Sage Journals: Discover world-class research

Abstract

Background

Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features.

Purpose

To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases.

Material and Methods

Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion (b = 800 s/mm²). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs.

Results

Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs.

Conclusion

Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions.

Keywords

Intrahepatic mass-forming cholangiocarcinoma solitary hypovascular liver lesions magnetic resonance imaging (MRI)diffusion weighted imaging

Get full access to this article

View all access options for this article.

References

Choi

Lee

Han

. Imaging of intrahepatic and hilar cholangiocarcinoma. Abdom Imaging 2004; 29: 548–557.

Lim

. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. Am J Roentgenol 2003; 181: 819–827.

Lee

Lim

Jang

et al.

Radiologic spectrum ofcholangiocarcinoma: emphasis on unusual manifestations and differential diagnosis. Radiographics 2001; 21: 97–116.

Braga

Semelka

Danet

et al.

Liver metastases from unknown primary site: demonstration on MR images. Magn Reson Imaging 2003; 21: 871–877.

Abbruzzese

Lenzi

Raber

et al.

The biology of unknown primary tumors. Semin Oncol 1993; 20: 238–243.

Pavlidis

Pentheroudakis

. Cancer of unknown primary site. Lancet 2012; 379: 1428–1435.

Taouli

Koh

. Diffusion-weighted MR imaging of the liver. Radiology 2010; 254: 47–66.

Koh

Collins

. Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol 2007; 188: 1622–1635.

Kanematsu

Goshima

Watanabe

et al.

Detection and characterization of focal hepatic lesions with diffusion-weighted MR imaging: a pictorial review. Abdom Imaging 2013; 38: 297–308.

10.

Taouli

. Diffusion-weighted MR imaging for liver lesion characterization: a critical look. Radiology 2012; 262: 378–380.

11.

Park

Kim

Park

et al.

Scirrhous hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging: emphasis on the differentiation of intrahepatic cholangiocarcinoma. J Comput Assist Tomogr 2013; 37: 872–881.

12.

Park

Kim

Park

et al.

Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging 2013; 38: 793–801.

13.

Fattach

Dohan

Guerrache

et al.

Intrahepatic and hilar mass-forming cholangiocarcinoma: Qualitative and quantitative evaluation with diffusion-weighted MR imaging. Eur J Radiol 2015; 84: 1444–1451.

14.

Al Ansari

Kim

Srirattanapong

et al.

Mass-forming cholangiocarcinoma and adenocarcinoma of unknown primary: can they be distinguished on liver MRI?

Abdom Imaging 2014; 39: 1228–1240.

15.

Shimonishi

Miyazaki

Nakanuma

. Cytokeratin profile relates to histological subtypes and intrahepatic location of intrahepatic cholangiocarcinoma and primary sites of metastatic adenocarcinoma of liver. Histopathology 2000; 37: 55–63.

16.

Somorácz

Tátrai

Horváth

et al.

Agrin immunohistochemistry facilitates the determination of primary versus metastatic origin of liver carcinomas. Hum Pathol 2010; 41: 1310–1319.

17.

Valverde

Bonhomme

Farges

et al.

Resection of intrahepatic cholangiocarcinoma: a Western experience. J Hepatobiliary Pancreat Surg 1999; 6: 122–127.

18.

Bridgewater

Galle

Khan

et al.

Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60: 1268–1289.

19.

Kim

Lee

Shin

et al.

Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 2016; 26: 1808–1817.

20.

Jeong

Kim

Chung

et al.

Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. Am J Roentgenol 2013; 201: W603–611.

21.

Maetani

Itoh

Watanabe

et al.

MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. Am J Roentgenol 2001; 176: 1499–1507.

22.

Okamura

Yoshida

Shibuya

et al.

Cellular and stromal characteristics in the scirrhous hepatocellular carcinoma: comparison with hepatocellular carcinomas and intrahepatic cholangiocarcinomas. Pathol Int 2005; 55: 724–731.

23.

Kim

Lee

et al.

Diagnostic accuracy and sensitivity of diffusion-weighted and of gadoxetic acid-enhanced 3-T MR imaging alone or in combination in the detection of small liver metastasis (≤ 1.5 cm in diameter). Invest Radiol 2012; 47: 159–166.

24.

Kim

Han

Kim

. Comparison of diffuse hepatocellular carcinoma and intrahepatic cholangiocarcinoma using sequentially acquired gadolinium-enhanced and Resovist-enhanced MRI. Eur J Radiol 2009; 70: 94–100.

25.

Outwater

Tomaszewski

Daly

et al.

Hepatic colorectal metastases: correlation of MR imaging and pathologic appearance. Radiology 1991; 180: 327–332.

26.

Soyer

Bluemke

Vissuzaine

et al.

CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule. Am J Roentgenol 1994; 162: 1119–1122.

27.

Jhaveri

Halankar

Aguirre

et al.

Intrahepatic bile duct dilatation due to liver metastases from colorectal carcinoma. Am J Roentgenol 2009; 193: 752–756.

28.

Ishida

Ishibashi

Ohsawa

et al.

Significance of hepatic lymph node metastasis in patients with unresectable synchronous liver metastasis of colorectal cancer. Int Surg 2011; 96: 291–299.

29.

Chung

Kim

Park

et al.

Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 2009; 29: 683–700.

30.

Kim

Lee

et al.

Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern–correlation with clinicopathologic findings. Radiology 2011; 260: 148–157.

31.

Danet

Semelka

Leonardou

et al.

Spectrum of MRI appearances of untreated metastases of the liver. Am J Roentgenol 2003; 181: 809–817.

Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible?

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

Get full access to this article

References