Clinical and Imaging Comparison of Primary Liver Carcinosarcoma and Sarcomatoid Carcinoma

Clinical and Imaging Comparison of Primary Liver Carcinosarcoma and Sarcomatoid Carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and Imaging Comparison of Primary Liver Carcinosarcoma and Sarcomatoid Carcinoma Lun Lu, Ruiping Zhang, Xingpeng Pan, Helin Li, Guihong Nian, Yiping Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6621988/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Aug, 2025 Read the published version in Abdominal Radiology → Version 1 posted 11 You are reading this latest preprint version Abstract Objective: Primary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver. Although the two tumors often overlap in clinical and imaging manifestations, there are currently no reports comparing the imaging features of these two tumors. Our study aims to compare the clinical characteristics and imaging features of these two tumors to further describe their distinct features, thereby enhancing understanding and diagnostic accuracy. Methods: A retrospective analysis was conducted on the clinical and imaging data of 17 patients with CS and 27 patients with SC diagnosed by surgical or needle biopsy between September 2010 and December 2024 at our hospital. The data were summarized and statistically analyzed. Results: Both groups were predominantly male, with a lower mean age (56.65 ± 11.82) in the CS group compared to the SC group (64.93 ± 8.15) (P = 0.01). Compared to the SC group, the CS group more commonly presented with hepatitis B, cirrhosis, and elevated AFP levels. Both groups were more commonly located in the right hepatic lobe, with larger tumors that were often solitary, irregularly shaped, and lobulated. Most tumors exhibited necrosis and hemorrhage. Calcification was observed in two cases in the CS group on CT scans. The tumor margins were predominantly indistinct, and the majority of tumors did not show a capsule. Approximately half of the patients in the SC group had lymph node metastasis, which was significantly higher than in the CS group (P = 0.023). After contrast enhancement, all cases in both groups showed heterogeneous enhancement in the arterial phase. Regarding enhancement distribution, the CS group more commonly exhibited enhancement at the margins and in the solid components, while most cases in the SC group showed enhancement at the margins and in the septa. In terms of dynamic enhancement patterns, the CS group more commonly exhibited partial or complete regression in the delayed phase, while the SC group more commonly exhibited progressive or persistent enhancement in the delayed phase, with statistical significance (P=0.042). Conclusion: Patients in the SC group had significantly higher age and lymph node metastasis than those in the CS group. In terms of tumor enhancement patterns, the CS group primarily exhibited delayed-phase regression or partial regression, while the SC group primarily exhibited delayed-phase persistent or progressive enhancement. primary liver carcinosarcoma primary liver sarcomatoid carcinoma computed tomography magnetic resonance imaging Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Primary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver, with reported incidence rates accounting for only 0.4% of all liver malignancies [ 1 ] . CS contains both carcinogenic and sarcomatous components, while SC is an epithelial-derived carcinoma with sarcomatous differentiation. Both are highly aggressive clinically, prone to recurrence and metastasis, and have a poor prognosis [ 2 – 4 ] . To date, only a few cases have been reported in the English literature, with most studies being case reports focusing on pathogenesis, pathological diagnosis, treatment, and prognosis [ 5 – 10 ] . Among these, only a few studies briefly described the imaging characteristics of CS or SC [ 11 – 14 ] , and there are currently no reports comparing the imaging features of these two tumors. Although the two conditions often overlap in clinical and imaging manifestations, there are some diagnostic features that can help distinguish them. Our study aims to summarize the clinical characteristics and imaging manifestations of 17 cases of primary hepatic sarcomas and 27 cases of sarcomatous carcinomas, compare the two conditions, and further describe their distinct features, thereby enhancing understanding and diagnostic accuracy. Materials and Methods 1. Patient Selection This study was approved by the Institutional Review Board of our hospital. As this is a retrospective study, informed consent from patients was not required. We collected data on patients diagnosed with CS or SC who underwent surgery or needle biopsy between September 2010 and December 2024 at our hospital. We reviewed all patients' medical records and collected the following clinical data: gender, age, chief complaint, preoperative laboratory test results, including serum alpha-fetoprotein (AFP) levels, hepatitis B serology, serum carbohydrate antigen 19 − 9 (CA19-9) and carcinoembryonic antigen (CEA) levels, as well as all preoperative imaging data from CT and MRI. The inclusion criteria for this study were as follows: (1) Patients with SC or CS confirmed by surgical resection or biopsy pathology; (2) Patients with complete preoperative clinical and imaging data, including liver plain scan and contrast-enhanced CT or MR images; (3) Patients who had not received any treatment prior to CT or MR imaging. (4) The interval between CT/MR imaging and surgical resection was less than 2 weeks. Exclusion criteria were as follows: (1) lack of pathological confirmation; (2) incomplete preoperative clinical and imaging data; (3) patients who received any treatment prior to CT/MR scanning; (4) the interval between CT/MR imaging and pathological examination exceeded two weeks; (5) patients with CT/MR images that were difficult to assess due to artifacts. Results: Among 18 CS patients, 1 patient underwent CT scan without contrast enhancement. Among 32 SC patients, 3 patients received transarterial chemoembolization (TACE) therapy prior to surgery; 1 of these patients had lung cancer metastasis to the liver, and 1 had uterine cancer metastasis to the liver. These 6 patients were excluded from the study. Ultimately, 17 CS patients and 27 SC patients were enrolled. 2. Image Acquisition All patients undergoing supine CT and MRI examinations had no history of contrast agent allergy. The scanning range extended from the upper margin of the diaphragm to the lower margin of the anterior superior iliac spine. 2.1 CT Scan Parameters CT scans were performed using a GE Discovery 750HD multi-slice spiral scanner. Patients were instructed to drink 800–1000 ml of water 10 minutes prior to scanning. A non-enhanced liver scan was followed by multi-phase contrast-enhanced scanning. Scan conditions: 120 kV, 250–280 mA, matrix 512 × 512, pitch 1.0, slice thickness 10 mm for plain scan and 5 mm for contrast-enhanced scan. Patients held their breath during scanning for 16–20 seconds. The contrast agent is Iohexol, with a total dose of 1.5 ml/kg, administered at a rate of 2.5–3.5 ml/s via the elbow vein. The arterial phase scan is performed 23–26 seconds after contrast agent injection, the portal phase scan at 50–60 seconds, and the delayed phase scan at 120–160 seconds. 2.2 MRI scan parameters MRI was performed using a GE Signa Infinity Twin Speed 1.5T and GE Optima MR360 1.5T scanner, equipped with an 8-channel abdominal surface coil. Patients were instructed to fast and abstain from drinking for 4 hours prior to scanning. Breathing exercises were performed before scanning. The patients lay back on the inspection bed with their feet entering first. After a whole-liver non-contrast scan, multi-phase contrast-enhanced scanning was performed. Scanning conditions and parameters were as follows: Transverse T1-weighted imaging (T1WI): Gradient echo sequence, breath-hold at end-expiration, TR/TE = 190/4.3 ms, slice thickness 8 mm, slice interval 2 mm, matrix = 256 × 160, FOV = 44 × 40 cm. Transverse T2WI: Rapid spin-echo sequence with fat suppression, using respiratory gating, TR/TE = 7059/85 ms, slice thickness 8 mm, slice interval 2 mm, matrix = 320×224, FOV = 44×40 cm. DWI: b = 600 sec/mm², breath-hold scan, TR/TE = 3000/74 ms, slice thickness 8 mm, slice interval 2 mm, matrix = 128×160, FOV = 44×40 cm. Contrast-enhanced: using three-dimensional LAVA technique, contrast agent: Gd-DTPA, high-pressure injection, total dose: 0.1 mmol/kg, followed by equal volume of normal saline, injection rate: 2.0–3.0 ml/s. After contrast agent administration via the elbow vein, perform arterial phase scanning at 20–28 seconds, portal phase scanning at 55–65 seconds, and delayed phase scanning at 120–160 seconds. 3. Image analysis The imaging results were independently reviewed by two abdominal radiologists with over 10 years of experience and cross-checked by another radiologist to reach a consistent conclusion. This study evaluated tumor characteristics including: lesion location (left, right,both or Caudate lobe ), number (single or multiple), size (maximum diameter, ≥ 5 cm or < 5 cm), shape (round or oval, irregular or lobulated), density/signal (cystic/necrotic, hemorrhage, calcification), margin (clear or unclear), capsule (present or absent), involvement of adjacent tissues (including vessels, bile ducts, lymph nodes, satellite nodules, invasion of adjacent viscera, ascites, or pleural effusion); enhancement patterns on contrast-enhanced images (global enhancement, marginal and solid component enhancement, marginal enhancement, or no enhancement); segmentation, homogeneity, and enhancement patterns (partial or complete regression, progressive or sustained enhancement, or no or minimal enhancement). 