Delayed-Phase Dynamic CT Enhancement as a Prognostic Factor for Mass-forming Intrahepatic Cholangiocarcinoma

Asayama, Yoshiki; Yoshimitsu, Kengo; Irié, Hiroyuki; Tajima, Tsuyoshi; Nishie, Akihiro; Hirakawa, Masakazu; Nakayama, Tomohiro; Kakihara, Daisuke; Taketomi, Akinobu; Aishima, Shin Ichi; Honda, Hiroshi

doi:10.1148/radiol.2381041765

Cited by 131 publications

(98 citation statements)

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“…In other reports, hypovascularity or delayed enhancement have been associated with poor survival [34,43], agreeing with the present results.…”

Section: Nanashima Et Al Page 10supporting

confidence: 94%

“…Yamamoto et al reported that peripheral mass-forming ICC mimics the clinical characteristics of HCC, including imaging findings [42]. Mass-forming-type ICC with high vascularity may show HCC-like characteristics, but with significant differences in enhancement pattern and tumor morphology [43]. Larger tumor size or lower degree of histological differentiation were related to the classical hypovascular ICC.…”

Section: Nanashima Et Al Page 10mentioning

confidence: 99%

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Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

et al. 2012

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Purpose: Arterial enhancement of intrahepatic cholangiocarcinoma (ICC) has been noted. To precisely identify the characteristics of tumor enhancement patterns, we examined the relationship between CT attenuation in the tumor and clinicopathological parameters or prognosis.Methods: Subjects were 42 ICC patients who had undergone hepatectomy. Microvessel density (MVD) determined by CD34 staining was compared with imaging. Attenuation was calculated in images from multi-detector CT of tumor and non-tumorous regions. Enhancement patterns were divided into two groups: arterial enhancement with higher attenuation (>16 HU; Hyper group, n=12); and arterial enhancement with lower attenuation (Hypo group, n=30).Results: Univariate analysis identified high tumor marker level, increased size, less-differentiation, incomplete resection, increased bleeding and lower MVD as significantly associated with poor survival (p<0.05). Increased attenuation throughout the whole ICC correlated significantly with radiological findings and MVD. Concomitant hepatitis, well-differentiation, and smaller tumor were more significantly frequent in the Hyper group than in the Hypo group (p<0.05). Postoperative early recurrence was significantly less frequent in the Hyper group, and overall survival was significantly better in the Hyper group (p<0.05). Conclusions:Increased CT attenuation correlated with ICC tumor vascularity. Increased tumor enhancement in the arterial phase was associated with chronic hepatitis, lower malignancy and better survival.Key words: intrahepatic cholangiocarcinoma-tumor enhancement-multidetector computed tomography-prognosis-hepatectomy Nanashima et al., Page 3 Intrahepatic cholangiocarcinoma (ICC) is a well-characterized liver cancer for which various prognostic risk factors have been clarified [1][2][3]. ICC is composed of cells that mostly resemble those of the peripheral bile ducts, but recent reports have suggested that ICC may not always display uniform characteristics [4][5][6][7][8]. ICC can be classified into subgroups according to macroscopic findings, with clinical and pathological characteristics and prognosis differing significantly among subgroups [9,10].While diagnosis of the ICC subtype would be useful for predicting prognosis and determining the need for adjuvant treatments with hepatic resection, clearly distinguishing subgroups is often difficult, particularly in advanced tumors. Although a variety of prognostic parameters have been identified in recent research, the definitive factors associated with poor prognosis have not been well clarified [11,12]. Recent histological and molecular studies have revealed that tumor vascularity of ICC is closely associated with malignant behavior and patient prognosis [13,14]. Higher tumor vascularity might be related to the presence of chronic viral hepatitis, which is also related to carcinogenesis for hepatocellular carcinoma (HCC) [15]. We have previously examined histological parameters in ICC and clarified that higher tumor vascularity as dete...

