Comparison of MRI and prognostic features of intrahepatic cholangiocarcinoma between patients with and without hepatitis B virus infection

Purpose To compare the clinical, MRI, and prognostic features of intrahepatic cholangiocarcinoma (ICCA) between patients with and without hepatitis B virus (HBV) infection. Methods We retrospectively analyzed 211 patients with ICCA who underwent preoperative MRI and curative-intent surgical resection between 2015 and 2018. Two radiologists independently reviewed MRI features. Clinicopathologic and MRI characteristics were compared according to HBV status. Recurrence-free survival (RFS) and overall survival (OS) were assessed using the Kaplan-Meier method and log-rank test. Recurrence rates were compared according to tumor site, and logistic regression analysis was used to identify independent predictors of intrahepatic recurrence. Results Among the 211 patients (mean age, 63.4 +/- 10.5 years; 126 men), 81 (38.4%) were HBV-positive and 130 (61.6%) were HBV-negative. The purely mass-forming type of ICCA was more common in the HBV-positive group (91.4% vs. 76.9%; p = 0.007), whereas combined types were more frequent in the HBV-negative group. On MRI, peripheral tumor location was more frequent in the HBV-positive group (55.5% vs. 34.6%; p = 0.011), while bile duct invasion/dilatation (p < 0.001), secondary confluence involvement (p = 0.005), and periductal tumor infiltration (p = 0.030) were less common. Rim or non-rim arterial-phase enhancement (85.2% vs. 68.5%; p = 0.024) and radiologically-evident cirrhosis (19.8% vs. 8.5%; p = 0.017) were more frequent in HBV-positive patients. Although RFS and OS did not significantly differ between the groups (p >= 0.327), the intrahepatic recurrence rate was significantly higher in the HBV-positive group (37.0% vs. 23.1%; p = 0.029). HBV positivity was also identified as an independent predictor of intrahepatic recurrence (odds ratio, 1.93; p = 0.047). Conclusion HBV-associated ICCA demonstrates distinct MRI features and is associated with a higher rate of intrahepatic recurrence following curative resection.