4. Pathological assessment All 17 cases of CS and 27 cases of SC included in this study were evaluated by two senior pathologists. When results differed, a final pathological conclusion was reached through discussion. Tumors were diagnosed based on the histomorphological features of hematoxylin and eosin (HE) stained sections and immunohistochemical results in both groups. The histopathological factors assessed for each tumor included: gross type, histological type, fibrous capsule, necrosis or hemorrhage, vascular invasion, bile duct invasion, satellite nodules or intrahepatic metastasis, and extrahepatic implantation or lymph node metastasis. Microscopically, the tumors primarily consisted of pleomorphic spindle cells (sarcomatous component) and moderately to poorly differentiated adenocarcinoma or hepatocellular carcinoma components. Immunohistochemical findings included: epithelial markers: CK-p, EMA, Hep-1, GPC3, Arginase, etc.; mesenchymal markers: vimentin (VIM), Desmin, S-100, SMA, etc.; vascular endothelial growth factor (VEGF); hepatocyte markers: phosphatidylinositol glycoprotein 3 (Gly-3); and cholangiocyte markers CK7 and CK19, etc. 5. Data analysis SPSS software version 27 (IBM, Chicago, Illinois, USA) was used for independent samplest-tests, chi-square tests, and Fisher's exact tests to assess differences in characteristics. Continuous variables (age) were analyzed using independent samples t-tests. Categorical variables (e.g., clinical characteristics and imaging features) were analyzed using two-sided chi-square tests and Fisher's exact tests. Receiver operating characteristic curves were used to assess the predictive performance of the model, calibration curves to evaluate consistency, and decision curves to determine the clinical utility of the model. A pvalue < 0.05 indicated a statistically significant difference between the two groups. Results Table 1 Comparison of clinical characteristics between the CS group and the SC group CS(n = 17) SC(n = 27) p Sex 0.211 Male 15(88.2%) 18(66.7%) Female 2(11.8%) 9(33.3%) Age(years) 56.65 ± 12.186 64.93 ± 8.302 0.01 Symptoms 0.831 Symptomatic 10(58.8%) 15(55.6%) Asymptomatic 7(41.2%) 12(44.4) Hepatitis B infection 0.143 With 12(70.6%) 13(48.1%) Without 5(29.4%) 14(51.9%) Liver cirrhosis 0.158 With 10(58.8%) 10(37.0%) Without 7(41.2%) 17(63.0%) Elevated CA199 level 0.988 With 5(29.4%) 8(33.3%) Without 12(70.6%) 19(66.7%) Elevated AFP level 0.108 With 7(41.2%) 4(14.8%) Without 10(58.8%) 23(85.2%) Elevated CEA level 〉0.99 With 0(0%) 0(0%) Without 17(100%) 27(100%) 1. Comparison of clinical characteristics The clinical data of patients in the CS group and SC group are summarized in Table 1. The CS group included 17 patients (15 males, 2 females, median age 57 years, range: 28–77 years), and the SC group included 27 patients (18 males, 9 females, median age 65 years, range: 45–78 years). Pathological diagnoses were obtained via surgical resection (17 CS cases, 19 CS cases) or biopsy (8 SC cases). The mean age of patients in the CS group (56.65 ± 11.82) was lower than that of patients in the SC group (64.93 ± 8.15), with statistical significance (P = 0.01). Both groups were predominantly male (88.2% vs. 66.7%). The most common chief complaint in both CS and SC patients was abdominal discomfort (58.8% vs 55.6%). Compared with the SC group, the CS group had a higher prevalence of hepatitis B (70.6% vs 48.1%), cirrhosis (58.8% vs 37.0%), and elevated AFP levels (41.2% vs 14.8%). Elevated CA199 levels were similar and rare in both groups (29.4% vs 33.3%), and no elevation of CEA was observed in either group. Table 2 Comparison of conventional imaging characteristics between the CS group and the SC group CS(n = 17) SC(n = 27) p Lesion site 0.893 Left lobe 3(17.65%) 7(25.93%) Right lobe 11(64.71%) 15(55.56%) Left and right lobe 3(17.65%) 4(14.81%) Caudate lobe 0(0.00%) 1(3.70%) Maximum tumor diameter(cm) 0.507 ≥ 5cm 11(64.71%) 20(74.07%) <5cm 6 (35.29%) 7(25.93%) Number of lesions 0.258 Single 12(70.59%) 24(88.89%) Multile 5(29.41%) 3(11.11%) Morphology 0.718 Round and round-like 6(35.29%) 11(40.74%) Irregular and lobulated 11(64.71%) 16(59.26%) Cystic degeneration /Necrosis 0.675 With 15(88.24%) 26(96.30%) Without 2(11.76%) 1(3.70%) Hemorrhage 0.211 With 15(88.24%) 18(66.67%) Without 2(11.76%) 9(33.33%) Calcification 0.144 With 2(11.76%) 0(0.00%) Without 15(88.24%) 27(100.00%) Margins 0.907 Clear 6(35.29%) 10(37.04%) Unclear 11(64.71%) 17(62.96%) Perimembranous membrane 0.961 Present 1(5.88%) 3(11.11%) Absent 16(94.12%) 24(88.89%) Involvement of adjacent tissues 0.085 With 9(52.94%) 21(77.78%) Without 8(47.06%) 6(22.22%) Vascular invasion 0.603 With 5(29.41%) 10(37.04%) Without 12(70.59%) 17(62.96%) Bile duct invasion 1.00 With 1(5.88%) 1(3.70%) Without 16(94.12%) 26(96.30%) Lymph node metastasis 0.023 With 2(11.76%) 12(44.44%) Without 15(88.24%) 15(55.56%) Satellite nodes 0.453 With 2(11.76%) 7(25.93%) Without 15(88.24%) 20(74.07%) Adjacent visceral invasion 0.924 With 4(23.53%) 8(29.63%) Without 13(76.47%) 19(70.37%) Ascites or pleural effusion 0.87 With 3(17.65%) 3(11.11%) Without 14(82.35%) 24(88.89%) 2. Comparison of conventional imaging characteristics Table 2 summarizes the comparison of conventional imaging characteristics between the CS group and the SC group. CS and SC were more commonly found in the right lobe of the liver (64.71% vs 55.56%), with larger tumor sizes, most of which had a maximum diameter ≥ 5 cm (64.71% vs 74.07%) and were solitary (70.59% vs 88.89%). tumor shapes were predominantly irregular and lobulated (64.71% vs 59.26%), and most tumors exhibited necrosis (88.24% vs 96.30%) and hemorrhage (88.24% vs 66.67%). Calcification was observed in only 2 cases (5.88%) in the CS group. The tumor margins were predominantly indistinct (64.71% vs 62.96%), and the vast majority of tumors did not show a capsule (5.88% vs 11.11%). Compared with CS, SC showed more significant involvement of adjacent tissues (52.94% vs 77.78%), with nearly half of the SC group having lymph node metastasis, significantly higher than the CS group (5.88% vs 48.15%), and statistically significant (P = 0.023). In both groups, a small proportion of patients had vascular (29.41% vs 37.04%) or bile duct invasion (5.88% vs 3.70%), satellite nodules (11.76% vs 25.93%), invasion of adjacent viscera (23.53% vs 29.63%), and ascites or pleural effusion (17.65% vs 11.11%). Table 3 Comparison of enhanced imaging features between the CS group and the SC group CS(n = 17) SC(n = 27) p Arterial phase enhancement 0.323 overall enhancement: 1(5.88%) 1(3.70%) marginal and solid partial enhancement 9(52.94%) 9(33.33%) marginal enhancement 7(41.18%) 17(62.96%) no enhancement 0(0.00%) 0(0.00%) Septum 0.19 Present 6(35.29%) 15(55.56%) Absent 11(64.71%) 12(44.44%) Homogeneity 1 Homogeneous 0(0.00%) 0(0.00%) Heterogeneous 17(100.00%) 27(100.00%) Enhancement pattern 0.042 partial or complete regression 11(64.71%) 9(33.33%) gradual or sustained enhancement 6(35.29%) 18(66.67%) no or minimal enhancement 0(0.00%) 0(0.00%) 3. Comparison of enhanced imaging features Table 3 summarizes the comparison of enhanced imaging features between the CS group and the SC group. All cases in both the CS group and the SC group exhibited heterogeneous enhancement during the arterial phase. Regarding enhancement distribution, both groups showed overall enhancement in the arterial phase in 1 case (5.88% vs 3.70%). Marginal and solid part enhancement was more common in the CS group (52.94% vs 33.33%). while marginal enhancement (41.18% vs 62.96%) and septations and septations enhancement (35.29% vs 55.56%) were more common in the SC group. No enhancement was observed in the central necrotic-like low density/signal in either group. Regarding dynamic enhancement patterns, partial or complete regression in the delayed phase (Figs. 1, 3, and 6) was more common in the CS group (64.71% vs 33.33%); progressive or persistent enhancement (Figs. 2, 4, and 5) was more common in the SC group (35.29% vs 66.67%), with statistical significance (P = 0.042). 4. Analysis of the diagnostic value of clinical and MRI imaging features for distinguishing primary liver carcinosarcoma from sarcomatoid carcinoma ROC curve analysis showed that the AUC values for distinguishing CS from SC based on age, lymph node metastasis characteristics, and enhancement pattern characteristics were 0.709, 0.633, and 0.657, respectively (Fig. 8A). We developed a predictive nomogram using the aforementioned predictive factors (Fig. 7). The AUC value for distinguishing CS from SC based on combined age, lymph node metastasis characteristics, and enhancement pattern characteristics was 0.826 (Fig. 8B). The calibration curve showed that the predicted probabilities were highly consistent with the actual status (Fig. 8C), and the decision curve demonstrated the clinical benefit for patients (see Fig. 8D). Discussions Primary CS and SC of the liver are extremely rare worldwide, with only a few cases reported in the English literature to date. In previous reports, these two types of tumors were identified as clinically highly aggressive cancers with extremely poor prognosis. In 2000, the third edition of the World Health Organization (WHO) tumor classification defined CS as a malignant tumor characterized by a close mixture of cancerous [hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCC)] and sarcomatous components, classified as a malignant tumor with bidirectional differentiation. SC, although morphologically similar to sarcomas, is essentially of epithelial origin with interstitial metaplasia and lacks true sarcomatous components, classified as a poorly differentiated carcinoma. Pathologists typically distinguish SC from CS based on phenotypic differences outlined in WHO guidelines. More stringent differentiation can also be based on immunohistochemical markers and ultrastructural features observed under electron microscopy. The sarcomatous components of CS lack epithelial markers and are considered true heterogeneous sarcomas, while the sarcomatous components of SC retain expression of epithelial markers [ 15 ] . The pathogenesis of both remains unclear, but increasing evidence in recent years supports the monoclonal origin theory [ 7 , 8 , 16 ] , suggesting that the tumor may originate from multipotent stem cells in the liver, which possess both epithelial and mesenchymal differentiation potential. Others propose that the malignant components may transform into sarcomatous components through metaplasia [ 17 ] . The most widely accepted theory for SC is the conversion theory, which posits that the sarcomatous component originates from the malignant transformation of the tumor during its evolutionary process [ 18 ] . Recent studies have also demonstrated that epithelial-mesenchymal transition is an important mechanism in sarcomatous transformation, further supporting this theory [ 19 ] . Our study found that among the 17 CS cases, 15 were male and 2 were female; among the 27 SC cases, 18 were male and 9 were female. with both groups showing a higher prevalence in males. The mean age in the CS group was 56.7 years (range: 28–77 years), with 8 cases (47%) aged over 60 years; in the SC group, the mean age was 64.9 years (range: 45–78 years), with 19 cases (70%) aged over 60 years. This indicates that both groups were more common in elderly male patients, consistent with previous literature reports [ 9 ] , and the average age of SC patients was 8 years higher than that of CS patients, with statistical significance (P = 0.01). In most cases, the symptoms of both groups were nonspecific, with right upper