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11.03.2019 | Gastrointestinal | Ausgabe 7/2019

European Radiology 7/2019

Hepatic sarcomatoid carcinoma: magnetic resonance imaging evaluation by using the liver imaging reporting and data system

European Radiology > Ausgabe 7/2019
Nieun Seo, Myeong-Jin Kim, Hyungjin Rhee
Wichtige Hinweise

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To evaluate how sarcomatoid carcinomas (SCs) would be classified on magnetic resonance imaging (MRI) by using the Liver Imaging Reporting and Data System (LI-RADS) and to assess imaging features of SC compared with other hepatic malignancies.


We retrieved 184 patients with pathologically confirmed SC (n = 46), hepatocellular carcinoma (HCC, n = 92), and intrahepatic cholangiocarcinoma (iCCA, n = 46) diagnosed between January 2006 and December 2017. Two readers independently reviewed MRI according to LI-RADS v2017. Classification rate of SC, as probably or definitely malignant but not specific for HCC (LR-M), was calculated. LR-TIV (tumor in vein) was subclassified as either 5V or MV. MRI features were compared between SC, HCC, and iCCA and between SC of LR-M and non-LR-M categories.


Chronic liver disease was present in 71.7% (33/46) of patients with SC, and LI-RADS was applied for these patients. SC was classified as LR-M in 24 (72.7%) of 33 patients at risk. SCs that had been classified as LR-4/5/5V were significantly smaller (median, 1.9 cm; range, 1.0–4.2 cm) than SCs classified as LR-M/MV (median, 4.3 cm; range, 1.3–20.6 cm) on independent t test (p = 0.012). SCs commonly showed MRI features similar to iCCAs than to HCCs. Targetoid appearance and capsular retraction were more frequent in iCCA than in SC (p ≤ 0.009) on Pearson’s chi-squared test or Fisher’s exact test.


Most SCs can be classified as LR-M on MRI, but small lesions may be indistinguishable from HCCs.

Key Points

• Most sarcomatoid carcinomas (SCs) are classified as LR-M on MRI by using LI-RADS v2017.
• SC showed various LR-M features similar to those of intrahepatic cholangiocarcinoma.
• Size of LR-4/5/5V SC was significantly smaller than that of LR-M/MV SC.

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