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CT Features of Intraductal Intrahepatic Cholangiocarcinoma

¹ Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744 Seoul, Korea.
² Department of Surgery, Seoul National University College of Medicine, Chongno-gu, 110-744 Seoul, Korea.

Received November 9, 1999; accepted after revision January 10, 2000.

 
Address correspondence to J. K. Han

Abstract

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OBJECTIVE. The objective of this report was to describe the CT features of intraductal intrahepatic cholangiocarcinoma.

CONCLUSION. Segmental or lobar dilatation of the intrahepatic bile ducts associated with or without intraductal polypoid mass, amorphous structures, or both with slight hyperattenuation are common CT findings of intraductal intrahepatic cholangiocarcinoma. The size of the intraductal mass determines the visibility on CT.

Introduction

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Intrahepatic cholangiocarcinoma is a carcinoma arising from any portion of the intrahepatic bile duct epithelium. It is the second most common primary intrahepatic malignancy after hepatocellular carcinoma and accounts for 10-20% of all cases of intrahepatic malignancy [1, 2]. According to the classification of primary liver cancer proposed by the Liver Cancer Study Group of Japan [3], intrahepatic cholangiocarcinomas are classified into three types on the basis of the macroscopic appearance of the tumor: massforming, periductal-infiltrating, and intraductal-growing [3,4,5,6,7]. Recent reports have shown that intraductal intrahepatic cholangiocarcinoma has a much better prognosis after surgical resection than other types of cholangiocarcinoma and has a peculiar growth pattern of superficial mucosal spreading in some instances [4,5,6,7]. Therefore, early detection and precise preoperative diagnosis of the intraductal extent of the tumor is important for this type of tumor.

There have been many reports about the radiologic appearance of intrahepatic cholangiocarcinoma; however, the reports have mainly focused on the more common massforming type [1, 2, 8]. To our knowledge, the radiologic appearances of intraductal intrahepatic cholangiocarcinomas have not yet been described. The purpose of our study was to describe the CT features of intraductal intrahepatic cholangiocarcinoma and to correlate them with pathologic features.

Materials and Methods

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Patients
From January 1985 to February 1998, 105 patients at our institution were proven to have intrahepatic cholangiocarcinomas after surgical resection. After a retrospective review of surgical and pathologic records, 16 patients were diagnosed with intraductal intrahepatic cholangiocarcinoma on the basis of the classification proposed by the Liver Cancer Study Group of Japan [3], and were included in this study. The classification was an intraductal papillary tumor, with superficially spreading mucosal carcinoma or intraductal tumor casts in some of the 16 patients. Lobectomy of the liver was performed in nine patients and segmentectomy in seven. The study group was composed of 12 men and four women (age range; 34-75 years; mean, 58.5 years). Two patients had previously undergone surgery for intrahepatic biliary stones.

Imaging Methods
Of 16 patients, CT was performed in 15 and cholangiography in 12 (percutaneous transhepatic cholangiography in 10 and ERCP in two). The time interval between CT and surgery ranged from 15 to 190 days (mean, 34.5 days). Helical CT was performed in eight patients and conventional CT in seven. Helical CT was performed with one of three scanners (HiSpeed, General Electric Medical Systems, Milwaukee, WI; and Somatom Plus-S or Somatom Plus-4, Siemens Medical Systems, Erlangen, Germany). Each patient received 100 mL or 120 mL of iopromide (Ultravist 300; Schering, Berlin, Germany) or iopamidol (Iopamiro 300; Bracco, Milan, Italy), which was injected into the antecubital vein through an 18-gauge cannula at a rate of 3 mL/sec. Helical CT parameters included a 20-sec acquisition time; 5-, 7-, or 10-mm collimation; and a 1:1 or 2:1 table pitch. Helical CT was performed 30 and 65 sec after the initiation of injection (arterial and portal venous phases, respectively). Images were reconstructed every 5, 7, or 10 mm. In conventional CT, incremental scans were obtained after manual injection of 100 mL of various contrast materials administered at about 2 mL/sec, with scanning begun 40-60 sec after initiation of the bolus of contrast material. Contiguous 10-mm axial sections were usually obtained with single scans and short interscan delays for patient breathing and table motion. An average of 3-4 min was needed to cover the liver.

