This poster is published under an
open license. Please read the
disclaimer for further details.
Keywords:
Liver, Biliary Tract / Gallbladder, Gastrointestinal tract, MR, Contrast agent-intravenous, Neoplasia, Cancer
Authors:
G. Mamone, G. Marrone, G. Gentile, V. Carollo, M. Milazzo, A. Luca; Palermo/IT
DOI:
10.1594/ecr2015/C-2590
Aims and objectives
Intrahepatic cholangiocarcinoma,
is defined as an adenocarcinoma arising from the intrahepatic biliary epithelium,
and is typically a mass-forming tumor.
It accounts for 5-10% of all cholangiocarcinomas [1].
Intrahepatic mass-forming cholangiocarcinoma (IMC) represents 10% of primary liver tumors,
and is the second most common hepatic malignancy after hepatocellular carcinoma [2].
MRI has become a gold standard in characterization and detection of focal liver lesions,
and offers the possibility of using liver-specific contrast agents [3].
However,
the detection and characterization of intrahepatic cholangiocarcinoma by imaging is a constant challenge.
Despite these facts,
most studies have focused on MRI findings with extracellular agents,
and there have been only a few papers describing the imaging findings of IMC using Gd-BOPTA MRI.
To the best of our knowledge,
only one large and extensive study on hepatobiliary enhancement patterns of IMC with Gd-BOPTA to differentiate cirrhotic hepatocellular carcinoma from cholangiocarcinoma has been published [4].
Other studies mention IMCs in the context of general imaging of hepatic lesions [5,
6] and in pictorial essays [7,
8].
Gd-BOPTA (gadobenate dimeglumine) combines both extracellular and hepatobiliary distribution through two main temporal acquisition phases: dynamic and delayed [9].
Through this liver-specific contrast medium,
the radiologist evaluates variations in enhancement pattern in both phases for detection and characterization of lesions. Since IMCs derive from bile duct epithelias,
no notable uptake is expected in the hepatobiliary phase (HBP) that would be valuable for the delineation and detection of the lesions,
thus facilitating treatment planning.
Because no reliable radiological features are available to distinguish IMCs from metastatic adenocarcinomas,
the diagnosis of intrahepatic cholangiocarcinoma is made on the reasonable exclusion of an extrahepatic primary tumor.
The purpose of our retrospective study was to describe the MRI appearance of intrahepatic mass-forming cholangiocarcinoma using Gd-BOPTA contrast medium,
and to assess radiologic findings to improve diagnosis of this disease.
Emphasis was on the hepatobiliary late phase features.