mm (range 20–80 mm), for true HCC the
median size was 47.5 mm (range 10–190 mm). According to LIRADS categories: 54 (87.1%) nodules as defined as LR-5,
1 (1.6%) as LR-3, and 7 (11.3%) as LR-M. Thirty-nine nodules (63%) showed hyper-enhancement in arterial phase; among
them 4 were cHCC-CCA (36.4% of cHCC-CCA) and 35 (68.6%) true HCC. Forty-three nodules (69.3%) showed washout
appearance; 6 cHCC-CCAs (54.5% of cHCC-CCA) and 37 true HCC (72.5%) had this feature. Only two cHCCCCA
patients (18.2% of cHCC-CCA) showed capsule appearance. Five cHCC-CCA (71.4% of cHCC-CCA) showed
hyperintensity on T2-W sequences while two (28.6%) showed inhomogeneous signal in T2-W. All cHCC-CCA showed
restricted diffusion. Seven cHCC-CCA patients showed a progressive contrast enhancement and satellite nodules.
Conclusions. The presence of satellite nodules, hyperintense signal on T2-W, restricted diffusion, the absence of
capsule appearance in nodule that shows peripheral and progressive contrast enhancement are suggestive features
of cHCC-CCA.

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