Small intrahepatic peripheral cholangiocarcinomas as mimics of hepatocellular carcinoma in multiphasic CT

Mendiratta‐Lala, Mishal; Park, Hakmin; Kolicaj, N.; Mendiratta, Vivek; Bassi, Deep

doi:10.1007/s00261-016-0840-6

Cited by 10 publications

(3 citation statements)

References 45 publications

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“…However, six ICCAs (12.5%) were misclassified as LR-5 (n = 4) or LR-4 (n = 2), which showed smaller tumor size (1-3 cm) and non-rim APHE. Other studies have indicated that small ICCA in the setting of chronic viral hepatitis or cirrhosis may show non-rim APHE with the nonperipheral washout appearance, mimicking hypervascular HCC on contrast-enhanced CT and MRI [8,26,27]. Knowledge of the uncommon patterns of smaller ICCA enhancement is particularly important in transplant centers.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of LI-RADS version 2018 in differentiating hepatocellular carcinoma from other hepatic malignancies in patients with hepatitis B virus infection

Shao

Liang

Kuang

et al. 2020

Bosn J of Basic Med Sci

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The diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) in differentiating hepatocellular carcinoma (HCC) from other hepatic malignancies has not been investigated in Chinese patients with chronic liver disease from hepatitis B virus (HBV) infection. The aim of this study was to evaluate the accuracy of the LI-RADS version 2018 in differentiating HCC, intrahepatic cholangiocarcinoma (ICCA), and combined HCC-cholangiocarcinoma (cHCC-CCA) in Chinese patients with HBV infection. Seventy consecutive HBV-infected patients with ICCA (n = 48) or cHCC-CCA (n = 22) who underwent contrast-enhanced magnetic resonance imaging (CE-MRI) between 2006 and 2017 were enrolled along with a comparison cohort of 70 patients with HCC and CE-MRI-matched for tumor size (10–19 mm, 20–30 mm, 31–50 mm, and >50 mm). Imaging feature frequencies for each tumor type were compared using Fisher’s exact test. The classification accuracy of LR-5 and LR-M was estimated for HCC versus non-HCC (ICCA and cHCC-CCA). The interobserver agreement was good for LI-RADS categories of HCC, and moderate for non-HCC. After consensus read, 66 of 70 (94%) HCCs were categorized LR-5 (including tumor in vein [TIV] with LR-5), while 42 of 48 (88%) ICCAs and 13 of 22 (59%) cHCC-CCAs were categorized LR-M (including TIV with LR-M) (p < 0.001). Thus, assignment of LR-5 provided 94% sensitivity and 81% specificity for HCC. LR-M provided 79% sensitivity and 97% specificity for non-HCC (ICCA and cHCC-CCA); and the sensitivity and accuracy were lower in differentiating HCC from non-HCC (tumor size <20 mm). LI-RADS v2018 category 5 and M reliably differentiated HBV-related HCC from ICCA. However, a substantial proportion of cHCC-CCAs were categorized LR-5 rather than LR-M. While management is controversial for these combined tumors, accurate prospective differentiation is desired for optimal treatment.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of LI-RADS version 2018 in differentiating hepatocellular carcinoma from other hepatic malignancies in patients with hepatitis B virus infection

Shao

Liang

Kuang

et al. 2020

Bosn J of Basic Med Sci

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“…Gradual enhancement pattern was relevant to the large amount of fibrous stroma of the tumor and indicated a poor prognosis [31]. Small IMCC with diameter less than 3 cm in the cirrhotic liver showed atypical wash in and wash out enhancement pattern frequently [32]. IMCC with wash in and wash out enhancement pattern demonstrated less central fibrous stroma and more cellular areas than that with gradual enhancement pattern; also, hyperenhancement on AP was an independent factor for longer survival.…”

Section: Discussionmentioning

confidence: 99%

Prediction for early recurrence of intrahepatic mass-forming cholangiocarcinoma: quantitative magnetic resonance imaging combined with prognostic immunohistochemical markers

Liang

et al. 2019

Cancer Imaging

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Background Partial hepatectomy is the first option for intrahepatic mass-forming cholangiocarcinoma (IMCC) treatment, which would prolong survival. The main reason for the poor outcome after curative resection is the high incidence of early recurrence (ER). The aim of this study was to investigate the combined predictive performance of qualitative and quantitative magnetic resonance imaging (MRI) features and prognostic immunohistochemical markers for the ER of IMCC. Methods Forty-seven patients with pathologically proven IMCC were enrolled in this retrospective study. Preoperative contrast-enhanced MRI and post-operative immunohistochemical staining of epidermal growth factor receptors (EGFR), vascular endothelial growth factor receptor (VEGFR), P53 and Ki67 were performed. Univariate analysis identified clinic-radiologic and pathological risk factors of ER. Radiomics analysis was performed based on four MRI sequences including fat suppression T2-weighted imaging (T2WI/FS), arterial phase (AP), portal venous phase (PVP), and delayed phase (DP) contrast enhanced imaging. A clinicoradiologic-pathological (CRP) model, radiomics model, and combined model were developed. And ROC curves were used to explore their predictive performance for ER stratification. Results Enhancement patterns and VEGFR showed significant differences between the ER group and non-ER group ( P = 0.001 and 0.034, respectively). The radiomics model based on AP, PVP and DP images presented superior AUC (0.889, 95% confidence interval (CI): 0.783–0.996) among seven radiomics models with a sensitivity of 0.938 and specificity of 0.839. The combined model, containing enhancement patterns, VEGFR and radiomics features, showed a preferable ER predictive performance compared to the radiomics model or CRP model alone, with AUC, sensitivity and specificity of 0.949, 0.875 and 0.774, respectively. Conclusions The combined model was the superior predictive model of ER. Combining qualitative and quantitative MRI features and VEGFR enables ER prediction, thus facilitating personalized treatment for patients with IMCC.

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“…The main mimicker in multiphasic CT is hepatocellular carcinoma that is differentiated from peripheral intrahepatic cholangiocarcinomas by different enhancement patterns. However, if classic enhancing features are not present, it will be difficult to differentiate them [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Extrahepatic cholangiocarcinoma with prolonged survival: a case report

Al-Zahir

AlAmeel

2017

J Med Case Reports

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BackgroundCholangiocarcinoma has poor prognosis and short term-survival. Here, we report the case of a patient with unusually prolonged survival.Case presentationOur patient was a 56-year-old Arab man with a 6-month history of obstructive jaundice. A computed tomography scan of his abdomen revealed a mass at the confluence of the hepatic ducts with suspected malignant strictures on endoscopy. A positive tissue diagnosis was achieved more than 18 months after commencement of his symptoms. He remained functional throughout this period despite recurrent episodes of cholangitis.ConclusionsCholangiocarcinoma is a presumably fatal disease, especially because patients tend to present late with unresectable disease. Many patient-related and disease-related factors may alter survival.

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Small intrahepatic peripheral cholangiocarcinomas as mimics of hepatocellular carcinoma in multiphasic CT

Cited by 10 publications

References 45 publications

Diagnostic performance of LI-RADS version 2018 in differentiating hepatocellular carcinoma from other hepatic malignancies in patients with hepatitis B virus infection

Diagnostic performance of LI-RADS version 2018 in differentiating hepatocellular carcinoma from other hepatic malignancies in patients with hepatitis B virus infection

Prediction for early recurrence of intrahepatic mass-forming cholangiocarcinoma: quantitative magnetic resonance imaging combined with prognostic immunohistochemical markers

Extrahepatic cholangiocarcinoma with prolonged survival: a case report

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