Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings (original) (raw)

Abstract

Objectives

To evaluate the relationship between the enhancement pattern of intrahepatic cholangiocarcinomas (ICCs) in the hepatic arterial phase (HAP) of dynamic hepatic CT and the clinicopathological findings with special reference to the perihilar type and the peripheral type.

Methods

Forty-seven patients with pathologically proven ICCs were enrolled. Based on the enhancement pattern in the HAP, the lesions were classified into three groups: a hypovascular group (n=13), rim-enhancement group (n=18), and hypervascular group (n=16). The clinicopathological findings were compared among the three groups.

Results

Perihilar-type ICCs were significantly more frequently observed in the hypovascular group than in the rim-enhancement and hypervascular groups (_p_=0.006 and p <0.001, respectively). Lymphatic invasion, perineural invasion, and biliary invasion were significantly more frequent in the hypovascular group than the rim- enhancement group (_p_=0.001, _p_=0.025 and _p_=0.029, respectively) or hypervascular group (p <0.001, p <0.001 and _p_=0.025, respectively). Patients with hypovascular lesions showed significantly poorer disease-free survival than patients with rim-enhancing or hypervascular lesions (_p_=0.001 and _p_=0.001, respectively). Hypovascularity was an independent preoperative prognostic factor for disease-free survival (p<0.001).

Conclusions

Hypovascular ICCs in the HAP tend to be of perihilar type and to have more malignant potential than other ICCs.

Key Points

• Hypovascular ICCs have greater malignant potential than rim-enhancing and hypervascular ICCs.

• Hypovascular ICCs show a higher frequency of perihilar-type ICCs.

• Perihilar-type ICCs do not always display distal ductal wall thickening.

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Abbreviations

ICC:

intrahepatic cholangiocarcinoma

HAP:

hepatic arterial phase

MDCT:

multidetector computed tomography

References

  1. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366:1303–1314
    Article PubMed Google Scholar
  2. Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg 211:277–287
    Google Scholar
  3. Patel T (2001) Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 33:1353–1357
    Article CAS PubMed Google Scholar
  4. Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9:43–57
    Article PubMed Google Scholar
  5. Asayama Y, Yoshimitsu K, Irie H et al (2006) Delayed-phase dynamic CT enhancement as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma. Radiology 238:150–155
    Article PubMed Google Scholar
  6. Koh J, Chung YE, Nahm JH et al (2015) Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Eur Radiol
  7. Kim SA, Lee JM, Lee KB et al (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern--correlation with clinicopathologic findings. Radiology 260:148–157
    Article PubMed Google Scholar
  8. Nanashima A, Abo T, Murakami G et al (2013) Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics. Abdom Imaging 38:785–792
    Article PubMed Google Scholar
  9. Ariizumi S, Kotera Y, Takahashi Y et al (2011) Mass-forming intrahepatic cholangiocarcinoma with marked enhancement on arterial-phase computed tomography reflects favorable surgical outcomes. J Surg Oncol 104:130–139
    Article PubMed Google Scholar
  10. Nakanuma Y, Hoso M, Sanzen T, Sasaki M (1997) Microstructure and development of the normal and pathologic biliary tract in humans, including blood supply. Microsc Res Tech 38:552–570
    Article CAS PubMed Google Scholar
  11. Aishima S, Kuroda Y, Nishihara Y et al (2007) Proposal of progression model for intrahepatic cholangiocarcinoma: clinicopathologic differences between hilar type and peripheral type. Am J Surg Pathol 31:1059–1067
    Article PubMed Google Scholar
  12. Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO Classification of Tumors of the Digestive System, 4th edn. IARC Press, Lyon, France
    Google Scholar
  13. Tsai JH, Huang WC, Kuo KT, Yuan RH, Chen YL, Jeng YM (2012) S100P immunostaining identifies a subset of peripheral-type intrahepatic cholangiocarcinomas with morphological and molecular features similar to those of perihilar and extrahepatic cholangiocarcinomas. Histopathology 61:1106–1116
    Article PubMed Google Scholar
  14. Aishima S, Oda Y (2015) Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci 22:94–100
    Article PubMed Google Scholar
  15. Aishima S, Iguchi T, Nishihara Y et al (2009) Decreased intratumoral arteries reflect portal tract destruction and aggressive characteristics in intrahepatic cholangiocarcinoma. Histopathology 54:452–461
    Article PubMed Google Scholar
  16. Takahashi S, Murakami T, Takamura M et al (2002) Multi-detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold. Radiology 222:81–88
    Article PubMed Google Scholar
  17. Foley WD, Mallisee TA, Hohenwalter MD, Wilson CR, Quiroz FA, Taylor AJ (2000) Multiphase hepatic CT with a multirow detector CT scanner. AJR Am J Roentgenol 175:679–685
    Article CAS PubMed Google Scholar
  18. Chung YE, Kim MJ, Park YN et al (2009) Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29:683–700
    Article PubMed Google Scholar
  19. Nanashima A, Shibata K, Nakayama T et al (2009) Relationship between microvessel count and postoperative survival in patients with intrahepatic cholangiocarcinoma. Ann Surg Oncol 16:2123–2129
    Article PubMed Google Scholar
  20. Merkle EM, Zech CJ, Bartolozzi C et al (2016) Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 26:674–682
    Article PubMed Google Scholar
  21. Neri E, Bali MA, Ba-Ssalamah A et al (2016) ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 26:921–931
    Article CAS PubMed Google Scholar
  22. Fattach HE, Dohan A, Guerrache Y et al (2015) Intrahepatic and hilar mass-forming cholangiocarcinoma: Qualitative and quantitative evaluation with diffusion-weighted MR imaging. Eur J Radiol 84:1444–1451
    Article PubMed Google Scholar
  23. Sakamoto Y, Kokudo N, Matsuyama Y et al (2016) Proposal of a new staging system for intrahepatic cholangiocarcinoma: Analysis of surgical patients from a nationwide survey of the Liver Cancer Study Group of Japan. Cancer 122:61–70
    Article PubMed Google Scholar

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Acknowledgments

We thank Dr. Yoshihiko Maehara, Department of Surgery and Science, Kyushu University, for providing the clinical information for this manuscript. This work was supported by a Grant-in-in-Aid for Scientific Research (C) (25461834) and (26461796) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology. The scientific guarantor of this publication is Professor Hiroshi Honda. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. No complex statistical methods were necessary for this paper.

Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts have not been previously reported.

Methodology: retrospective, diagnostic or prognostic study / observational, performed at one institution.

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
    Nobuhiro Fujita, Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Daisuke Okamoto, Koichiro Moirta & Hiroshi Honda
  2. Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
    Yukihisa Takayama
  3. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
    Ken Shirabe
  4. Department of Pathology and Microbiology, Faculty of Medicine, Saga University Hospital, Nabesima 5-1-1, Saga City, Saga, 849-8501, Japan
    Shinichi Aishima
  5. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
    Huanlin Wang & Yoshinao Oda

Authors

  1. Nobuhiro Fujita
  2. Yoshiki Asayama
  3. Akihiro Nishie
  4. Kousei Ishigami
  5. Yasuhiro Ushijima
  6. Yukihisa Takayama
  7. Daisuke Okamoto
  8. Koichiro Moirta
  9. Ken Shirabe
  10. Shinichi Aishima
  11. Huanlin Wang
  12. Yoshinao Oda
  13. Hiroshi Honda

Corresponding author

Correspondence toYoshiki Asayama.

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Fujita, N., Asayama, Y., Nishie, A. et al. Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings.Eur Radiol 27, 498–506 (2017). https://doi.org/10.1007/s00330-016-4386-3

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