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“…In other reports, hypovascularity or delayed enhancement have been associated with poor survival [34,43], agreeing with the present results.…”

Section: Nanashima Et Al Page 10supporting

confidence: 94%

Section: Nanashima Et Al Page 10mentioning

confidence: 99%

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

et al. 2012

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“…It was confirmed that CT and/or MRI findings of ICC were correlated with pathological findings; that is, the hyperenhancing areas always indicated a large number of tumour cells and the areas of delayed enhancement corresponded to fibrotic stroma at pathological examination. In addition, different morphological subtypes tended to exhibit distinct enhancement characteristics on CT [7,8,[11][12][13]. On CEUS, besides the specific feature of peripheral rim-like hyperenhancement, diverse imaging findings of ICC were reported [9,10,[14][15][16][17].…”

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confidence: 99%

Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination

Xu¹,

Chen²,

Liu³

et al. 2012

The British Journal of Radiology

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Objective: To investigate the correlation between enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and pathological findings. Methods: The CEUS enhancement patterns of 40 pathologically proven ICC lesions were retrospectively analysed. Pathologically, the degree of tumour cell and fibrosis distribution in the lesion was semi-quantitatively evaluated. Results: 4 enhancement patterns were observed in the arterial phase for 32 massforming ICCs: peripheral rim-like hyperenhancement (n519); heterogeneous hyperenhancement (n56); homogeneous hyperenhancement (n53); and heterogeneous hypo-enhancement (n54). Among the four enhancement patterns, the differences in tumour cell distribution were statistically significant (p,0.05). The hyperenhancing area on CEUS corresponded to more tumour cells for mass-forming ICCs. Heterogeneous hyperenhancement (n52) and heterogeneous hypo-enhancement (n52) were observed in the arterial phase for four periductal infiltrating ICCs. In this subtype, fibrosis was more commonly found in the lesions. Heterogeneous hyperenhancement (n51) and homogeneous hyperenhancement (n53) were observed in the arterial phase for four intraductal growing ICCs. This subtype tended to have abundant tumour cells. Conclusion: The CEUS findings of ICC relate to the degree of carcinoma cell proliferation at pathological examination. Hyperenhancing areas in the tumour always indicated increased density of cancer cells.

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“…The imaging features of ICC have been reported by many researchers (3,4). Most of these focused on imaging characteristics in relation to the internal desmoplastic change.…”

Section: Discussionmentioning

confidence: 99%

“…The Japanese Liver Cancer Group has classified ICCs into three types: mass-forming, periductal-infiltrative, and intraductal (1). The mass-forming type of intrahepatic cholangiocarcinoma (mICC) is the most common (60% of all ICCs) (2) and can show various imaging findings on dynamic computed tomography (CT) or magnetic resonance imaging (MRI) using extracellular contrast agent (3,4). Regardless of the findings on the arterial phase, delayed temporal contrast enhancement is a typical feature of ICC because of the distribution of extracellular contrast into intratumoral fibrous stroma (5).…”

mentioning

confidence: 99%

Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI

Asayama¹,

Nishie²,

Ishigami³

et al. 2015

Diagn Interv Radiol

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ABDOMINAL IMAGINGORIGINAL ARTICLE PURPOSE We aimed to gain further insight in magnetic resonance imaging characteristics of mass-forming intrahepatic cholangiocarcinoma (mICC), its enhancement pattern with gadoxetic acid contrast agent, and distinction from poorly differentiated hepatocellular carcinoma (pHCC). METHODSFourteen mICC and 22 pHCC nodules were included in this study. Two observers recorded the tumor shape, intratumoral hemorrhage, fat on chemical shift imaging, signal intensity at the center of the tumor on T2-weighted image, fibrous capsule, enhancement pattern on arterial phase of dynamic study, late enhancement three minutes after contrast injection (dynamic late phase), contrast uptake on hepatobiliary phase, apparent diffusion coefficient, vascular invasion, and intrahepatic metastasis. RESULTSLate enhancement was more common in mICC (n=10, 71%) than in pHCC (n=3, 14%) (P < 0.001). A fat component was observed in 11 pHCC cases (50%) versus none of mICC cases (P = 0.002). Fibrous capsule was observed in 13 pHCC cases (59%) versus none of mICC cases (P < 0.001). On T2-weighted images a hypointense area was seen at the center of the tumor in 43% of mICC (6/14) and 9% of pHCC (2/22) cases (P = 0.018). Other parameters were not significantly different between the two types of nodules. CONCLUSIONThe absence of fat and fibrous capsule, and presence of enhancement at three minutes appear to be most characteristic for mICC and may help its differentiation from pHCC.

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Delayed-Phase Dynamic CT Enhancement as a Prognostic Factor for Mass-forming Intrahepatic Cholangiocarcinoma

Abstract: The degree of enhancement on delayed-phase CT scans is a useful indicator for prediction of the prognosis of patients with mass-forming ICC.

Cited by 131 publications

References 18 publications

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination

Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI

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