# The value of gadobenate dimeglumine-enhanced MRI quantification in predicting aggressiveness and prognosis of typical intrahepatic mass-forming cholangiocarcinoma: a multicenter retrospective study

## TL;DR

This study shows that MRI measurements using gadobenate dimeglumine can predict the aggressiveness and survival outcomes of a type of liver cancer called intrahepatic mass-forming cholangiocarcinoma.

## Contribution

The study introduces MRI-based quantitative parameters as noninvasive predictors of tumor aggressiveness and prognosis in intrahepatic mass-forming cholangiocarcinoma.

## Key findings

- Volume ratio (VR) and relative intensity ratio (RIRrim) were independent risk factors for tumor aggressiveness.
- VR and RIRrim were effective predictors of overall and disease-free survival in patients with IMCC.
- MRI parameters outperformed traditional markers like CA19-9 and tumor necrosis in predicting aggressiveness.

## Abstract

This study aimed to evaluate the predictive value of quantitative gadobenate dimeglumine-enhanced MRI parameters in aggressiveness and prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).

A total of 158 patients with IMCC who underwent preoperative MRI at three centers were included, and their clinical and imaging data were analyzed retrospectively. Multimodal quantitative parameters were measured in various tumor areas, including relative intensity ratio (RIR) and relative enhancement ratio (RER) of the central and rim areas of the tumor to the liver in the hepatobiliary phase, and the center area-tumor volume ratio. Patients were classified into low-aggressiveness (Ki-67 LI < 25%) and high-aggressiveness (Ki-67 LI ≥ 25%) groups based on the Ki-67 labeling index (LI). Potential risk factors of aggressiveness were determined using multivariate logistic regression analysis. The prediction efficacy of factors was assessed using receiver operating characteristic (ROC) curves. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Cox proportional-hazards regression model.

The volume ratio (VR) and RIRrim were independent risk factors for aggressiveness (p < 0.05). The area under the ROC curve was 0.803 [95% confidence interval (CI), 0.728–0.878] and 0.799 (95% CI, 0.727–0.872), both higher than that of CA19-9 ≥ 34 U/mL and intratumoral necrosis (all, p < 0.05). VR and RIRrim were identified as independent predictors of OS and DFS in patients with IMCC (p < 0.05).

The multimodal quantitative MRI parameters, VR and RIRrim, were effective risk factors for predicting both aggressiveness and prognoses in patients with IMCC.

Noninvasive MRI hepatobiliary-phase quantification stratified aggressiveness and prognosis in intrahepatic mass-forming cholangiocarcinoma. It might provide important clinical information for treatment strategies.

The volume ratio (VR), relative intensity ratio (RIRrim), CA19-9 ≥ 34 U/mL, and necrosis were independent predictors of high aggressiveness.The VR, RIRrim, CA19-9 ≥ 34 U/mL, and tumor boundary were independent predictors of poorer overall survival.The VR, RIRrim, CA19-9 ≥ 34 U/mL, tumor boundary, and tumor maximum size ≥ 3 cm were independent predictors of shorter disease-free survival.

The volume ratio (VR), relative intensity ratio (RIRrim), CA19-9 ≥ 34 U/mL, and necrosis were independent predictors of high aggressiveness.

The VR, RIRrim, CA19-9 ≥ 34 U/mL, and tumor boundary were independent predictors of poorer overall survival.

The VR, RIRrim, CA19-9 ≥ 34 U/mL, tumor boundary, and tumor maximum size ≥ 3 cm were independent predictors of shorter disease-free survival.