abdominal pain and abdominal distension reported as the most common chief complaints [ 11 , 20 ] . In this study, more than half of the patients in both groups exhibited such symptoms. Most patients in the CS group had hepatitis B, cirrhosis, and elevated AFP levels in nearly half of the cases, significantly higher than in the SC group. As is well known, most HCC cases are associated with hepatitis B, cirrhosis, and elevated AFP levels. Therefore, this study suggests that CS may have a more similar tumorigenic process to HCC than SC. Both groups had a similar proportion of patients with elevated CA199 levels, while none of the cases in this study showed elevated CEA levels. CS and SC were more commonly located in the right lobe of the liver and were predominantly solitary tumors. The majority of tumors were large, with an average diameter of 8.5 cm (range 4–18 cm) in the CS group, and 11 cases (64.71%) had a tumor diameter ≥ 5 cm; in the SC group, the average diameter was 7.7 cm (range 1.7–21.5 cm), with 20 cases (74.07%) having a tumor diameter ≥ 5 cm. The incidence of necrosis was high in both groups, with a wide range of necrosis, and the necrotic areas were mostly located in the central region of the tumor, while the solid components were located in the peripheral region. The authors believe that both tumors have high malignancy and grow rapidly, but their blood supply cannot keep up, leading to necrosis and cystic transformation. Most tumors in both groups had indistinct borders and lacked a distinct capsule, indicating that most tumors, due to the absence of a complete capsule, were prone to invading surrounding areas. Previous studies have observed calcification and bone tissue in tumors containing chondrosarcoma and osteosarcoma components, which are considered important CT features for diagnosing CS [ 21 , 22 ] . Since SC does not exhibit osteogenic activity, osteogenic activity is a specific diagnostic feature of CS with osteosarcoma components. In this study, two out of 17 CS patients exhibited signs of calcification or bone tissue, manifested as extremely high-density shadows on plain CT scans (Fig. 2). Due to the high malignant grade of both patient groups, most cases involved involvement of adjacent tissues. Among the SC group, nearly half of the patients had lymph node enlargement, significantly higher than the CS group, with statistical significance (P = 0.023). We speculate that this may be due to the different biological characteristics of the two tumors. The sarcomatoid components of SC are more aggressive and tend to spread via the lymphatic system, leading to a higher rate of lymph node metastasis. In contrast, CS may be more similar to traditional hepatocellular carcinoma, primarily spreading via hematogenous metastasis with relatively fewer lymph node metastases. Previous studies have reported that in 63 cases of CS, lymph node metastasis occurred in 16.2% of patients, while in 22 cases of SC, lymph node enlargement was observed in 27.3% of patients. Shi et al. analyzed 10 cases of SC and found that 40% of patients developed lymph node metastasis. Additionally, a small proportion of patients in both groups exhibited vascular or bile duct invasion, satellite nodules, extrahepatic metastasis, or ascites or pleural effusion. Due to differences in the proportions of malignant and sarcomatous components and varying pathological types between the CS and SC groups, the imaging enhancement patterns also differed. All cases in this study exhibited heterogeneous enhancement during the arterial phase. In the CS group, marginal and solid component enhancement and marginal enhancement accounted for the majority, with similar proportions; in the SC group, marginal enhancement was predominant, while marginal and solid component enhancement were less common, suggesting that SC may be more expansive than CS. More septa were observed in the SC group after enhancement. The enhancement patterns of the two groups showed significant differences (P = 0.042). In the CS group, the late phase was primarily characterized by regression or partial regression, with a small proportion showing persistent or progressive enhancement, whereas in the SC group, persistent or progressive enhancement was predominant, with regression or partial regression accounting for a small proportion. This suggests that in terms of enhancement patterns, CS may be more similar to HCC, SC is more similar to ICC. Bin [ 12 ] et al. summarized the dynamic enhancement patterns of 20 CS cases, with only 1 case showing a continuous progressive enhancement process, while the remaining cases exhibited “rapid onset and rapid resolution” (70%) or “rapid onset and slow resolution” (25%) dynamic enhancement patterns. Other studies have also found [ 23 ] that the CT enhancement characteristics of 22 SC lesions were significantly different from those of HCC lesions and similar to those of ICC lesions, characterized by progressive enhancement in the delayed phase. Additionally, 1/5 of the lesions exhibited a non-peripheral washout pattern. Another report [ 24 ] of 17 SC lesions showed that approximately two-thirds of the cases demonstrated sustained high enhancement in the delayed phase on enhanced MRI scans. These findings are consistent with our study results. This is a single-center retrospective comparative study and has certain limitations. First, although the number of cases in our study is relatively adequate compared with previous imaging studies, the total number of cases remains relatively small due to the low incidence of CS and SC, so we did not explore differences in imaging findings between the two subtypes. Second, we did not provide patient outcomes or survival data, as most patients were lost to follow-up, resulting in incomplete survival data for the entire study cohort. Finally, as this is our preliminary study, we did not use quantitative imaging features. In future studies, we plan to include multicenter data to expand the sample size and introduce radiomics and artificial intelligence methods to distinguish between CS and SC. Conclusion In summary, the typical features of CS and SC include solitary lesions, large tumor size, common bleeding and necrosis, and heterogeneous enhancement in the arterial phase. Valuable clues for distinguishing between the two include a higher age in the SC group compared to the CS group, and significantly more lymph node metastasis in the SC group than in the CS group. In terms of enhancement patterns, the CS group primarily exhibited partial or complete regression in the delayed phase, while the SC group primarily exhibited persistent or progressive enhancement, indicating that CS is more similar to HCC in imaging findings, whereas SC is more similar to ICC. Therefore, a detailed analysis of clinical and imaging characteristics will aid in achieving an accurate diagnosis. Declarations Author Contribution Lun Lu , Ruiping Zhang ,Xingpeng Pan,Helin Li and Guihong Nian are co-first authors.Yiping Liu, Yayuan Feng and Ningyang Jia are co-corresponding authors.Lun Lu , Ruiping Zhang ,Xingpeng Pan,Helin Li and Guihong Nian wrote the main manuscript text. Yiping Liu and Yayuan Feng prepared figures. 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Chen L T, Ruan S J, Wang P.et al. Imaging features of primary hepatic sarcomatoid carcinoma: Differentiation from hepatocellular carcinoma and intrahepatic cholangiocarcinoma on CT: A preliminary study. Heliyon. 2023;9(3):e14123 Zhang H B, Chai S Y, Chen L T. et al. MRI Features of Hepatic Sarcomatoid Carcinoma Different From Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.Front Oncol.2021;11:611738. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Aug, 2025 Read the published version in Abdominal Radiology → Version 1 posted Editorial decision: Revision requested 03 Jun, 2025 Reviews received at journal 02 Jun, 2025 Reviews received at journal 26 May, 2025 Reviewers agreed at journal 18 May, 2025 Reviews received at journal 15 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers invited by journal 13 May, 2025 Editor assigned by journal 12 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 08 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6621988","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456190866,"identity":"1c25b13c-893a-4f2c-8a27-81e21727730c","order_by":0,"name":"Lun Lu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Lun","middleName":"","lastName":"Lu","suffix":""},{"id":456190867,"identity":"c0f83eeb-604b-40ae-8bea-76de21daf1e4","order_by":1,"name":"Ruiping Zhang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ruiping","middleName":"","lastName":"Zhang","suffix":""},{"id":456190868,"identity":"6bb83319-1851-40fa-a9ba-4b78a6082aa6","order_by":2,"name":"Xingpeng Pan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xingpeng","middleName":"","lastName":"Pan","suffix":""},{"id":456190869,"identity":"9d9c7ec7-d7bb-4fbb-a0b7-834481bce050","order_by":3,"name":"Helin Li","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Helin","middleName":"","lastName":"Li","suffix":""},{"id":456190870,"identity":"451bcaa7-ba20-4bb8-b476-1eef7618e23c","order_by":4,"name":"Guihong Nian","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Guihong","middleName":"","lastName":"Nian","suffix":""},{"id":456190873,"identity":"1896ac77-1813-4e78-8c1f-d38e2191baa1","order_by":5,"name":"Yiping Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACPmYgkcAgwcDAzNj44IOBjRxBLWxwLezMhw1nFKQZE9YCZ/GzpUnzfDicSFgLO4+ZxMMdFnnyzjzGxjYGzAkM7IePbsDvMKCWxDMSxYaHeQwf5xiw5THwpKXdIKylTSJxYzPQlhwDnmIGCR4zorWYSVsYSCQ2EK1lPjPQ+wwGBsRoYSu2APolcQMzMJB7DBKM2Qj5hZ//8MabP3fUJc7vP9j44Mef/3L87IeP4dUCBCwSjA0MDAYHYPYSUA4CzB9AWuQbiFA6CkbBKBgFIxMAABG0QEAO7zzeAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Yiping","middleName":"","lastName":"Liu","suffix":""},{"id":456190875,"identity":"1349e43e-b408-4dc1-9d32-00a4263a23be","order_by":6,"name":"Yayuan Feng","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yayuan","middleName":"","lastName":"Feng","suffix":""},{"id":456190876,"identity":"f10ca21f-3eaa-4f6f-ba60-4de2481f2942","order_by":7,"name":"Ningyang Jia","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ningyang","middleName":"","lastName":"Jia","suffix":""}],"badges":[],"createdAt":"2025-05-08 15:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6621988/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6621988/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00261-025-05156-8","type":"published","date":"2025-08-23T16:29:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82887305,"identity":"601571de-ebd9-4ffb-8db4-df79eae7507e","added_by":"auto","created_at":"2025-05-16 11:55:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":536524,"visible":true,"origin":"","legend":"\u003cp\u003eA 60-year-old male patient with CS, presented with a liver mass for over a month. \u003cstrong\u003eA.