Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging.
BACKGROUND
The diagnosis of intrahepatic cholangiocellular carcinoma (ICC) remains elusive at imaging, which is a critical issue in cirrhotic patients in whom a diagnosis of hepatocellular carcinoma (HCC) can be established only by imaging.


OBJECTIVE
The aim of the study was to evaluate the potential of MRI in the diagnosis of ICC in cirrhosis using 'hepatocyte-specific' Gadolinium (Gd)-based contrast agents.


METHODS
Sixteen histologically proven and retrospectively identified ICCs on cirrhosis were investigated with hepatocyte-specific magnetic resonance contrast agents (6 in Bologna with Gd-EOB-DTPA and 10 in Milan with Gd-BOPTA). The control group consisted of 41 consecutively and prospectively collected nodules (31 HCCs) imaged with Gd-EOB-DTPA.


RESULTS
Fifteen ICC nodules (94%) displayed hypointensity in the hepatobiliary phase, suggesting malignancy. Thirteen cholangiocarcinomas (81%) showed hyperenhancement in the venous phase. Only 2 cholangiocarcinoma nodules showed hypoenhancement in the venous phase, corresponding to washout, in both cases preceded by rim enhancement in arterial phase. All the hepatocarcinomas showed hypointensity in hepatobiliary phase, but was always preceded by hypointensity in the venous phase; arterial rim enhancement was never observed in any hepatocarcinoma or regenerative nodule.


CONCLUSIONS
MRI with hepatocyte-specific Gd-based contrast agents showed a pattern of malignancy in almost all the ICCs, concurrently avoiding misdiagnosis with hepatocarcinoma. These findings suggest a greater diagnostic capacity for this technique compared with the results of MRI with conventional contrast agents reported in the literature in this setting.
Division of Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Fabio
F
Piscaglia
Massimo
M
Iavarone
Marzia
M
Galassi
Sara
S
Vavassori
Matteo
M
Renzulli
Laura Virginia
LV
Forzenigo
Alessandro
A
Granito
Veronica
V
Salvatore
Angelo
A
Sangiovanni
Rita
R
Golfieri
Massimo
M
Colombo
Luigi
L
Bolondi
D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D022781:Hepatocytes / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D012189:Retrospective Studies
D003287:Contrast Media; D009942:Organometallic Compounds; C073590:gadolinium ethoxybenzyl DTPA; C064572:gadobenic acid; D008536:Meglumine; D019786:Gadolinium DTPA