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Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To determine the different imaging features of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).

Methods

This retrospective study was institutional review board approved and the requirement for informed consent was waived. Patients who underwent gadoxetic acid-enhanced MRI with histologically confirmed IMCCs (n = 46) or HCCs (n = 58) were included. Imaging features of IMCCs and HCCs on gadoxetic acid-enhanced MRI including T2- and T1-weighted, diffusion weighted images, dynamic study and hepatobiliary phase (HBP) images were analyzed. Univariate and multivariate logistic regression analyses were performed to identify relevant differentiating features between IMCCs and HCCs.

Results

Multivariate analysis revealed heterogeneous T2 signal intensity and a hypointense rim on the HBP as suggestive findings of IMCCs and the wash-in and “portal wash-out” enhancement pattern as well as focal T1 high signal intensity foci as indicative of HCCs (all, p < 0.05). When we combined any three of the above four imaging features, we were able to diagnose IMCCs with 94 % (43/46) sensitivity and 86 % (50/58) specificity.

Conclusions

Combined interpretation of enhancement characteristics including HBP images, morphologic features, and strict application of the “portal wash-out” pattern helped more accurate discrimination of IMCCs from HCCs.

Key Points

• Analysis of enhancement characteristics helped accurate discrimination of IMCCs from HCCs.

• Wash-out should be determined on the PVP of gadoxetic acid-enhanced MRI.

• A hypointense rim on the HBP was a significant finding of IMCCs.

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Abbreviations

AP:

Arterial phase

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

MRI:

Agnetic resonance imaging

PVP:

Portal venous phase

TP:

Transitional phase

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Acknowledgments

The scientific guarantor of this publication is Byung Ihn Choi. The authors of this manuscript declare relationships with the following companies: Jeong Min Lee is a consultant for Siemens Healthcare; has received grants from GE Healthcare, Donseo Medical, CMS, Acuzen, Starmed, and RF MEDICAL and nonfinancial technical support from Siemens Healthcare; grants from Donseo Medical, CMS, Acuzen, Starmed, RF Medical, and Bayer Healthcare; personal fees from Bayer Healthcare for lectures. Byung Ihn Choi received a grant from Samsung Electronics.

The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, case–control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea

    Rihyeon Kim, Jeong Min Lee, Cheong-Il Shin, Jeong Hee Yoon, Ijin Joo, Seong Ho Kim, Inpyeong Hwang & Joon Koo Han

  2. Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea

    Jeong Min Lee & Joon Koo Han

  3. Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea

    Eun Sun Lee & Byung Ihn Choi

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  1. Rihyeon Kim
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Correspondence to Jeong Min Lee.

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Kim, R., Lee, J.M., Shin, CI. et al. Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 26, 1808–1817 (2016). https://doi.org/10.1007/s00330-015-4005-8

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  • DOI: https://doi.org/10.1007/s00330-015-4005-8

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