\u003c/strong\u003e Non-contrast CT revealed a lobulated mass in the right lobe segment V, with dilated bile ducts visible at the margins. \u003cstrong\u003eB. \u003c/strong\u003eDuring the arterial phase, the tumor margins and solid components show mild to moderate enhancement.\u003cstrong\u003e C and D. \u003c/strong\u003eDuring the portal venous phase and delayed phase, the tumor margins and solid components show decreased enhancement. \u003cstrong\u003eE.\u003c/strong\u003e HE is staining (×100): The tumor tissue primarily consists of spindle-shaped cells arranged in a woven pattern, with occasional glandular epithelial cells visible.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/ad60f5c86680abc6dce0587c.png"},{"id":82888784,"identity":"236af851-cc6d-4f02-b0c7-8a53da750115","added_by":"auto","created_at":"2025-05-16 12:03:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1222820,"visible":true,"origin":"","legend":"\u003cp\u003eA 73-year-old male patient with CS, presented with a right hepatic mass detected by ultrasound for one week. \u003cstrong\u003eA and B.\u003c/strong\u003eNon-contrast CT revealed an irregular mass in the right hepatic segments V and VI, with scattered dense calcifications visible within.\u003cstrong\u003e C. \u003c/strong\u003eDuring the arterial phase, the margins and solid components of the mass showed mild to moderate enhancement. \u003cstrong\u003eD and E. \u003c/strong\u003ePortal phase and delayed phase: The margins and solid components of the mass appear as isodense lesions. \u003cstrong\u003eF and G. \u003c/strong\u003eThe same patient's MR plain scan T1WI in-out of phase shows an irregularly hypointense mass. \u003cstrong\u003eH. \u003c/strong\u003eT2 fat-suppressed images show the mass as hyperintense. \u003cstrong\u003eI. \u003c/strong\u003eArterial phase: The margins and solid components of the mass show mild to moderate enhancement. \u003cstrong\u003eJ. \u003c/strong\u003eDelayed phase: The mass shows persistent enhancement. \u003cstrong\u003eK. \u003c/strong\u003eHE staining (×100): Tumor tissue arranged in two patterns: most are woven, with spindle-shaped cells, and a small portion are glandular tubular.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/fdec6ac440b54b583c0af037.png"},{"id":82887310,"identity":"15b87f35-4911-4356-89f3-7927d7b8c29e","added_by":"auto","created_at":"2025-05-16 11:55:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":842017,"visible":true,"origin":"","legend":"\u003cp\u003eA 40-year-old male patient with CS, presented with recurrent right upper abdominal distension and discomfort accompanied by radiating pain in the back for 20 days. \u003cstrong\u003eA and B. \u003c/strong\u003eMR plain scan T1WI in-out of phase shows a round-shaped mixed high and low signal mass in segments V and VI. \u003cstrong\u003eC. \u003c/strong\u003eDWI shows mixed high signal. \u003cstrong\u003eD. \u003c/strong\u003eT2WI shows mixed high signal. \u003cstrong\u003eE. \u003c/strong\u003eIn the arterial phase, the edges and solid parts of the mass show significant enhancement. \u003cstrong\u003eF.\u003c/strong\u003e In the portal venous phase, the mass continues to enhance. \u003cstrong\u003eG. \u003c/strong\u003eIn the delayed phase, the mass shows reduced enhancement in the coronal view. \u003cstrong\u003eH. \u003c/strong\u003eHE staining (×100): Tumor tissue arranged in two patterns: most are glandular tubular, and a small portion are woven, with spindle-shaped cells.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/64c4e94e406741514b406493.png"},{"id":82888786,"identity":"71662c37-a0c1-459b-ab9c-919519fdff14","added_by":"auto","created_at":"2025-05-16 12:03:53","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":503965,"visible":true,"origin":"","legend":"\u003cp\u003eA 68-year-old male patient with SC, presented with a right hepatic mass detected by ultrasound 11 days prior. \u003cstrong\u003eA. \u003c/strong\u003eNon-contrast CT revealed a roundish low-density mass in the right hepatic lobe segment VII. \u003cstrong\u003eB.\u003c/strong\u003e During the arterial phase, the mass showed marginal enhancement with abnormal perfusion around the periphery. \u003cstrong\u003eC and D. \u003c/strong\u003ePortal phase and delayed phase show progressive enhancement of the mass. \u003cstrong\u003eE.\u003c/strong\u003eHE staining ( ×100): spindle-shaped, pleomorphic atypical cells show proliferative growth with diffuse infiltrative pattern, accompanied by a background of numerous lymphoplasmacytic cells and a few multinucleated giant cells.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/50ac39adf5c903e3d0416d64.png"},{"id":82887307,"identity":"707d96e5-febf-4e95-b3d9-68302a936447","added_by":"auto","created_at":"2025-05-16 11:55:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":919166,"visible":true,"origin":"","legend":"\u003cp\u003eA 69-year-old female patient with SC, was found to have a liver mass in the caudate lobe during a physical examination 20 days prior. \u003cstrong\u003eA and B.\u003c/strong\u003e MR plain scan T1WI in-out of phase shows a round, mixed low-signal mass in segment I. \u003cstrong\u003eC.\u003c/strong\u003e DWI shows mixed high signal. \u003cstrong\u003eD. \u003c/strong\u003eT2WI shows mixed high signal. \u003cstrong\u003eE. \u003c/strong\u003eDuring the arterial phase, the mass shows marked enhancement at the margins. \u003cstrong\u003eF and G. \u003c/strong\u003eProgressive enhancement of the mass in the portal and delayed phases. \u003cstrong\u003eH. \u003c/strong\u003eHE staining (×100): Showing spindle-shaped, pleomorphic, atypical cells with infiltrative growth, involving the fibrous capsule, with a background of scattered lymphoplasmacytic cells.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/00fae316dbf16051d848048d.png"},{"id":82887312,"identity":"ff1c593a-24e8-4a22-8449-c1fb135b1ebd","added_by":"auto","created_at":"2025-05-16 11:55:53","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":897640,"visible":true,"origin":"","legend":"\u003cp\u003eA 67-year-old female patient with SC, presented with abdominal pain and a liver mass on physical examination for 5 days. \u003cstrong\u003eA and B: \u003c/strong\u003eMR plain scan with T1WI in-out of phase show a II, IV segments with lobulated, mixed low-signal intensity masses. \u003cstrong\u003eC. \u003c/strong\u003eDWI shows mixed high-signal intensity. \u003cstrong\u003eD. \u003c/strong\u003eT2WI shows mixed high-signal intensity. \u003cstrong\u003eE. \u003c/strong\u003eT2WI reveals lymph node metastasis in the hepatic hilum (red arrow). \u003cstrong\u003eF. \u003c/strong\u003eIn the arterial phase, the tumor margins and solid components show marked enhancement, with internal septal enhancement. \u003cstrong\u003eG and H. \u003c/strong\u003eIn the portal phase and delayed phase, the edges and solid components of the mass show decreased enhancement. \u003cstrong\u003eI. \u003c/strong\u003eHE staining (×100): Show spindle-shaped, pleomorphic atypical cells with proliferative growth, presenting diffuse infiltrative growth, accompanied by a background of numerous lymphoplasmacytic cells.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/e6dbe38316be7b5fc270ee17.png"},{"id":82891166,"identity":"70fc224f-1291-4785-826c-9c2d41220b86","added_by":"auto","created_at":"2025-05-16 12:11:53","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":38964,"visible":true,"origin":"","legend":"\u003cp\u003eDiagnostic line chart for patients in the CS group and SC group.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/87b02a1475d1ddfb23d58c4f.png"},{"id":82887309,"identity":"26052fbb-cf56-4b1b-9d2c-b67ba01cbd72","added_by":"auto","created_at":"2025-05-16 11:55:53","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":127201,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA. \u003c/strong\u003eROC curve analysis of age, lymph node metastasis characteristics, and enhancement pattern characteristics for the diagnosis of patients in the CS group and SC group. \u003cstrong\u003eB.\u003c/strong\u003e ROC curve analysis of the diagnostic performance of combined age, lymph node metastasis characteristics, and enhancement pattern characteristics for patients in the CS group and SC group. \u003cstrong\u003eC.\u003c/strong\u003e Diagnostic calibration curve of patients in the CS group and SC group. \u003cstrong\u003eD. \u003c/strong\u003eDiagnostic decision curve of patients in the CS group and SC group.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/0631216a69cd4d6ba9a3b5c3.png"},{"id":82892558,"identity":"4580e117-1bde-443d-829a-72e0aac43b90","added_by":"auto","created_at":"2025-05-16 12:19:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6432066,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6621988/v1/6ce1ad2d-b31d-494d-a20b-fb4eeebd48d3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical and Imaging Comparison of Primary Liver Carcinosarcoma and Sarcomatoid Carcinoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePrimary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver, with reported incidence rates accounting for only 0.4% of all liver malignancies \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. CS contains both carcinogenic and sarcomatous components, while SC is an epithelial-derived carcinoma with sarcomatous differentiation. Both are highly aggressive clinically, prone to recurrence and metastasis, and have a poor prognosis\u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. To date, only a few cases have been reported in the English literature, with most studies being case reports focusing on pathogenesis, pathological diagnosis, treatment, and prognosis \u003csup\u003e[\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Among these, only a few studies briefly described the imaging characteristics of CS or SC\u003csup\u003e[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, and there are currently no reports comparing the imaging features of these two tumors. Although the two conditions often overlap in clinical and imaging manifestations, there are some diagnostic features that can help distinguish them. Our study aims to summarize the clinical characteristics and imaging manifestations of 17 cases of primary hepatic sarcomas and 27 cases of sarcomatous carcinomas, compare the two conditions, and further describe their distinct features, thereby enhancing understanding and diagnostic accuracy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e1. Patient