Article

Abdominal Imaging

, Volume 39, Issue 6, pp 1228-1240

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

  • Najwa Al AnsariAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill
  • , Bong Soo KimAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill
  • , Saowanee SrirattanapongAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill
  • , Charles T. A. SemelkaAffiliated withDepartment of Biomedical Engineering, University of North Carolina at Chapel Hill
  • , Miguel RamalhoAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill
  • , Ersan AltunAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill
  • , John T. WoosleyAffiliated withDepartment of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill
  • , Benjamin CalvoAffiliated withDepartment of Surgery, University of North Carolina at Chapel Hill
  • , Richard C. SemelkaAffiliated withDepartment of Radiology, University of North Carolina at Chapel Hill Email author 

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Abstract

Purpose

To determine MR features suggestive of mass-forming cholangiocarcinoma (CCA) or liver metastases of adenocarcinoma of unknown primary (AUP), and to compare the ability of two experienced radiologists to establish the correct diagnosis.

Materials and methods

61 patients with CCA or AUP, with MRIs were placed into two groups: population 1, 28 patients with certain diagnosis of either CCA or AUP; and population 2, 33 patients with uncertain diagnosis. Using population 1 with known diagnosis, two investigators formulated imaging criteria for CCA or AUP, which represented phase 1 of the study. In phase 2, two independent radiologists categorized the patients in populations 1 and 2 as CCA or AUP using the formulated criteria. This categorization was compared with the patient medical records and pathologist review. Findings were tested for statistical significance.

Results

In phase 1, solitary lesion, multifocal lesions with dominant lesion, capsule retraction, and porta hepatis lymphadenopathy were features of CCA; multifocal lesions with similar size, and ring enhancement were features of AUP. The number of lesions, capsule retraction, and early tumor enhancement pattern were observed to be significant features (P < 0.05). In phase 2, agreement between the two radiologists was good (k = 0.663). For population 1, the agreement was good (k = 0.659), and was fair for population 2 (k = 0.293). Concordance between the two radiologists, medical record, and the pathologist was found in 41/61 (67%) patients.

Conclusion

Distinctive features of CCA and AUP are identifiable on MRI images, which may aid the radiologist to establish the correct diagnosis.

Keywords

Cholangiocarcinoma Abdominal MRI Primary liver tumor Liver metastases Unknown primary site Adenocarcinoma