MR Imaging of Intrahepatic Cholangiocarcinoma with Pathologic Correlation
Yoji Maetani1,
Kyo Itoh1,
Chihiro Watanabe2,
Toshiya Shibata1,
Fumie Ametani1,
Hirohiko Yamabe2 and
Junji Konishi1
1
Department of Radiology and Nuclear Medicine, Kyoto University School of
Medicine, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
2
Department of Pathology, Kyoto University Hospital, Kyoto, 606-8507,
Japan.
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Fig. 1A. —53-year-old woman with intrahepatic cholangiocarcinoma.
T2-weighted MR image displays central hypointense area in tumor.
Signal-intensity difference is 4 (area 1) - 2 (area 2) = 2. Note cyst
(arrow) in subcapsular portion of left lobe of liver.
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Fig. 1B. —53-year-old woman with intrahepatic cholangiocarcinoma.
Dynamic MR images obtained before (B) and at 20 (C), 80
(D), and 300 (E) sec after injection of contrast material show
initial rim enhancement in early phase and lack of enhancement in late phase
at tumor edge. Central area reveals heterogeneous delayed enhancement.
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Fig. 1C. —53-year-old woman with intrahepatic cholangiocarcinoma.
Dynamic MR images obtained before (B) and at 20 (C), 80
(D), and 300 (E) sec after injection of contrast material show
initial rim enhancement in early phase and lack of enhancement in late phase
at tumor edge. Central area reveals heterogeneous delayed enhancement.
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Fig. 1D. —53-year-old woman with intrahepatic cholangiocarcinoma.
Dynamic MR images obtained before (B) and at 20 (C), 80
(D), and 300 (E) sec after injection of contrast material show
initial rim enhancement in early phase and lack of enhancement in late phase
at tumor edge. Central area reveals heterogeneous delayed enhancement.
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Fig. 1E. —53-year-old woman with intrahepatic cholangiocarcinoma.
Dynamic MR images obtained before (B) and at 20 (C), 80
(D), and 300 (E) sec after injection of contrast material show
initial rim enhancement in early phase and lack of enhancement in late phase
at tumor edge. Central area reveals heterogeneous delayed enhancement.
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Fig. 1F. —53-year-old woman with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen at tumoral center (area 1 in A),
which exhibits delayed enhancement on dynamic imaging, shows severe fibrotic
change. (Masson's trichrome stain, x100)
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Fig. 1G. —53-year-old woman with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen at tumoral edge (area 2 in A),
which reveals initial rim enhancement on dynamic imaging, shows many tumor
cells with little fibrosis. Fibrotic ratio difference is 44 - 5.9 = 38(%).
(Masson's trichrome stain, x100)
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Fig. 2A. —43-year-old woman with intrahepatic cholangiocarcinoma.
Unenhanced T1-weighted MR image shows hypointense well-defined lesion.
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Fig. 2B. —43-year-old woman with intrahepatic cholangiocarcinoma.
T2-weighted MR image displays hyperintense edge of tumor, confluent area of
low signal intensity internally, and central region of high signal
intensity.
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Fig. 2C. —43-year-old woman with intrahepatic cholangiocarcinoma.
Contrast-enhanced T1-weighted MR image shows delayed enhancement of tumor edge
and internal hypointense area. No enhancement is observed in central
hyperintense area.
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Fig. 2D. —43-year-old woman with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen from tumor edge shows numerous viable
tumor cells with moderate degree of fibrosis. Area revealed early enhancement
on dynamic CT (not shown). (Masson's trichrome stain, x100)
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Fig. 2E. —43-year-old woman with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen from internal hypointense area exhibits
severe fibrotic change. (Masson's trichrome stain, x100)
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Fig. 2F. —43-year-old woman with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen from the central hyperintense area
exhibits coagulative necrosis and cell debris. (Masson's trichrome stain,
x100)
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Fig. 3A. —74-year-old man with intrahepatic cholangiocarcinoma.
Unenhanced T1-weighted MR image shows hypointense well-defined tumor.
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Fig. 3B. —74-year-old man with intrahepatic cholangiocarcinoma.
T2-weighted MR image displays large central hypointense area.
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Fig. 3C. —74-year-old man with intrahepatic cholangiocarcinoma.
Contrast-enhanced T1-weighted MR image reveals slight heterogeneous
enhancement.
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Fig. 3D. —74-year-old man with intrahepatic cholangiocarcinoma.
Photomicrograph of pathology specimen from region exhibiting little
enhancement (square in C) indicates severe of coagulative necrosis and little
fibrosis. (Masson's trichrome stain, x100)
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Fig. 4A. —74-year-old man presenting with intrahepatic
cholangiocarcinoma. Unenhanced T1-weighted MR image reveals hypointense
well-defined tumor.
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Fig. 4B. —74-year-old man presenting with intrahepatic
cholangiocarcinoma. T2-weighted MR image displays large central hyperintense
area. Arrow indicates right posterior branch of portal vein seen as
low-signal-intensity band that penetrates tumor.
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Fig. 4C. —74-year-old man presenting with intrahepatic
cholangiocarcinoma. Contrast-enhanced T1-weighted MR image exhibits no
enhancement at central hyperintense area.
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Fig. 4D. —74-year-old man presenting with intrahepatic
cholangiocarcinoma. Photomicrograph of pathology specimen reveals that area
consists of coagulative necrosis. (Masson's trichrome stain, x100)
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Fig. 5. —Graph illustrates statistically significant correlation
between signal intensity differences on T2-weighted images and fibrotic ratio
differences (r = 0.72; 95% confidence interval, 0.48-0.86; p
= 0.0001). With respect to central portion of tumor, this finding indicates
that strong fibrotic changes are correlated with reduced signal intensity on
T2-weighted images.
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