Selection\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of our hospital. As this is a retrospective study, informed consent from patients was not required. We collected data on patients diagnosed with CS or SC who underwent surgery or needle biopsy between September 2010 and December 2024 at our hospital. We reviewed all patients' medical records and collected the following clinical data: gender, age, chief complaint, preoperative laboratory test results, including serum alpha-fetoprotein (AFP) levels, hepatitis B serology, serum carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9) and carcinoembryonic antigen (CEA) levels, as well as all preoperative imaging data from CT and MRI. The inclusion criteria for this study were as follows: (1) Patients with SC or CS confirmed by surgical resection or biopsy pathology; (2) Patients with complete preoperative clinical and imaging data, including liver plain scan and contrast-enhanced CT or MR images; (3) Patients who had not received any treatment prior to CT or MR imaging. (4) The interval between CT/MR imaging and surgical resection was less than 2 weeks. Exclusion criteria were as follows: (1) lack of pathological confirmation; (2) incomplete preoperative clinical and imaging data; (3) patients who received any treatment prior to CT/MR scanning; (4) the interval between CT/MR imaging and pathological examination exceeded two weeks; (5) patients with CT/MR images that were difficult to assess due to artifacts. Results: Among 18 CS patients, 1 patient underwent CT scan without contrast enhancement. Among 32 SC patients, 3 patients received transarterial chemoembolization (TACE) therapy prior to surgery; 1 of these patients had lung cancer metastasis to the liver, and 1 had uterine cancer metastasis to the liver. These 6 patients were excluded from the study. Ultimately, 17 CS patients and 27 SC patients were enrolled.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e2. Image Acquisition\u003c/h3\u003e\n\u003cp\u003eAll patients undergoing supine CT and MRI examinations had no history of contrast agent allergy. The scanning range extended from the upper margin of the diaphragm to the lower margin of the anterior superior iliac spine.\u003c/p\u003e\n\u003ch3\u003e2.1 CT Scan Parameters\u003c/h3\u003e\n\u003cp\u003eCT scans were performed using a GE Discovery 750HD multi-slice spiral scanner. Patients were instructed to drink 800\u0026ndash;1000 ml of water 10 minutes prior to scanning. A non-enhanced liver scan was followed by multi-phase contrast-enhanced scanning. Scan conditions: 120 kV, 250\u0026ndash;280 mA, matrix 512 \u0026times; 512, pitch 1.0, slice thickness 10 mm for plain scan and 5 mm for contrast-enhanced scan. Patients held their breath during scanning for 16\u0026ndash;20 seconds. The contrast agent is Iohexol, with a total dose of 1.5 ml/kg, administered at a rate of 2.5\u0026ndash;3.5 ml/s via the elbow vein. The arterial phase scan is performed 23\u0026ndash;26 seconds after contrast agent injection, the portal phase scan at 50\u0026ndash;60 seconds, and the delayed phase scan at 120\u0026ndash;160 seconds.\u003c/p\u003e\n\u003ch3\u003e2.2 MRI scan parameters\u003c/h3\u003e\n\u003cp\u003eMRI was performed using a GE Signa Infinity Twin Speed 1.5T and GE Optima MR360 1.5T scanner, equipped with an 8-channel abdominal surface coil. Patients were instructed to fast and abstain from drinking for 4 hours prior to scanning. Breathing exercises were performed before scanning. The patients lay back on the inspection bed with their feet entering first. After a whole-liver non-contrast scan, multi-phase contrast-enhanced scanning was performed. Scanning conditions and parameters were as follows: Transverse T1-weighted imaging (T1WI): Gradient echo sequence, breath-hold at end-expiration, TR/TE\u0026thinsp;=\u0026thinsp;190/4.3 ms, slice thickness 8 mm, slice interval 2 mm, matrix\u0026thinsp;=\u0026thinsp;256 \u0026times; 160, FOV\u0026thinsp;=\u0026thinsp;44 \u0026times; 40 cm. Transverse T2WI: Rapid spin-echo sequence with fat suppression, using respiratory gating, TR/TE\u0026thinsp;=\u0026thinsp;7059/85 ms, slice thickness 8 mm, slice interval 2 mm, matrix\u0026thinsp;=\u0026thinsp;320\u0026times;224, FOV\u0026thinsp;=\u0026thinsp;44\u0026times;40 cm. DWI: b\u0026thinsp;=\u0026thinsp;600 sec/mm\u0026sup2;, breath-hold scan, TR/TE\u0026thinsp;=\u0026thinsp;3000/74 ms, slice thickness 8 mm, slice interval 2 mm, matrix\u0026thinsp;=\u0026thinsp;128\u0026times;160, FOV\u0026thinsp;=\u0026thinsp;44\u0026times;40 cm. Contrast-enhanced: using three-dimensional LAVA technique, contrast agent: Gd-DTPA, high-pressure injection, total dose: 0.1 mmol/kg, followed by equal volume of normal saline, injection rate: 2.0\u0026ndash;3.0 ml/s. After contrast agent administration via the elbow vein, perform arterial phase scanning at 20\u0026ndash;28 seconds, portal phase scanning at 55\u0026ndash;65 seconds, and delayed phase scanning at 120\u0026ndash;160 seconds.\u003c/p\u003e\n\u003ch3\u003e3. Image analysis\u003c/h3\u003e\n\u003cp\u003eThe imaging results were independently reviewed by two abdominal radiologists with over 10 years of experience and cross-checked by another radiologist to reach a consistent conclusion. This study evaluated tumor characteristics including: lesion location (left, right,both or Caudate lobe ), number (single or multiple), size (maximum diameter, \u0026ge;\u0026thinsp;5 cm or \u0026lt;\u0026thinsp;5 cm), shape (round or oval, irregular or lobulated), density/signal (cystic/necrotic, hemorrhage, calcification), margin (clear or unclear), capsule (present or absent), involvement of adjacent tissues (including vessels, bile ducts, lymph nodes, satellite nodules, invasion of adjacent viscera, ascites, or pleural effusion); enhancement patterns on contrast-enhanced images (global enhancement, marginal and solid component enhancement, marginal enhancement, or no enhancement); segmentation, homogeneity, and enhancement patterns (partial or complete regression, progressive or sustained enhancement, or no or minimal enhancement).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch3\u003e4. Pathological assessment\u003c/h3\u003e\n\u003cp\u003eAll 17 cases of CS and 27 cases of SC included in this study were evaluated by two senior pathologists. When results differed, a final pathological conclusion was reached through discussion. Tumors were diagnosed based on the histomorphological features of hematoxylin and eosin (HE) stained sections and immunohistochemical results in both groups. The histopathological factors assessed for each tumor included: gross type, histological type, fibrous capsule, necrosis or hemorrhage, vascular invasion, bile duct invasion, satellite nodules or intrahepatic metastasis, and extrahepatic implantation or lymph node metastasis. Microscopically, the tumors primarily consisted of pleomorphic spindle cells (sarcomatous component) and moderately to poorly differentiated adenocarcinoma or hepatocellular carcinoma components. Immunohistochemical findings included: epithelial markers: CK-p, EMA, Hep-1, GPC3, Arginase, etc.; mesenchymal markers: vimentin (VIM), Desmin, S-100, SMA, etc.; vascular endothelial growth factor (VEGF); hepatocyte markers: phosphatidylinositol glycoprotein 3 (Gly-3); and cholangiocyte markers CK7 and CK19, etc.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e5. Data analysis\u003c/h3\u003e\n\u003cp\u003eSPSS software version 27 (IBM, Chicago, Illinois, USA) was used for independent samplest-tests, chi-square tests, and Fisher's exact tests to assess differences in characteristics. Continuous variables (age) were analyzed using independent samples t-tests. Categorical variables (e.g., clinical characteristics and imaging features) were analyzed using two-sided chi-square tests and Fisher's exact tests. Receiver operating characteristic curves were used to assess the predictive performance of the model, calibration curves to evaluate consistency, and decision curves to determine the clinical utility of the model. A pvalue\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated a statistically significant difference between the two groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical characteristics between the CS group and the SC group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCS(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSC(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSymptomatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsymptomatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatitis B infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver cirrhosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated CA199 level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.988\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated AFP level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(85.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated CEA level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e〉0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e1. Comparison of clinical characteristics\u003c/h2\u003e\n \u003cp\u003eThe clinical data of patients in the CS group and SC group are summarized in Table\u0026nbsp;1. The CS group included 17 patients (15 males, 2 females, median age 57 years, range: 28\u0026ndash;77 years), and the SC group included 27 patients (18 males, 9 females, median age 65 years, range: 45\u0026ndash;78 years). Pathological diagnoses were obtained via surgical resection (17 CS cases, 19 CS cases) or biopsy (8 SC cases). The mean age of patients in the CS group (56.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.82) was lower than that of patients in the SC group (64.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15), with statistical significance (P\u0026thinsp;=\u0026thinsp;0.01). Both groups were predominantly male (88.2% vs. 66.7%). The most common chief complaint in both CS and SC patients was abdominal discomfort (58.8% vs 55.6%). Compared with the SC group, the CS group had a higher prevalence of hepatitis B (70.6% vs 48.1%), cirrhosis (58.8% vs 37.0%), and elevated AFP levels (41.2% vs 14.8%). Elevated CA199 levels were similar and rare in both groups (29.4% vs 33.3%), and no elevation of CEA was observed in either group.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of conventional imaging characteristics between the CS group and the SC group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 51.4218%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003eCS(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003eSC(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLesion site\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eLeft lobe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e3(17.