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Intrahepatic cholangiocarcinoma and its differential diagnosis at MRI: how radiologist should assess MR features

  • Diagnostic Imaging in Oncology
  • Published:
La radiologia medica Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, Naples, Italy

    Vincenza Granata, Sergio Venanzio Setola & Antonella Petrillo

  2. Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, Naples, Italy

    Roberta Grassi & Salvatore Cappabianca

  3. Medical Oncology Division, Igea SpA, Naples, Italy

    Roberta Fusco

  4. Division of Hepatobiliary Surgical Oncology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, Naples, Italy

    Andrea Belli & Francesco Izzo

  5. Abdominal Oncology Division, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, Naples, Italy

    Alessandro Ottaiano & Guglielmo Nasti

  6. Department of Radiology, UOC San Severo Hospital, 71016, San Severo, Italy

    Michelearcangelo La Porta

  7. Division of Radiodiagnostic, “Azienda Ospedaliero-Universitaria Careggi”, Firenze, Italy

    Ginevra Danti

  8. Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy

    Ginevra Danti

  9. Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

    Carmen Cutolo

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  1. Vincenza Granata
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Correspondence to Roberta Fusco.

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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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