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Potential Imaging Characteristics Allow for Distinction in Cirrhotic Livers

January 15, 2008
Written by: , Filed in: Abdominal Imaging
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The objective of a recent study was to determine whether certain enhancement patterns of intrahepatic cholangiocarcinoma in a cirrhotic liver are diagnostic.
Enhancement patterns of cholangiocarcinoma in cirrhotic patients were found to differ depending on its size.

The retrospective analysis consisted of 105 patients comprising 2 groups. The first group consisted of 26 patients with cholangiocarcinoma and cirrhosis. The second group consisted of 79 patients with hepatocellular carcinoma and cirrhosis.

CT examinations were performed on single-detector units or 4, 8, 16, or 64 multi-detector CT (MDCT) units.
All 105 patients had contrast-enhanced images, while 95 also had unenhanced scans.

The dual-phase helical CT technique consisted of hepatic arterial and portal venous phases. CT images were reviewed by 2 radiologists. Number, size, margin, and enhancement patterns of masses were recorded.

The lesion margin was recorded as follows:

  • sharp and round;
  • lobulated;
  • ill defined.

Presence or absence of the following morphologic features was also reported:

  • capsular retraction;

  • pseudocapsule;
  • biliary dilatation;
  • arterioportal shunt;
  • transient hepatic attenuation difference;
  • portal vein involvement.

Lesion enhancement patterns on the hepatic arterial phase were classified as follows:

  • peripheral enhancement;

  • peripheral and central enhancement;
  • minimal enhancement.

Lesion enhancement patterns on the portal venous phase were classified as follows:

  • peripheral rim enhancement;

  • centripetal pattern;
  • minimal enhancement;
  • washout pattern;
  • persistent hyperdense enhancement.


Regarding mass attenuation, cholangiocarcinomas were either hypodense or isodense on unenhanced images. On hepatic arterial phase images, the majority of lesions were hypodense. On portal venous phase scans, the majority were hypodense and the remainder were isodense. Hepatocellular carcinomas were also either hypodense or isodense on unenhanced images.

In the hepatic arterial phase, the majority of lesions became hyperdense, with a few becoming isodense or remaining hypodense.

In the portal venous phase, the majority of lesions became hypodense, with a few becoming isodense or remaining hyperdense.

Cholangiocarcinomas demonstrated a different pattern of enhancement on the hepatic arterial phase and portal venous phase, depending on lesion size. Peripheral rim-like enhancement on hepatic arterial phase and centripetal enhancement on portal venous phase were found in the majority of lesions measuring >3 cm.

In contradistinction, there was no significant difference in the pattern of enhancement for hepatocellular carcinoma according to tumor size.

In lesions measuring <3 cm, there is no significant difference in washout pattern or in peripheral enhancement among cholangiocarcinomas and hepatocellular carcinomas. Therefore, the difference between the prevalent CT enhancement pattern of cholangiocarcinoma and that of hepatocellular carcinoma depended on the size of the lesion. Reviewer’s Comments
The Results of this study are helpful in demonstrating potential imaging characteristics allowing for distinction between cholangiocarcinoma and hepatocellular carcinoma in cirrhotic livers.

This is useful for clinical practice, as the 2 lesions are managed in different manners. One limitation in this study is that different CT scanners and protocols were used.

Author: : John C. Sabatino, MD, MSD

Reference: :

Kim SJ, Lee JM, et al. Peripheral Mass-Forming Cholangiocarcinoma in Cirrhotic Liver. AJR; 2007; 189 (December): 1428-1434

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