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e7(25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eRight lobe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e15(55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eLeft and right lobe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e3(17.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e4(14.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eCaudate lobe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e1(3.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum tumor diameter(cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e20(74.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u0026lt;5cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e6 (35.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e7(25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of lesions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e12(70.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e24(88.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eMultile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e5(29.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e3(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMorphology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eRound and round-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e6(35.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e11(40.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eIrregular and lobulated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e16(59.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCystic degeneration /Necrosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e15(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e26(96.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e2(11.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e1(3.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemorrhage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e15(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e18(66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e2(11.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e9(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalcification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e2(11.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e15(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e27(100.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMargins\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eClear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e6(35.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e10(37.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e17(62.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerimembranous membrane\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e1(5.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e3(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e16(94.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e24(88.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvolvement of adjacent tissues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e9(52.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e21(77.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e8(47.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e6(22.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e5(29.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e10(37.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e12(70.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e17(62.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBile duct invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e1(5.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e1(3.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e16(94.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e26(96.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymph node metastasis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e2(11.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e12(44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e15(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e15(55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatellite nodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e2(11.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e7(25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e15(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e20(74.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjacent visceral invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e4(23.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e8(29.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e13(76.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e19(70.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAscites or pleural effusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 18.7204%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6161%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 9.2417%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e3(17.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e3(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 51.4218%;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 18.7204%;\"\u003e\n \u003cp\u003e14(82.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 20.6161%;\"\u003e\n \u003cp\u003e24(88.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.2417%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e2. Comparison of conventional imaging characteristics\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;2 summarizes the comparison of conventional imaging characteristics between the CS group and the SC group. CS and SC were more commonly found in the right lobe of the liver (64.71% vs 55.56%), with larger tumor sizes, most of which had a maximum diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm (64.71% vs 74.07%) and were solitary (70.59% vs 88.89%). tumor shapes were predominantly irregular and lobulated (64.71% vs 59.26%), and most tumors exhibited necrosis (88.24% vs 96.30%) and hemorrhage (88.24% vs 66.67%). Calcification was observed in only 2 cases (5.88%) in the CS group. The tumor margins were predominantly indistinct (64.71% vs 62.96%), and the vast majority of tumors did not show a capsule (5.88% vs 11.11%). Compared with CS, SC showed more significant involvement of adjacent tissues (52.94% vs 77.78%), with nearly half of the SC group having lymph node metastasis, significantly higher than the CS group (5.88% vs 48.15%), and statistically significant (P\u0026thinsp;=\u0026thinsp;0.023). In both groups, a small proportion of patients had vascular (29.41% vs 37.04%) or bile duct invasion (5.88% vs 3.70%), satellite nodules (11.76% vs 25.93%), invasion of adjacent viscera (23.53% vs 29.63%), and ascites or pleural effusion (17.65% vs 11.11%).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of enhanced imaging features between the CS group and the SC group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCS(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSC(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eArterial phase enhancement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoverall enhancement:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1(5.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1(3.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emarginal and solid partial enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e9(52.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e9(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emarginal enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e7(41.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e17(62.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeptum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6(35.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e15(55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e12(44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHomogeneity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomogeneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterogeneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17(100.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e27(100.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnhancement pattern\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epartial or complete regression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e11(64.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e9(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egradual or sustained enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6(35.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e18(66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno or minimal enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0(0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 5.5556%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 1.1396%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3. Comparison of enhanced imaging features\u003c/h2\u003e\n \u003cp\u003eTable 3 summarizes the comparison of enhanced imaging features between the CS group and the SC group. All cases in both the CS group and the SC group exhibited heterogeneous enhancement during the arterial phase. Regarding enhancement distribution, both groups showed overall enhancement in the arterial phase in 1 case (5.88% vs 3.70%). Marginal and solid part enhancement was more common in the CS group (52.94% vs 33.33%). while marginal enhancement (41.18% vs 62.96%) and septations and septations enhancement (35.29% vs 55.56%) were more common in the SC group. No enhancement was observed in the central necrotic-like low density/signal in either group. Regarding dynamic enhancement patterns, partial or complete regression in the delayed phase (Figs. 1, 3, and 6) was more common in the CS group (64.71% vs 33.33%); progressive or persistent enhancement (Figs. 2, 4, and 5) was more common in the SC group (35.29% vs 66.67%), with statistical significance (P\u0026thinsp;=\u0026thinsp;0.042).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4. Analysis of the diagnostic value of clinical and MRI imaging features for distinguishing primary liver carcinosarcoma from sarcomatoid carcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eROC curve analysis showed that the AUC values for distinguishing CS from SC based on age, lymph node metastasis characteristics, and enhancement pattern characteristics were 0.709, 0.633, and 0.657, respectively (Fig.