Comparative Analysis of Clinical and MR Imaging Characteristics between Dual-Phenotype Hepatocellular Carcinoma and Conventional Hepatocellular Carcinoma: A Retrospective Study

Objective: This study aimed to investigate the clinical and MR imaging differences between dual-phenotype hepatocellular carcinoma (DPHCC) and conventional hepatocellular carcinoma (HCC). Methods: A retrospective analysis was conducted on the clinical data and MRI findings of 29 patients with DPHCC and 29 propensity score-matched patients with conventional HCC, confirmed by surgical pathology, from January 2019 to January 2022 at Fudan University Zhongshan Hospital. Clinical characteristics, lesion location, morphology, size, signal intensity, enhancement patterns, vascular invasion, and lymph node metastasis were analyzed for both groups. Results: Between the DPHCC group and the HCC group, statistically significant differences were found in cirrhosis, pathological grade, lesion morphology, enhancement patterns, delayed capsular enhancement, and lymph node metastasis. There were no statistically significant differences between the two groups in terms of age, gender, hepatitis B infection, AFP, CA199, microvascular invasion (MVI), capsular invasion, lesion size, location, vascular invasion, ADC values, and T1WI and T2WI signals. discussion: Primary liver cancer is a major global malignancy, with hepatocellular carcinoma (HCC) being the most common type. Dual-phenotype hepatocellular carcinoma (DPHCC) is a unique HCC subtype, accounting for about 10% of cases and characterized by high recurrence and low survival rates. Pathologically, DPHCC is diagnosed by the presence of both hepatocyte and cholangiocyte markers in tumor cells, distinguishing it from classical HCC. CK19 is a key marker associated with its aggressive behavior. Clinically, DPHCC predominantly affects middle-aged to elderly males with chronic hepatitis B, showing elevated AFP levels and a higher tendency for microvascular and capsular invasion compared to HCC. On MRI, DPHCC often exhibits slow enhancement patterns, irregular lesion shapes, and increased lymph node enlargement, reflecting its dual biological behavior and stronger proliferative and invasive capabilities. Conclusion: Compared to HCC, DPHCC has a higher pathological grade, more irregular lesion morphology, and a higher incidence of both fast-in and slow-out and slow-in and slow-out enhancement patterns, as well as higher rates of lymph node metastasis. The findings have provided valuable insights for the accurate diagnosis of DPHCC.