Combined hepatocellular carcinoma-cholangiocarcinoma: report of MR appearance in eleven patients.
OBJECTIVE
To describe the magnetic resonance imaging (MRI) appearance of hepatic combined hepatocellular-cholangiocarcinoma (cHCC-CC) in 11 patients.


METHODS
The database of the Department of Pathology was cross-referenced with the MRI database to identify patients with confirmed cHCC-CC who had undergone MRI. Eleven consecutive patients were included (seven female, mean age 57.6 years). All patients were Caucasian. Five of 11 had a clinical history of chronic liver disease. Two radiologists retrospectively analyzed the images in consensus.


RESULTS
cHCC-CC was a single mass in 10/11 patients. Margins were well-defined in 6/11. All tumors showed heterogeneous hyperintensity on T2. On postcontrast imaging, 6/11 showed early ring-enhancement (four noncirrhotic), with progressive enhancement in central portions, and 5/11 patients showed a diffuse heterogeneous early enhancement. Three of these five were cirrhotic and displayed partial washout with portions of contrast retention on later phases. Other findings included: late capsule enhancement (two patients), biliary dilatation (one), venous invasion (three), lymphadenopathy (six), and findings of cirrhosis (five).


CONCLUSIONS
cHCC-CC presents most commonly as a single mass. Five of 11 had MR findings of cirrhosis. Clues to the diagnosis were moderately high signal on T2, portions of tumor that show progressive enhancement/contrast retention, and frequent lack of capsule. Early enhancement patterns included early ring-enhancement and diffuse heterogeneous enhancement.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7510, USA.
Rafael O P
RO
de Campos
Richard C
RC
Semelka
Rafael M
RM
Azevedo
Miguel
M
Ramalho
Vasco
V
Heredia
Diane M
DM
Armao
John T
JT
Woosley
D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity