Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge

Abstract

Background: Hepatocellular carcinoma (HCC) with hilar bile duct tumor thrombus (HBDTT) often mimic hilar cholangiocarcinoma (hilar CC). The purpose of this study is to analyze the Computed Tomography (CT) characteristics of HCC with HBDTT and to identify imaging features to aid its differentiation from hilar CC on enhanced CT. Methods: We retrospectively identified 58 cases with pathologically proved HCC with HBDTT between 2011 and 2018. Seventy-seven cases of pathologically proven hilar CCs were selected during the same period. The clinical features and CT findings of the two groups were reviewed and compared. Results: HCC with HBDTTs are more commonly found in men (87.9% vs 63.6%, p = 0.001) with lower age of onset (49.84 vs 58.61 years; p < 0.001) in comparison to hilar CCs. Positive correlation were identified between HCC with HBDTTs and chronic HBV infection (72.4% vs 11.7%; p < 0.001), increased serum AFP (67.2% vs 1.3%; p < 0.001), CA19-9 level (58.6% vs 85.7%; p < 0.001) and CEA level (3.4% vs 29.9%; p = 0.001), parenchymal lesion with intraductal lesion (100% vs 18.2%; p < 0.001), washout during the portal venous phase (84.5% vs 6.5%; p < 0.001), thickened bile duct wall (8.6% vs 93.5%; p < 0.001), intrahepatic vascular embolus (44.8% vs 7.8%; p < 0.001), splenomegaly (34.5% vs 2.6%, p < 0.001). A scoring system consisting of the five parameters obtained from characteristics mentioned above was trialed. The sensitivity and specificity for diagnosing HCC with HBDTT were 96.39, 100 and 92.5% respectively when the total score was 2 or more. Conclusions: HCC with HBDTTs are often distinguishable from hilar CCs based on washout during portal venous phase without thickened bile duct wall. HBV infection and serum AFP level facilitate the differentiation.

Imaging Features of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Multicenter Study

“…Therefore, distinctive image features of HCC with BDTT seem especially important to be recognized. HCC lesions and soft tissue masses in the biliary ducts are two typical features, which is the key for diagnosing HCC with B4 BDTT [15,17]. Our results con rmed that HCC lesions and the localized bile duct dilation may be imaging features of patients with B1-B3 BDTT.…”

“…HCC with BDTT should be differentially diagnosed with intrahepatic cholangiocarcinoma (intraductal type). Both HCC with BDTT and intrahepatic cholangiocarcinoma have similar image features like intraductal neoplasm and upstream bile duct dilatation [17,25]. Most BDTT show early enhancement at HAP and rapid wash out of contrast agent with hypointense signal at PVP [14,26].…”

“…Most BDTT show early enhancement at HAP and rapid wash out of contrast agent with hypointense signal at PVP [14,26]. Intrahepatic cholangiocarcinoma usually manifests a narrowed bile duct with irregular wall thickening and progressively delayed enhancement at PVP [17]. Hepatic parenchymal mass and the T1W hyperintense signal on distal segment are valuable to distinguish BDTT from intraductal growing-cholangiocarcinoma [25].…”

“…There are still di cult and challenging problems in diagnosis of HCC with BDTT before operation. Few reports focusing on the CT or MRI features of HCC with B4 BDTT were available [12][13][14][15][16][17].…”

Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion

“…Only five retrospective studies met our search criteria (Table 4 ). Notably, all of the studies were from China[ 12 - 16 ]. The studies included 151 patients with HCC with BDTT who received various treatments from 1984 to 2018.…”