CT imaging of intrabiliary growth of colorectal liver metastases: a comparison of pathological findings of resected specimens

Abstract

The objective of this study was to assess the usefulness of CT in the pre-operative evaluation of macroscopic intrabiliary tumour growth of colorectal liver metastases. 25 metastatic nodules of 18 patients who underwent an initial hepatectomy for colorectal liver metastasis were retrospectively evaluated. The CT appearance and pathological findings of the resected specimens were correlated. A number of unusual peritumoral features associated with intrabiliary tumour growth were detected by pre-operative CT. These were classified into three patterns: (1) thickened portal tract; (2) intrahepatic bile duct dilatation; and (3) a wedge-shaped area with enhancement. In 8 (32%) of the 25 nodules the portal tract was depicted as thicker than usual and these features were found proximal to the tumour in three instances, distal to the tumour in four instances, and both proximal and distal in one instance. All of the three intrabiliary tumours larger than 30 mm resulted in thickening of the portal tract. Intrahepatic bile duct dilatation was detected in association with 10 (40%) of 25 nodules. Bile duct dilatation was observed in more than one segment when intrabiliary tumour reached the hepatic hilus from the tumour. The presence of bile duct dilatation was not related to either the size of the tumour or the extent of intrabiliary tumour growth. An abnormally high density wedge-shaped area on contrast enhanced CT was another feature indicating intrabiliary tumour growth and was seen in association with four nodules. Such areas were seen in the liver parenchyma distal to the tumour on three occasions, or encompassing the tumour on one accasion. This wedge-shaped area appeared as a well demarcated dark red-brown region in the cut surface of the resected specimen. CT was useful for detecting the presence of intrabiliary tumour growth with these three patterns of radiological findings in patients with liver metastases from colorectal cancer

Intraductal papillary growth of liver metastasis originating from colon carcinoma in the bile duct: Report of a case

“…3,5,6,8,15 Tumor growth confined to the bile duct, as in the present case, has rarely been described. 3,5,16 Itatsu et al 3 and Blumgart et al 16 Nanashima et al, Page 7 provided summaries of a small number of cases.…”

“…8,11,12 Most patients underwent surgery, because of the diagnostic development on imaging. 15 CT might be the most powerful imaging modality, although the usefulness of percutaneous transhepatic cholangiography was reported by Hiramatsu et al 17 Advanced imaging modalities can identify dilation and cystic changes in the biliary duct in the early stage. The tumor in the present case was limited to the liver and had not extended into the extrahepatic bile duct or surrounding vessels or lymph nodes.…”

Liver metastasis with intraductal invasion originating from rectal cancer: Report of a case

“…8 On the other hand, bile duct invasion is a common characteristic of IHCCs. Although sporadic cases of liver metastases from colorectal cancer showing intraductal growth have been reported, [9][10][11][12][13] it is still diffi cult to differentiate preoperatively if liver metastases originate from colorectal cancer or IHCC. It is also diffi cult to distinguish between these conditions even using conventional histological examination with H&E staining.…”

Metastatic Liver Disease: Colorectal Carcinomas

“…The duct stenosis caused by intraductal metastases can induce marked intrahepatic bile duct dilatation (Jhaveri et al 2009). The wedge-shaped area seen on CT images in part of the cases was visualized as a well-demarcated dark red-brown region in the cut surface of resected specimens (Okano et al 2002).…”

“…However, massive bile duct invasion by colorectal cancer metastases is much rarer. Intrabiliary cancer thrombi associated with biliary tract dilation is visualized by imaging techniques, including CT imaging (Okano et al 2002). In one study, macroscopic intrabiliary tumors were detected pre-or intraoperatively by use of CT, ultrasonography, and intraoperative ultrasonography (Sugiura et al 2006).…”