Image Analysis
CT features were retrospectively reviewed with to particular attention to the location (segmental or lobar), degree (mild or marked [larger than 15 mm in diameter]) of the intrahepatic bile duct dilatation, attenuation within the dilated bile duct, the presence and attenuation of intraductal polypoid mass, and associated findings such as biliary calculi, ascites, lymphadenopathy, or distant metastasis. Four radiologists reviewed the findings. CT scans were evaluated in one session and interpreted by consensus. After the evaluation of images, radiologists discussed the findings with two surgeons to correlate imaging features with gross appearances.

Results

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CT Findings
The location of the intrahepatic bile duct dilatation was lobar in four patients (left in three and right in one) and segmental in 11. Intrahepatic bile duct dilatation was marked in two and mild in the others (Fig. 1A,1B,1C).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. CT scan shows marked dilatation of intrahepatic duct in left lobe. Multiple intraductal papillary masses (arrows) are clearly seen along dilated bile duct.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. Endoscopic retrograde cholangiopancreatogram shows amorphous filling defect (arrows) in markedly dilated left hepatic duct. Peripheral left hepatic ducts are not opacified. Considering CT features, amorphous filling defect is formed by mucin pool rather than mass itself.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. Photograph shows papillary masses (arrows) and large amount of mucin seen in dilated duct at surgery.

Intraductal masses were revealed on CT in eight patients (53.3%). The masses were seen as multiple intraductal papillary tumors within the markedly dilated ducts in two patients (Fig. 1A,1B,1C) and a single mass measuring 1-4 cm in the distal end of the dilated ducts with mild dilatation of the peripheral ducts in six (Figs. 2A,2B and 3). The masses had slightly lower attenuation than the hepatic parenchyma on both enhanced conventional CT and helical CT (during both arterial and portal phases) (Figs. 1A,1B,1C,2A,2B,3). In seven patients (46.6%), the intraductal mass was not found on CT (Figs. 4 and 5A,5B,5C).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —Intraductal intrahepatic cholangiocarcinoma in 73-year-old man in whom disease was confirmed by left lateral segmentectomy. CT scan shows bile duct dilatation in left lateral segment and mass (arrowheads) in distal end of dilated duct.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —Intraductal intrahepatic cholangiocarcinoma in 73-year-old man in whom disease was confirmed by left lateral segmentectomy. Gross specimen shows 1.5 x 0.8 cm intraductal mass (arrows) in dilated duct (arrowheads).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —Intraductal intrahepatic cholangiocarcinoma in 64-year-old man in whom disease was confirmed by left lobectomy. Preoperative diagnosis was hepatocellular carcinoma with bile duct invasion. In this case, pathology revealed intraductal mass in distal end of dilated duct with tumor casts in peripheral small ducts. CT scan shows low-attenuation mass (arrows) compared with hepatic parenchyma in distal end of dilated bile duct in left lateral segment. Increased attenuation (arrowheads) in duct compared with bile are also seen in peripheral ducts.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by left lateral segmentectomy. Gross specimen showed 0.5-cm polypoid intraductal mass in confluence of B2 and B3. CT scan shows bile duct dilatation (arrows) in left lateral segment but did not reveal mass.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. CT scan shows dilated intrahepatic ducts (arrows) in anterior segment of right hepatic lobe. We could not find cause of ductal dilatation on CT.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. Percutaneous transhepatic cholangiogram shows segmental narrowing (arrows) in distal B8 near bifurcation site. There are multiple small filling defects (arrowheads) in dilated peripheral ducts.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. Photograph shows discernible mass (arrows) in distal B8 seen at surgery. According to pathologic records, tumor casts in peripheral small ducts were found.

In seven patients (46.6%), some parts of the dilated ducts showed slight hyperattenuation on CT compared with other parts of the dilated ducts or the lumen of the gallbladder (Figs. 3 and 6A,6B). An intraductal mass in the distal ends of the dilated duct was seen in three of these seven patients.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by right lobectomy. CT scan shows dilated bile duct (arrowheads) in segment VII of liver. Attenuation of bile duct is higher in right lobe than in left lobe.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by right lobectomy. Photograph of gross pathology specimen shows granular, friable, and papillary masses (arrows) in dilated intrahepatic ducts.

