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Objective To investigate the correlation between clinicopathological features and dynamic enhancement patterns on CT and MR imaging in combined hepatocellular cholangiocarcinomas(cHCC-CCs).Materials and methods From January 2005 to December 2015,23 patients(age,54.7 years ± 9.3 [range,43-74 years]; 16 men,7 women)with pathology-confirmed cHCC-CCs according to the 2010 WHO new classification were included in the retrospective study.Two reviewers evaluated in consensus dynamic enhancement patterns as well as morphological characteristics.Clinicalpathological data were reviewed including age,gender,viral hepatitis status,background of cirrhosis,HCC-like(AFP)and CC-like tumor markers(CA125,CA19-9,and CEA).Results Dynamic enhancement images of cHCC-CCs were classified into three patterns: type Ⅰ(n=3,13.0%),intense arterial enhancement followed by venous/delayed washout(HCC-like pattern).One case demonstrated characteristic “reversal sign” — peripheral arterial enhancement following venous washout and delayed central enhancement.Type Ⅱ(n=10,43.5%),peripheral intense arterial enhancement with progressive enhancement on venous/delayed phase(CC-like pattern).Type Ⅲ(n=10,43.5%),mild enhancement during all dynamic phases(indeterminate pattern).All tumors with type 1 demonstrated expansive growth pattern without either tumor marker elevation or extrahepatic involvement.HBV infection incidence was higher in type 2(90%)than in type 1(33.3%)and type 3(60%)(p=0.028 and 0.039,respectively).Infiltrative growth pattern was more frequent in type 2(80%)than in type 3(50%)(p=023).The elevation of tumor markers were less frequent in type 2 than in type 3(22.2%vs 66.7%for AFP,p=0.003; 37.5%vs 62.5%for CC-like marker,p=0.016).No significant difference was identified in lymph nodes and vessel involvement between type 2(40%)and type 3(40%)(p=1.000).At microscopic observation,there existed obvious sinusoid dilation in HCC components and abundant fibrosis stroma in CC components without fibrotic capsule for type 2.Conclusion cHCC-CCs commonly appeared as CC-like or indeterminate pattern on dynamic CT and MRI.The tumor with CC-like enhancement pattern had higher HBV infection incidence,lower tumor marker level,and more aggressive behavior.