\u0026nbsp;8A). We developed a predictive nomogram using the aforementioned predictive factors (Fig.\u0026nbsp;7). The AUC value for distinguishing CS from SC based on combined age, lymph node metastasis characteristics, and enhancement pattern characteristics was 0.826 (Fig.\u0026nbsp;8B). The calibration curve showed that the predicted probabilities were highly consistent with the actual status (Fig.\u0026nbsp;8C), and the decision curve demonstrated the clinical benefit for patients (see Fig.\u0026nbsp;8D).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003ePrimary CS and SC of the liver are extremely rare worldwide, with only a few cases reported in the English literature to date. In previous reports, these two types of tumors were identified as clinically highly aggressive cancers with extremely poor prognosis. In 2000, the third edition of the World Health Organization (WHO) tumor classification defined CS as a malignant tumor characterized by a close mixture of cancerous [hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCC)] and sarcomatous components, classified as a malignant tumor with bidirectional differentiation. SC, although morphologically similar to sarcomas, is essentially of epithelial origin with interstitial metaplasia and lacks true sarcomatous components, classified as a poorly differentiated carcinoma. Pathologists typically distinguish SC from CS based on phenotypic differences outlined in WHO guidelines. More stringent differentiation can also be based on immunohistochemical markers and ultrastructural features observed under electron microscopy. The sarcomatous components of CS lack epithelial markers and are considered true heterogeneous sarcomas, while the sarcomatous components of SC retain expression of epithelial markers \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The pathogenesis of both remains unclear, but increasing evidence in recent years supports the monoclonal origin theory \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, suggesting that the tumor may originate from multipotent stem cells in the liver, which possess both epithelial and mesenchymal differentiation potential. Others propose that the malignant components may transform into sarcomatous components through metaplasia \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The most widely accepted theory for SC is the conversion theory, which posits that the sarcomatous component originates from the malignant transformation of the tumor during its evolutionary process \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Recent studies have also demonstrated that epithelial-mesenchymal transition is an important mechanism in sarcomatous transformation, further supporting this theory \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study found that among the 17 CS cases, 15 were male and 2 were female; among the 27 SC cases, 18 were male and 9 were female. with both groups showing a higher prevalence in males. The mean age in the CS group was 56.7 years (range: 28\u0026ndash;77 years), with 8 cases (47%) aged over 60 years; in the SC group, the mean age was 64.9 years (range: 45\u0026ndash;78 years), with 19 cases (70%) aged over 60 years. This indicates that both groups were more common in elderly male patients, consistent with previous literature reports\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, and the average age of SC patients was 8 years higher than that of CS patients, with statistical significance (P\u0026thinsp;=\u0026thinsp;0.01). In most cases, the symptoms of both groups were nonspecific, with right upper abdominal pain and abdominal distension reported as the most common chief complaints \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. In this study, more than half of the patients in both groups exhibited such symptoms. Most patients in the CS group had hepatitis B, cirrhosis, and elevated AFP levels in nearly half of the cases, significantly higher than in the SC group. As is well known, most HCC cases are associated with hepatitis B, cirrhosis, and elevated AFP levels. Therefore, this study suggests that CS may have a more similar tumorigenic process to HCC than SC. Both groups had a similar proportion of patients with elevated CA199 levels, while none of the cases in this study showed elevated CEA levels.\u003c/p\u003e \u003cp\u003eCS and SC were more commonly located in the right lobe of the liver and were predominantly solitary tumors. The majority of tumors were large, with an average diameter of 8.5 cm (range 4\u0026ndash;18 cm) in the CS group, and 11 cases (64.71%) had a tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm; in the SC group, the average diameter was 7.7 cm (range 1.7\u0026ndash;21.5 cm), with 20 cases (74.07%) having a tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm. The incidence of necrosis was high in both groups, with a wide range of necrosis, and the necrotic areas were mostly located in the central region of the tumor, while the solid components were located in the peripheral region. The authors believe that both tumors have high malignancy and grow rapidly, but their blood supply cannot keep up, leading to necrosis and cystic transformation. Most tumors in both groups had indistinct borders and lacked a distinct capsule, indicating that most tumors, due to the absence of a complete capsule, were prone to invading surrounding areas. Previous studies have observed calcification and bone tissue in tumors containing chondrosarcoma and osteosarcoma components, which are considered important CT features for diagnosing CS \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Since SC does not exhibit osteogenic activity, osteogenic activity is a specific diagnostic feature of CS with osteosarcoma components. In this study, two out of 17 CS patients exhibited signs of calcification or bone tissue, manifested as extremely high-density shadows on plain CT scans (Fig.\u0026nbsp;2). Due to the high malignant grade of both patient groups, most cases involved involvement of adjacent tissues. Among the SC group, nearly half of the patients had lymph node enlargement, significantly higher than the CS group, with statistical significance (P\u0026thinsp;=\u0026thinsp;0.023). We speculate that this may be due to the different biological characteristics of the two tumors. The sarcomatoid components of SC are more aggressive and tend to spread via the lymphatic system, leading to a higher rate of lymph node metastasis. In contrast, CS may be more similar to traditional hepatocellular carcinoma, primarily spreading via hematogenous metastasis with relatively fewer lymph node metastases. Previous studies have reported that in 63 cases of CS, lymph node metastasis occurred in 16.2% of patients, while in 22 cases of SC, lymph node enlargement was observed in 27.3% of patients. Shi et al. analyzed 10 cases of SC and found that 40% of patients developed lymph node metastasis. Additionally, a small proportion of patients in both groups exhibited vascular or bile duct invasion, satellite nodules, extrahepatic metastasis, or ascites or pleural effusion.\u003c/p\u003e \u003cp\u003eDue to differences in the proportions of malignant and sarcomatous components and varying pathological types between the CS and SC groups, the imaging enhancement patterns also differed. All cases in this study exhibited heterogeneous enhancement during the arterial phase. In the CS group, marginal and solid component enhancement and marginal enhancement accounted for the majority, with similar proportions; in the SC group, marginal enhancement was predominant, while marginal and solid component enhancement were less common, suggesting that SC may be more expansive than CS. More septa were observed in the SC group after enhancement. The enhancement patterns of the two groups showed significant differences (P\u0026thinsp;=\u0026thinsp;0.042). In the CS group, the late phase was primarily characterized by regression or partial regression, with a small proportion showing persistent or progressive enhancement, whereas in the SC group, persistent or progressive enhancement was predominant, with regression or partial regression accounting for a small proportion. This suggests that in terms of enhancement patterns, CS may be more similar to HCC, SC is more similar to ICC. Bin \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e et al. summarized the dynamic enhancement patterns of 20 CS cases, with only 1 case showing a continuous progressive enhancement process, while the remaining cases exhibited \u0026ldquo;rapid onset and rapid resolution\u0026rdquo; (70%) or \u0026ldquo;rapid onset and slow resolution\u0026rdquo; (25%) dynamic enhancement patterns. Other studies have also found \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e that the CT enhancement characteristics of 22 SC lesions were significantly different from those of HCC lesions and similar to those of ICC lesions, characterized by progressive enhancement in the delayed phase. Additionally, 1/5 of the lesions exhibited a non-peripheral washout pattern. Another report \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e of 17 SC lesions showed that approximately two-thirds of the cases demonstrated sustained high enhancement in the delayed phase on enhanced MRI scans. These findings are consistent with our study results.\u003c/p\u003e \u003cp\u003eThis is a single-center retrospective comparative study and has certain limitations. First, although the number of cases in our study is relatively adequate compared with previous imaging studies, the total number of cases remains relatively small due to the low incidence of CS and SC, so we did not explore differences in imaging findings between the two subtypes. Second, we did not provide patient outcomes or survival data, as most patients were lost to follow-up, resulting in incomplete survival data for the entire study cohort. Finally, as this is our preliminary study, we did not use quantitative imaging features. In future studies, we plan to include multicenter data to expand the sample size and introduce radiomics and artificial intelligence methods to distinguish between CS and SC.