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Abdominal Radiology

, Volume 37, Issue 5, pp 767–774 | Cite as

Malignant versus benign hepatic masses in patients with recurrent pyogenic cholangitis: MR differential diagnosis

  • Hyo Won Eun
  • Jung Hoon KimEmail author
  • Seong Sook Hong
  • Young Jae Kim
Article

Abstract

Purpose

To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in recurrent pyogenic cholangitis (RPC).

Materials and methods

During a recent 6-year period, we performed MRI in 352 patients with RPC. Among them, 58 had confirmed hepatic masses; cholangiocarcinoma (n = 15), abscess (n = 37), inflammatory pseudotumor (n = 3), biloma (n = 3). Two radiologists assessed MR findings including enhancement patterns, intratumoral appearance, peritumoral changes, mass location, and multiplicity. They also graded the malignancy using common MR findings. The receiver operating characteristic analysis and Chi-square test were used. The κ statistics was used to determine interobserver agreement.

Results

The common findings for cholangiocarcinoma were thin and lobulated enhancement at the periphery (n = 8, 53%, P < 0.05); ill-defined enhancement (n = 7, 47%, P < 0.05); slightly high signal on T2 (n = 13, 87%, P < 0.05); mass located in the same lobe of atrophy (n = 11, 73%, P < 0.05) and portal vein thrombosis (n = 15, 100%, P < 0.05). The common findings for benign mass were target-like enhancement (n = 36, 84%, P < 0.05); cluster appearance (n = 15, 35%, P < 0.05); central, fluid-like space (n = 29, 67%, P < 0.05); peritumoral regional high signal on T2 (n = 32, 74%, P < 0.05); multiplicity(n = 21, 49%, P < 0.05). Interobserver agreement was excellent (κ = 0.81–1.000). Area under the curve (Az) for differentiating malignant masses was 0.989, sensitivity was 95.3%, and specificity was 95.3%. There was good interobserver agreement (κ = 0.74).

Conclusion

MR imaging is very useful for differential diagnosis of malignant vs. benign hepatic masses in patients with RPC.

Keywords

Biliary system Pyogenic cholangitis Cancer Cholangiocarcinoma Abscess MRI 

Notes

Acknowledgment

We would like to thank Bonnie Hami, MA (USA) for her editorial assistance in the preparation of the manuscript.

References

  1. 1.
    Lim JH (1991) Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol 157:1–8CrossRefPubMedGoogle Scholar
  2. 2.
    Carmona RH, Crass RA, Lim RC Jr, Trunkey DD (1984) Oriental cholangitis. Am J Surg 148:117–124CrossRefPubMedGoogle Scholar
  3. 3.
    Chen MF, Jan YY, Wang CS, et al. (1993) A reappraisal of cholangiocarcinoma in patients with hepatolithiasis. Cancer 71:2461–2465CrossRefPubMedGoogle Scholar
  4. 4.
    Su CH, Shyr YM, Lui WY, P’Eng FK (1997) Hepatolithiasis associated with cholangiocarcinoma. Br J Surg 84:969–973CrossRefPubMedGoogle Scholar
  5. 5.
    Kim JH, Kim TK, Eun HW, et al. (2006) CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis. AJR Am J Roentgenol 187(6):1571–1577CrossRefPubMedGoogle Scholar
  6. 6.
    Kim MJ, Cha SW, Mitchell DG, et al. (1999) MR imaging findings in recurrent pyogenic cholangitis. AJR Am J Roentgenol 173:1545–1549CrossRefPubMedGoogle Scholar
  7. 7.
    Park MS, Yu JS, Kim KW, et al. (2001) Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology 220:677–682CrossRefPubMedGoogle Scholar
  8. 8.
    Jain M, Agarwal A (2008) MRCP findings in recurrent pyogenic cholangitis. Eur J Radiol 66(1):79–83CrossRefPubMedGoogle Scholar
  9. 9.
    Radin DR, Ray MJ, Ralls PW, Boswell WD Jr, Halls JM (1987) Hepatolithiasis complicated by cholangiocarcinoma. J Comput Tomogr 11:315–317CrossRefPubMedGoogle Scholar
  10. 10.
    Kubo S, Kinoshita H, Hirohashi K, Hamba H (1995) Hepatolithiasis associated with cholangiocarcinoma. World J Surg 19:637–641CrossRefPubMedGoogle Scholar
  11. 11.
    Sheen-Chen SM, Chou FF, Eng HL (1991) Intrahepatic cholangiocarcinoma in hepatolithiasis: a frequently overlooked disease. J Sur Oncol 37:131–135CrossRefGoogle Scholar
  12. 12.
    Chijiiwa K, Ichimiya H, Kuroki S, Koga A, Nakayama F (1993) Late development of cholangiocarcinoma after the treatment of hepatolithiasis. Surg Gynecol Obstet 177:279–282PubMedGoogle Scholar
  13. 13.
    Ohta T, Nagakawa T, Ueda N, et al. (1991) Mucosal dysplasia of the liver and the intraductal variant of peripheral cholangiocarcinoma in hepatolithiasis. Cancer 68:2217–2223CrossRefPubMedGoogle Scholar
  14. 14.
    Tsui WM, Chan YK, Wong CT, et al. (2011) Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis 31:33–48CrossRefPubMedGoogle Scholar
  15. 15.
    Mathieu D, Vasile N, Fagniez PL, et al. (1985) Dynamic CT features of hepatic abscesses. Radiology 154:749–752CrossRefPubMedGoogle Scholar
  16. 16.
    Gabata T, Kadoya M, Matsui O, et al. (2001) Dynamic CT of hepatic abscesses: significance of transient segmental enhancement. AJR Am J Roentgenol 176:675–679CrossRefPubMedGoogle Scholar
  17. 17.
    Jeffrey RB Jr, Tolentino CS, Chang FC, Federle MP (1988) CT of small pyogenic hepatic abscesses: the cluster sign. AJR Am J Roentgenol 151:487–489CrossRefPubMedGoogle Scholar
  18. 18.
    Hanazaki K, Kajikawa S, Nagai N, et al. (2001) Portal vein thrombosis associated with hilar bile duct carcinoma and liver abscess. Hepatogastroenterology 48:79–80PubMedGoogle Scholar
  19. 19.
    Alvarez JA, Gonzalez JJ, Baldonedo RF, et al. (2001) Single and multiple pyogenic liver abscesses: etiology, clinical course, and outcome. Dig Surg 18:283–288CrossRefPubMedGoogle Scholar
  20. 20.
    Zibari GB, Maguire S, Aultman DF, McMillan RW, McDonald JC (2000) Pyogenic liver abscess. Surg Infect (Larchmt) 1:15–21CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Hyo Won Eun
    • 1
  • Jung Hoon Kim
    • 2
    Email author
  • Seong Sook Hong
    • 3
  • Young Jae Kim
    • 3
  1. 1.Health Promotion Center, Asan Medical CenterUniversity of UlsanSeoulSouth Korea
  2. 2.Department of Radiology and Institute of Radiation MedicineSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologySoonchunhyang University HospitalSeoulSouth Korea

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