Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings
- 728 Downloads
To evaluate the relationship between the enhancement pattern of intrahepatic cholangiocarcinomas (ICCs) in the hepatic arterial phase (HAP) of dynamic hepatic CT and the clinicopathological findings with special reference to the perihilar type and the peripheral type.
Forty-seven patients with pathologically proven ICCs were enrolled. Based on the enhancement pattern in the HAP, the lesions were classified into three groups: a hypovascular group (n=13), rim-enhancement group (n=18), and hypervascular group (n=16). The clinicopathological findings were compared among the three groups.
Perihilar-type ICCs were significantly more frequently observed in the hypovascular group than in the rim-enhancement and hypervascular groups (p=0.006 and p <0.001, respectively). Lymphatic invasion, perineural invasion, and biliary invasion were significantly more frequent in the hypovascular group than the rim- enhancement group (p=0.001, p=0.025 and p=0.029, respectively) or hypervascular group (p <0.001, p <0.001 and p=0.025, respectively). Patients with hypovascular lesions showed significantly poorer disease-free survival than patients with rim-enhancing or hypervascular lesions (p=0.001 and p=0.001, respectively). Hypovascularity was an independent preoperative prognostic factor for disease-free survival (p<0.001).
Hypovascular ICCs in the HAP tend to be of perihilar type and to have more malignant potential than other ICCs.
• Hypovascular ICCs have greater malignant potential than rim-enhancing and hypervascular ICCs.
• Hypovascular ICCs show a higher frequency of perihilar-type ICCs.
• Perihilar-type ICCs do not always display distal ductal wall thickening.
KeywordsIntrahepatic cholangiocarcinoma Perihilar cholangiocarcinoma Peripheral cholangiocarcinoma Computed tomography Arterial enhancement pattern
hepatic arterial phase
multidetector computed tomography
We thank Dr. Yoshihiko Maehara, Department of Surgery and Science, Kyushu University, for providing the clinical information for this manuscript. This work was supported by a Grant-in-in-Aid for Scientific Research (C) (25461834) and (26461796) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology. The scientific guarantor of this publication is Professor Hiroshi Honda. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. 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. Study subjects or cohorts have not been previously reported.
Methodology: retrospective, diagnostic or prognostic study / observational, performed at one institution.
- 2.Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg 211:277–287Google Scholar
- 6.Koh J, Chung YE, Nahm JH et al (2015) Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Eur RadiolGoogle Scholar
- 12.Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO Classification of Tumors of the Digestive System, 4th edn. IARC Press, Lyon, FranceGoogle Scholar
- 13.Tsai JH, Huang WC, Kuo KT, Yuan RH, Chen YL, Jeng YM (2012) S100P immunostaining identifies a subset of peripheral-type intrahepatic cholangiocarcinomas with morphological and molecular features similar to those of perihilar and extrahepatic cholangiocarcinomas. Histopathology 61:1106–1116CrossRefPubMedGoogle Scholar