Objective: Microvascular invasion (MVI) is a significant adverse prognostic indicator of intrahepatic cholangiocarcinoma (ICC) and affects the selection of individualized treatment regimens. This study sought to establish a radiomics nomogram based on the optimal VOI of multi-sequence MRI for predicting MVI in ICC tumors. Methods: 160 single ICC lesions with MRI scanning confirmed by postoperative pathology were randomly separated into training and validation cohorts (TC and VC). Multivariate analysis identified independent clinical and imaging MVI predictors. Radiomics features were obtained from images of 6 MRI sequences at 4 different VOIs. The least absolute shrinkage and selection operator algorithm was performed to enable the derivation of robust and effective radiomics features. Then, the best three sequences and the optimal VOI were obtained through comparison. The MVI prediction nomogram combined the independent predictors and optimal radiomics features, and its performance was evaluated via the receiver operating characteristics, calibration, and decision curves. Results: Tumor size and intrahepatic ductal dilatation are independent MVI predictors. Radiomics features extracted from the best three sequences (T1WI-D, T1WI, DWI) with VOI_10mm (including tumor and 10 mm peritumoral region) showed the best predictive performance, with AUC_TC = 0.987 and AUC_VC = 0.859. The MVI prediction nomogram obtained excellent prediction efficacy in both TC (AUC = 0.995, 95%CI 0.987–1.000) and VC (AUC = 0.867, 95%CI 0.798–0.921) and its clinical significance was further confirmed by the decision curves. Conclusion: A nomogram combining tumor size, intrahepatic ductal dilatation, and the radiomics model of MRI multi-sequence fusion at VOI_10mm may be a predictor of preoperative MVI status in ICC patients.

Background: The presence of microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICC) is a significant adverse prognostic factor. This study sought to investigate the correlation between preoperative imaging parameters and MVI in ICC. Methods: A total of 108 patients with surgically resected single ICC tumors (34 MVI-positive and 74 MVI-negative lesions) who underwent MRI examination, including T1WI, T2WI, DWI, and dynamic enhancement imaging, were enrolled in this retrospective study. The following qualitative and quantitative characteristics were evaluated: tumor morphology, signal features on T1WI and T2WI, intrahepatic duct dilatation, hepatic capsule retraction, target sign on DWI, dynamic enhancement pattern, arterial phase enhancement pattern, dot−/band-like enhancement inside the tumor, visible vessel penetration inside the tumor (hepatic artery, portal vein, or hepatic vein), integrity of the enhancement edge of the arterial phase, peripheral hepatic enhancement, tumor size, maximum enhancement edge thickness, arterial edge enhancement ratio, and delayed phase enhancement ratio. Other clinicopathological features were also used to predict and evaluate MVI in ICC. Chi-square test, Fisher’s exact test, and independent t-test were used for univariate analysis to determine the relationships among the presence of MVI and these MR parameters. Logistic regression analysis was used to identify predictors of MVI among these MR parameters. Results: Among MRI characteristics, tumor morphology, intrahepatic duct dilatation, arterial phase enhancement pattern, visible hepatic artery penetration sign, maximum diameter of the tumor and the arterial phase edge enhancement ratio were correlated with MVI (P = 0.007, 0.003, 0.008, 0.000, 0.003, and 0.002, respectively). Furthermore, higher CA19–9 levels (≥37 U/ml) and pathological tumor grade III were also related to MVI (P = 0.014 and 0.004, respectively). However, multivariate logistic regression analysis demonstrated that none of the parameters were independent risk factors for the diagnosis of MVI in ICCs. Conclusion: For the preoperative prediction of MVI in ICC, six qualitative and quantitative data obtained on preoperative MRI, as well as one tumorigenic marker and the pathological tumor grade, were statistically significant. More research is needed to identify MR characteristics that can be used as independent risk factors.

Video-assisted thoracoscopic surgery (VATS) has been widely used for diagnostic wedge resection of lung nodules. When VATS is performed for multiple lung nodules, preoperative localization for each target nodule is required. In this study, we evaluated the clinical effectiveness of computed tomography (CT)-guided simultaneous coil localization in one-stage VATS wedge resection for multiple lung nodules. Between November 2015 to March 2018, 19 patients with multiple target nodules underwent CT-guided simultaneous coil localization and one-stage VATS resection at our center. Data on the technical success of simultaneous localization and wedge resection, complications, and pathological results were collected. A total of 43 nodules were localized. The localization was successfully achieved in 42 of 43 nodules (97.7%). The technique of simultaneous localization was successfully achieved in 18 of 19 patients (94.7%). Fifteen patients underwent unilateral lung localization and four patients underwent bilateral lung localization. Three patients (15.8%) experienced asymptomatic pneumothorax after localization. All patients successfully underwent one-stage wedge resection for all target nodules. The mean duration of one-stage VATS procedure was 171.8 ± 84.0 min. The mean volume of blood loss was 94.2 ± 58.0 mL. Three patients experienced pleural effusion after VATS. During a follow-up of 6–31 months (median 18 months), no patient developed new lung nodules or distant metastasis. Preoperative simultaneous coil implantation is a safe and simple method for localization of multiple lung nodules. Simultaneous coil localization could effectively guide a one-stage VATS diagnostic wedge resection procedure.

Purpose: This study aimed to compare the feasibility, safety, diagnostic accuracy, and radiation dose between computed tomography (CT) fluoroscopy (CTF)–guided and conventional CT (CCT)–guided lung biopsy. Methods: Relevant articles up until February 2020 were identified within the PubMed, Embase, and Cochrane Library databases. Diagnostic accuracy rate, pneumothorax, and pneumothorax requiring chest tube served as primary end points, with technical success, hemoptysis, operative time, and radiation dose serving as secondary end points. Pooled odds ratios (ORs) were calculated for the dichotomous variables. Pooled estimates of the mean difference (MD) were measured for the continuous variables. Results: This meta-analysis included 9 studies. Seven studies were retrospective, and 2 studies were randomized controlled trials. A total of 6998 patients underwent either CTF-guided (n = 3858) or CCT-guided (n = 3154) lung biopsy. The diagnostic accuracy rate was significantly higher in the CTF group compared with the CCT group (OR, 0.32; P < 0.00001). No significant differences were detected between the CTF and CCT groups in terms of incidence rates of pneumothorax (OR, 0.95; P = 0.84), rates of pneumothorax requiring chest tube insertion (OR, 0.95; P = 0.84), technical success rates (OR, 0.41; P = 0.15), incidence rates of hemoptysis (OR, 1.19; P = 0.61), operative time (MD, −4.38; P = 0.24), and radiation dose (MD, 158.60; P = 0.42). A publication bias was found for the end points of pneumothorax requiring chest tube insertion and operative time. Conclusions: Compared with CCT-guided lung biopsy, CTF-guided lung biopsy could yield a higher diagnostic accuracy with similar safety and radiation exposure.