These authors contributed equally to this manuscript.
Article first published online: 11 MAY 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 50, Issue 3, pages 791–798, September 2009
How to Cite
Rimola, J., Forner, A., Reig, M., Vilana, R., de Lope, C. R., Ayuso, C. and Bruix, J. (2009), Cholangiocarcinoma in cirrhosis: Absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology, 50: 791–798. doi: 10.1002/hep.23071
This study has been performed within the cooperation framework established by the Transversal Cancer Action approved by the Council of Ministers on October 11, 2007 in accordance with the agreement between The Carlos III Health Institute (ISCIII), which is an autonomous entity currently belonging to the Ministry of Science and Innovation, and the Spanish Biomedical Research Network (CIBER) for the area of hepatic and digestive disorders.
Potential conflict of interest: Nothing to report.
- Issue published online: 27 AUG 2009
- Article first published online: 11 MAY 2009
- Accepted manuscript online: 11 MAY 2009 12:00AM EST
- Manuscript Accepted: 5 MAY 2009
- Manuscript Received: 17 MAR 2009
- Instituto de Salud Carlos III. Grant Numbers: PI 06/132, PI 08/0146, PI 05/645
- BBVA foundation
This study assesses the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis with specific analysis of the contrast enhancement pattern. Cholangiocarcinoma may show increased contrast uptake in the arterial phase, and, if washout in the delayed venous phase were to be detected, the noninvasive diagnostic criteria proposed in the American Association for the Study of Liver Diseases guidelines would be refuted. We reviewed the MR findings of 25 patients with cirrhosis with 31 histologically confirmed ICC nodules. Signal intensity on basal T1-weighted and T2-weighted images and characteristics of enhancement after contrast administration on arterial, portal, and delayed phase were registered. Enhancement pattern was defined according to the behavior of the lesions in each phase, and dynamic pattern was described according to the progression of enhancement throughout the different phases. The most frequent pattern displayed by ICC was a progressive contrast uptake (80.6%). Stable contrast enhancement was registered in 19.4%. None of the ICCs showed a washout pattern, a profile that is specific for hepatocellular carcinoma (HCC). The ICC dynamic behavior differed significantly according to tumor size: progressive enhancement pattern was the most frequent (20 of 25 cases) in lesions larger than 20 mm, whereas the stable pattern was mainly identified in nodules smaller than 20 mm. The most characteristic MR contrast pattern in ICC in cirrhosis is a progressive contrast uptake throughout the different phases, whereas contrast washout at delayed phases is not observed. Because stable enhancement pattern without washout also can be registered in small HCC nodules, the evaluation of delayed phase is mandatory for a proper nodule characterization. If washout is not registered, a biopsy should be mandatory for diagnosis. (HEPATOLOGY 2009.)