title: Contrast enhanced CT-scan to diagnose intrahepatic cholangiocarcinoma in patients with cirrhosis.
abstract: OBJECTIVE
  Contrast enhanced computed tomography (CT-scan) is a standard of care for the radiological diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. This technique, however, is not validated to exclude intrahepatic cholangiocarcinoma (ICC) which may develop in patients with cirrhosis, as well.
  
  
  METHODS
  To assess the features of contrast CT-scan in the diagnosis of ICC, we reviewed all CT-scan films obtained in cirrhotic patients with a histologically documented ICC, taking in consideration the pattern and dynamics of the arterial, portal venous and delayed phases of contrast uptake.
  
  
  RESULTS
  Thirty-two patients had 40 nodules of ICC (22 male; median age 62years; 13 hepatitis C) that were identified either during surveillance with abdominal ultrasound (21 patients, 66%) or incidentally (11 patients, 34%). ICC was either multifocal or ≥ 30 mm in 11 of the former and 10 of the latter group (52% vs. 91%, p<0.05). Two nodules (5%) escaped detection by CT-scan, while the remaining 38 showed a heterogeneous contrast enhancement pattern, being the arterial peripheral-rim enhancement present in 19 (50%) cases and a progressive homogeneous contrast uptake in 16 (42%) cases during the three vascular phases, with no relation to tumor size. Importantly, all nodules lacked the radiological hallmark of HCC, the only ICC nodule showing a homogeneous wash-in during the arterial phase followed by a wash-out in the delayed venous phase, however showing a homogeneous wash-in during the portal phase too.
  
  
  CONCLUSIONS
  ICC in cirrhotic patients displays distinct vascular patterns at CT-scan that allow for differentiation from HCC.
authors.affiliation: A.M. & A. Migliavacca Center for Liver Disease, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Iavarone
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Sara
authors.initials: S
authors.lastname: Vavassori
authors.forename: Marzia
authors.initials: M
authors.lastname: Galassi
authors.forename: Angelo
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: Laura
authors.initials: L
authors.lastname: Venerandi
authors.forename: Laura Virginia
authors.initials: LV
authors.lastname: Forzenigo
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media