ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

Imaging Features and Diagnostic Accuracy of MRI in Combined Hepatocholangiocarcinoma

M. Najjar1, J. Makkar1, S. Sun1, J. Zou1, O. Perez1, P. Jiang1, Y. Saenger1, E. Zheng1, E. Verna1, A. Mathur1, A. Griesemer1, K. Halazun2, B. Samstein2, T. Kato1, J. Emond1

1Columbia University Medical Center/New-York Presbyterian, New York, NY, 2Weill Cornell Medicine, New York, NY

Meeting: 2020 American Transplant Congress

Abstract number: A-145

Keywords: Hepatocellular carcinoma, Malignancy, Radiologic assessment, Recurrence

Session Information

Session Name: Poster Session A: Liver: Hepatocellular Carcinoma and Other Malignancies

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Combined hepatocholangiocarcinomas (HCC-CCA) are rare tumors with both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) differentiations. They are usually associated with a worse prognosis after liver transplantation (LT) than pure HCC tumors, however they are almost always diagnosed postoperatively. No clear radiological features or guidelines are currently available to differentiate HCC-CCA from HCC on preoperative imaging. We sought to assess the diagnostic accuracy of preoperative imaging and identify imaging characteristics associated with HCC-CCA.

*Methods: A total of 21 patients (out of 645) who underwent LT for HCC at a single center from January 1998 to January 2019 were found to have HCC-CCA on explant pathology. Fourteen of these patients had available diagnostic MRIs, they were consequently matched 2:1 with patients with pure HCC (n=28) on explant based on tumor size, MELD and highest pre-LT AFP. All images were reviewed by 2 radiologists who were blinded to the final pathological diagnosis, MRI features were systematically reported for each lesion. Features were grouped into “typical HCC” or “atypical HCC features” (Table 1), LIRADS scores were also reported.

*Results: Despite some overlap in “typical features” between HCC and HCC-CCA, “atypical features” were significantly more common in combined HCC-CCA vs HCC tumors (50, 40 and 40% vs 31, 23 and 1% for heterogeneous, atypical and delayed enhancement respectively). Moreover, whereas 21, 7, 46 and 7% of HCC lesions were respectively LIRADS 3, 4, 5 and M, all HCC-CCA were either LIRADS 5 or M. Based on this observation, the combination of LIRADS M or 5 and at least 1 “atypical feature” would allow for the correct diagnosis of 80% of HCC-CCA (sensitivity=0.8), while 22% of HCCs would be misdiagnosed as HCC-CCA (specificity=0.78) (Table 2). Clinically, patients with combined HCC-CCA tumors had a significantly lower 5-year survival rate of 39 vs 75% (p<0.001) as well as a lower 5-year recurrence-free survival rate of 42 vs 87% (p<0.001).

*Conclusions: Preoperative diagnosis of combined HCC-CCA tumors on the basis of imaging is possible if atypical features, beyond the LIRADS HCC features, are systematically assessed and incorporated in the diagnosis. Considering the dismal outcomes of HCC-CCA following LT, biopsy should be considered for all suspicious lesions in order to preoperatively confirm the diagnosis and potentially guide management.

 border=

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Najjar M, Makkar J, Sun S, Zou J, Perez O, Jiang P, Saenger Y, Zheng E, Verna E, Mathur A, Griesemer A, Halazun K, Samstein B, Kato T, Emond J. Imaging Features and Diagnostic Accuracy of MRI in Combined Hepatocholangiocarcinoma [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/imaging-features-and-diagnostic-accuracy-of-mri-in-combined-hepatocholangiocarcinoma/. Accessed May 11, 2025.

« Back to 2020 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences