Prognostic Implications of CT- and MRI-Based LI-RADS Category M Features in Intrahepatic Cholangiocarcinoma: An Intraindividual Comparison

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Objective: Liver Imaging Reporting and Data System category M (LR-M) is associated with a poor prognosis in intrahepatic cholangiocarcinoma (iCCA).However, the prognostic value of individual LR-M features across imaging modalities remains unclear.We aimed to determine, through intraindividual comparisons, whether the prognostic value of individual LR-M features differs between CT and MRI in patients with iCCA at risk for hepatocellular carcinoma.Materials and Methods: This retrospective study included consecutive patients with cirrhosis or chronic hepatitis B who underwent curative-intent resection for iCCA and preoperative multiphasic CT and MRI between 2010 and 2019.CT and MRI images were reviewed in separate sessions ≥4 weeks apart.Cox proportional hazards regression analyses with and without adjustment for LI-RADS categorization (non-LR-M vs. single-modality LR-M or dual-modality LR-M) were performed to evaluate the associations of CT-and MRI-based targetoid and non-targetoid LR-M features and other variables with recurrence-free survival (RFS) and overall survival (OS).Results: A cohort of 122 patients (mean age, 57.9 ± 10.4 years) was included.MRI demonstrated significantly higher frequencies than CT for targetoid (84.4% vs. 73.8%,P = 0.007) and non-targetoid features (43.4% vs. 20.5%,P < 0.001), resulting in a higher rate of LR-M categorization (90.2% vs. 81.1%,P = 0.003).In the multivariable analysis, CT-based targetoid features (hazard ratio [HR] = 2.31 for RFS, P = 0.010; HR = 1.85 for OS, P = 0.043) and MRI-based non-targetoid features (HR = 2.15 for RFS, P = 0.005; HR = 2.09 for OS, P = 0.008) were independently associated with poorer survival.After adjustment for LI-RADS categorization, MRI-based non-targetoid features remained independently associated with poorer RFS (HR = 1.76,P = 0.041) and OS (HR = 1.79,P = 0.038).Dual-modality LR-M designation was independently associated with poorer RFS (HR = 8.02, P = 0.042). Conclusion:The prognostic implications of LR-M features in iCCA vary by imaging modality and feature type.CT-based targetoid and MRI-based non-targetoid features were associated with poorer survival, and the associations between MRIbased non-targetoid features and survival remained significant after adjustment for LI-RADS categorization.

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