Pharmacokinetic Analysis of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Distinguishing Hepatocellular Carcinoma From Cholangiocarcinoma in Pre–Liver Transplantation Evaluation

• DCE-MRI presents a new and practical approach for differential diagnosis between HCC and cholangiocarcinoma in pretransplantation imaging evaluation.
• DCE-MRI has no radiation exposure thus can provide more information than CT and excellent contrast between liver parenchyma and tumor.
• DCE-MRI could be a noninvasive method in preoperative liver tumor differential diagnosis in liver recipient candidates and potentially replace the biopsy in the future.

ObjectiveLiver transplantation for intrahepatic cholangiocarcinoma is notorious for rapid recurrence with poor survival rate postoperatively and has therefore been discontinued in most centers. The purpose of this study is to distinguish hepatocellular carcinoma (HCC) from cholangiocarcinoma in pretransplantation imaging evaluation by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Materials and MethodsFrom January 2014 to September 2015, 19 patients were included in the study, with a mean age of 62.8 years. All subjects underwent pretransplantation DCE-MRI and surgical excision or core biopsy. The DCE-MRI parameters were measured using the Tofts model 1999. Statistical analysis included nonparametric tests and area under the curve for the receiver operating characteristic.ResultsFourteen HCCs and 5 cholangiocarcinomas were diagnosed by surgical pathology. The mean size of tumor was 6.4 cm (range, 1.5 cm to 13.7 cm). All DCE-MRI parameters were calculated as the ratio between the tumor and normal liver parenchyma and Ktrans (1/min) was used as a distinguishing parameter between the two tumors. Ktrans was higher in the cholangiocarcinoma group (1.89 ± 1.13) than in the HCC group (0.46 ± 0.35). Univariate analysis revealed that Ktrans has a high significant difference (P = .001). The optimal Ktrans value cutoffs were 1 or more (area under the curve = 0.971) for detection of HCCs or cholangiocarcinomas.ConclusionThe analysis of DCE-MRI with the kinetic model (Tofts, 1999) presents a new and practical approach indiscrimination of HCC from cholangiocarcinoma for pretransplantation imaging evaluation.