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the typical features of CS and SC include solitary lesions, large tumor size, common bleeding and necrosis, and heterogeneous enhancement in the arterial phase. Valuable clues for distinguishing between the two include a higher age in the SC group compared to the CS group, and significantly more lymph node metastasis in the SC group than in the CS group. In terms of enhancement patterns, the CS group primarily exhibited partial or complete regression in the delayed phase, while the SC group primarily exhibited persistent or progressive enhancement, indicating that CS is more similar to HCC in imaging findings, whereas SC is more similar to ICC. Therefore, a detailed analysis of clinical and imaging characteristics will aid in achieving an accurate diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLun Lu , Ruiping Zhang ,Xingpeng Pan,Helin Li and Guihong Nian are co-first authors.Yiping Liu, Yayuan Feng and Ningyang Jia are co-corresponding authors.Lun Lu , Ruiping Zhang ,Xingpeng Pan,Helin Li and Guihong Nian wrote the main manuscript text. Yiping Liu and Yayuan Feng prepared figures. Ningyang Jia conceived the research idea and designed the manuscript framework. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang Q B, Cui B K, Weng J M,et al.Clinicopathological characteristics and outcome of primary sarcomatoid carcinoma and carcinosarcoma of the liver. J Gastrointest Surg, 2012;16(9):1715\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi B L, Zhang Y Q, Hou J,et al. Primary liver carcinosarcoma and 18F-FDG PET/CT.Clin. Clin Nucl Med. 2016;41(8):e383-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorisue R, Kojima M, Suzuki T, et al. Sarcomatoid hepatocellular carcinoma is distinct from ordinary hepatocellular carcinoma: Clinicopathologic, transcriptomic and immunologic analyses. Int J Cancer. 2021;149(3):546\u0026ndash;560.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu L, Tsilimigras D I, Farooq A, et al. Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population-based analysis. Cancer. 2019,125(21):3767\u0026ndash;3775.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHao D Q,Huai B G, Ze L ,et al. Primary hepatocellular carcinosarcoma: A case series and literature review. Clin Res Hepatol Gastroenterol. 2025;49(2):102520.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamoto Y, Ojima H, Shimada K, et al. Longterm recurrence-free survival in a patient with primary hepatic carcinosarcoma: case report with a literature review. Jpn J Clin Oncol. 2010;40(2):166\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin Y S, Wang T Y, Lin J C, et al. Hepatic carcinosarcoma: clinicopathologic features and a review of the literature. Ann Hepatol 2013;12(3):495\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu Y J, Zhu Y Y,Lu X Y et al.Hepatic carcinosarcoma: evidence of polyclonal origin based on microsatellite analysis. Pathol Res Pract. 2015;211(12): 905\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J P, Yao Z G, Sun Y W, et al. Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma. World J Gastroenterol 2020; 26(29): 4327\u0026ndash;4342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao S H, Su T H, Jeng Y M, et al. Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma. Hepatology. 2019(1); 69: 209\u0026ndash;221\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Liang P, Zhang D D, et al. Primary carcinosarcoma of the liver: imaging features and clinical ffndings in six cases and a review of the literature. Cancer Imaging. 2018;18(1):7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBin F L, Chen Z H, Liu P, et al. The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature. J Hepatocell Carcinoma.2020;7:169\u0026ndash;180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe G M,Huang W Q,Zhou Z M.et al.Dynamic contrastenhanced CT and clinical features of sarcomatoid hepatocellular carcinoma. Abdom Radiol (NY). 2023;48(10):3091\u0026ndash;3100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi D L, Ma L, Zhao D W.et al.Imaging and clinical features of primary hepatic sarcomatous carcinoma. Cancer Imaging. 2018;18(1):36\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshak KG, Anthony PP, Niederau C. Mesenchymal tumours of the liver. In: Stanley RH, Lauri AA, editors. WHO international histological classification of Tumours, Pathology \u0026amp; Genetics of the Tumours of the digestive system. Lyon: IARC Press; 2000. p. 198\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYasutake T, Kiryu S, Akai H, et al. MR imaging of carcinosarcoma of the liver using Gd-EOB-DTPA. Magn Reson Med Sci. 2014;13(2):117\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLao X M,Chen D Y, Zhang Y Q, et al.Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature.Am J Surg Pathol. 2007;31(6): 817\u0026ndash;826.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim D K, Kim B R, Jeong J S, Baek Y H. Analysis of intrahepatic sarcomatoid cholangiocarcinoma: Experience from 11 cases within 17 years. World J Gastroenterol. 2019; 25(5): 608\u0026ndash;621.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung C O, Choi H, Lee K W, Kim S H. Sarcomatoid carcinoma represents a complete phenotype with various pathways of epithelial mesenchymal transition. J Clin Pathol. 2013; 66(7): 601\u0026ndash;606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKan A, Guo R P. The Prognosis of Subsequent Surgical Treatment in Patients With Sarcomatoid Carcinoma in the Liver: A Retrospective Study. Int J Surg. 2018;55:145\u0026ndash;151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai Q, Levi Sandri G B, Melandro F, et al. An unusual case of hepatic carcinosarcoma. G Chir. 2011;32(8\u0026ndash;9):372\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiang S, Chen Y F, Guan Y. et al.Primary combined hepatocellularcholangiocellular sarcoma: An unusual case. World J Gastroenterol. 2015;21(23): 7335\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L T, Ruan S J, Wang P.et al. Imaging features of primary hepatic sarcomatoid carcinoma: Differentiation from hepatocellular carcinoma and intrahepatic cholangiocarcinoma on CT: A preliminary study. Heliyon. 2023;9(3):e14123\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H B, Chai S Y, Chen L T. et al. MRI Features of Hepatic Sarcomatoid Carcinoma Different From Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.Front Oncol.2021;11:611738.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"primary liver carcinosarcoma, primary liver sarcomatoid carcinoma, computed tomography, magnetic resonance imaging","lastPublishedDoi":"10.21203/rs.3.rs-6621988/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6621988/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Primary liver carcinosarcoma (CS) and sarcomatoid carcinoma (SC) are rare malignant tumors of the liver. Although the two tumors often overlap in clinical and imaging manifestations, there are currently no reports comparing the imaging features of these two tumors. Our study aims to compare the clinical characteristics and imaging features of these two tumors to further describe their distinct features, thereby enhancing understanding and diagnostic accuracy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis was conducted on the clinical and imaging data of 17 patients with CS and 27 patients with SC diagnosed by surgical or needle biopsy between September 2010 and December 2024 at our hospital. The data were summarized and statistically analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Both groups were predominantly male, with a lower mean age (56.65 ± 11.82) in the CS group compared to the SC group (64.93 ± 8.15) (P = 0.01). Compared to the SC group, the CS group more commonly presented with hepatitis B, cirrhosis, and elevated AFP levels. Both groups were more commonly located in the right hepatic lobe, with larger tumors that were often solitary, irregularly shaped, and lobulated. Most tumors exhibited necrosis and hemorrhage. Calcification was observed in two cases in the CS group on CT scans. The tumor margins were predominantly indistinct, and the majority of tumors did not show a capsule. Approximately half of the patients in the SC group had lymph node metastasis, which was significantly higher than in the CS group (P = 0.023). After contrast enhancement, all cases in both groups showed heterogeneous enhancement in the arterial phase. Regarding enhancement distribution, the CS group more commonly exhibited enhancement at the margins and in the solid components, while most cases in the SC group showed enhancement at the margins and in the septa. In terms of dynamic enhancement patterns, the CS group more commonly exhibited partial or complete regression in the delayed phase, while the SC group more commonly exhibited progressive or persistent enhancement in the delayed phase, with statistical significance (P=0.042).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePatients in the SC group had significantly higher age and lymph node metastasis than those in the CS group. In terms of tumor enhancement patterns, the CS group primarily exhibited delayed-phase regression or partial regression, while the SC group primarily exhibited delayed-phase persistent or progressive enhancement.\u003c/p\u003e","manuscriptTitle":"Clinical and Imaging Comparison of Primary Liver Carcinosarcoma and Sarcomatoid Carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 11:55:48","doi":"10.21203/rs.3.rs-6621988/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-03T15:42:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T06:35:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T10:25:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61279159174590121024003542612752632125","date":"2025-05-19T01:00:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T10:25:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285755323507911981433972853860592851813","date":"2025-05-13T22:51:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328888122982009589191956505540956809143","date":"2025-05-13T19:05:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T06:26:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-12T09:59:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T09:56:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Abdominal Radiology","date":"2025-05-08T15:34:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dee80a2a-0d04-4e20-b2ee-cb013a13a229","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:38:27+00:00","versionOfRecord":{"articleIdentity":"rs-6621988","link":"https://doi.org/10.1007/s00261-025-05156-8","journal":{"identity":"abdominal-radiology","isVorOnly":false,"title":"Abdominal Radiology"},"publishedOn":"2025-08-23 16:29:57","publishedOnDateReadable":"August 23rd, 2025"},"versionCreatedAt":"2025-05-16 11:55:48","video":"","vorDoi":"10.1007/s00261-025-05156-8","vorDoiUrl":"https://doi.org/10.1007/s00261-025-05156-8","workflowStages":[]},"version":"v1","identity":"rs-6621988","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6621988","identity":"rs-6621988","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}