Abstract
Background
Intrahepatic cholangiocarcinoma (ICC) is the second most common type of primary hepatic malignancy. Aim of this work is to analyse the features of ICC and its differential diagnosis at MRI, assessing two categories intraparenchymal and peribiliary lesions.
Methods
The study population included 88 patients with histological diagnosis of ICCs: 61 with mass-forming type, 23 with periductal-infiltrating tumours and 4 with intraductal-growing type. As a control study groups, we identified: 86 consecutive patients with liver colorectal intrahepatic metastases (mCRC) (groups A); 35 consecutive patients with peribiliary metastases (groups B); 62 consecutive patients (groups C) with hepatocellular carcinoma (HCC); 18 consecutive patients (groups D) with combined hepatocellular cholangiocarcinoma (cHCC-CCA); and 26 consecutive patients (groups E) with hepatic hemangioma. For all lesions, magnetic resonance (MR) features were assessed according to Liver Imaging Reporting and Data System (LI-RADS) version 2018. The liver-specific gadolinium ethoxybenzyl dimeglumine—EOB (Primovist, Bayer Schering Pharma, Germany), was employed. Chi-square test was employed to analyse differences in percentage values of categorical variable, while the nonparametric Kruskal–Wallis test was used to test for statistically significant differences between the median values of the continuous variables. However, false discovery rate adjustment according to Benjamin and Hochberg for multiple testing was considered.
Results
T1- and T2-weighted signal intensity (SI), restricted diffusion, transitional phase (TP) and hepatobiliary phase (HP) aspects allowed the differentiation between study group (mass-forming ICCs) and each other control group (A, C, D, E) with statistical significance, while arterial phase (AP) appearance allowed the differentiation between study group and the control groups C and D with statistical significance and PP appearance allowed the differentiation between study group and the control groups A, C and D with statistical significance. Instead, no MR feature allowed the differentiation between study group (periductal-infiltrating type) and control group B.
Conclusion
T1 and T2 W SI, restricted diffusion, TP and HP appearance allowed the differentiation between mass-forming ICCs and mimickers with statistical significance, while AP appearance allowed the differentiation between study group and the control groups C and D with statistical significance and PP appearance allowed the differentiation between study group and the control groups A, C and D.
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Abbreviations
- ADC:
-
Apparent diffusion coefficient
- APHE:
-
Arterial phase hyperenhancement
- AP:
-
Arterial phase
- CC:
-
Cholangiocarcinoma
- cHCC-CCA:
-
Combined hepatocellular cholangiocarcinoma
- DWI:
-
Diffusion-weighted imaging
- FLASH:
-
Fast low angle shot magnetic resonance imaging
- FISP:
-
Fast imaging with steady-state free precession
- HASTE:
-
Half-Fourier-acquired single-shot turbo spin echo
- HCC:
-
Hepatocellular carcinoma
- HP:
-
Hepatobiliary phase
- Hyper:
-
Hyperintense
- Hypo:
-
Hypointense
- ICC:
-
Intrahepatic cholangiocarcinoma
- IN:
-
Inhomogeneous
- Iso:
-
Isointense
- LI-RADS:
-
Liver Imaging Reporting and Data System
- mCRC:
-
Colorectal intrahepatic metastases
- MR:
-
Magnetic resonance
- NA:
-
Not assessed
- NPW:
-
Non-peripheral washout appearance
- PCE:
-
Progressive contrast enhancement
- PP:
-
Portal phase
- ROI:
-
Region of interest
- SPAIR:
-
Spectral attenuated inversion recovery
- SI:
-
Signal intensity
- TA:
-
Targetoid appearance
- TP:
-
Transitional phase
- VIBE:
-
Volumetric interpolated breath-hold examination
- W:
-
Weighted
- WA:
-
Washout appearance
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Acknowledgements
The authors are grateful to Alessandra Trocino, librarian at the National Cancer Institute of Naples, Italy. Moreover, for the collaboration, authors are grateful to Paolo Pariante and Paola Gargiulo (research support) and Dr Ivano Rossi (TSRM) of Radiology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli,” Naples, I-80131, Italy
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Granata, V., Grassi, R., Fusco, R. et al. Intrahepatic cholangiocarcinoma and its differential diagnosis at MRI: how radiologist should assess MR features. Radiol med 126, 1584–1600 (2021). https://doi.org/10.1007/s11547-021-01428-7
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DOI: https://doi.org/10.1007/s11547-021-01428-7