Intrahepatic bile duct stones were seen in two patients and gallbladder stones in two others. No abdominal lymph node enlargement, ascites, or distant metastasis was found.

CT-Pathology Correlation
We grouped the CT findings of the 15 patients who underwent CT into five subtypes according to the degree of bile duct dilatation, attenuation of dilated duct, and presence of intraductal mass. We correlated these five subtypes of CT findings with pathology.

In type 1 (n = 3; intrahepatic bile duct dilatation only on CT [Figs. 4 and 5A,5B,5C]), gross pathology revealed a single small (<1 cm) intraductal mass in the dilated duct (n = 2). In one patient, an intraductal mass with tumor casts plugged into the peripheral duct was noted; however, the time interval between CT examination and the surgery was 190 days in this patient (Fig. 3).

In type 2 (n = 3; detectable mass in distal end of dilated intrahepatic bile ducts without hyperattenuation on CT [Fig. 2A,2B]), a single intraductal mass was present in large ducts. The size of the mass found in each of the three patients was 1.5, 1.5, and 2 cm. No tumor casts were found in the peripheral ducts at pathology.

In type 3 (n = 4; hyperattenuation of dilated ducts without demonstrable mass on CT [Fig. 6A,6B]), the surgical specimen revealed numerous small papillary tumors spreading along the wall of the bile duct. Peripheral ducts were filled with tumor cell casts and small papillary tumors.

In type 4 (n = 3; a detectable mass in the distal end of the dilated bile ducts with hyperattenuation on CT [Fig. 3]), a large polypoid mass (2.5, 2, and 4 cm in the three patients) with superficially spreading masses and tumor casts plugging peripheral dilated ducts was noted.

In type 5 (n = 2; papillary intraductal tumors with markedly dilated ducts on CT [Fig. 1A,1B,1C]), intrahepatic bile ducts were filled with a large amount of mucin at pathology. Thick mucinous fluid retained within the duct caused marked ductal dilatation. In one patient, distal common bile duct was also dilated as a result of intraductal mucin.

At microscopic examination, all patients had papillary adenocarcinomas except two (one with papillotubular and one with intestinal type). The worm of Clonorchis sinensis was found in four patients, and intrahepatic stones were found in four others. In two, the intrahepatic bile duct stones were too small to be imaged on radiologic studies.

Discussion

Top Abstract Introduction Materials and Methods Results Discussion References

 
Macroscopic types of intrahepatic cholangiocarcinoma are classified as the mass-forming type, the periductal-infiltrating type, and the intraductal-growth type according to the Liver Cancer Study Group of Japan [3,4,5,6,7]. Most intrahepatic cholangiocarcinomas are of the mass-forming type that invades hepatic parenchyma early in their growth. However, there are several reports of cholangiocarcinoma with an intraductal growth pattern. This rare type of tumor has been termed the "intraductal variant of peripheral cholangiocarcinoma of the liver" [9, 10] or "intraductal growth type of intrahepatic cholangiocarcinomas" [3,4,5,6,7]. Histologically, this type of tumor is mostly papillary adenocarcinoma and has a significantly better prognosis than other types of cholangiocarcinoma. Because of the peculiar growth patterns, this type is thought to be a different entity rather than an early manifestation of the usual (mass-forming type) intrahepatic cholangiocarcinoma [3,4,5,6,7, 9,10]. Intraductal cholangiocarcinoma may be the counterpart of polypoid cholangiocarcinoma in the extrahepatic bile duct or hepatic hilum, considering that the biliary epithelium is histologically identical from the papilla of Vater to the peripheral intrahepatic duct. Intraductal cholangiocarcinomas constituted 15.2% of all resected cholangiocarcinomas in our series and 8.3-18% in other studies [4, 6, 7].

In our study, CT findings of intraductal intrahepatic cholangiocarcinoma can be grouped into five categories. The degree of ductal dilatation was determined by the presence of mucin. In tumors that excrete excessive amounts of mucin into the bile duct, the accumulated mucin caused significant ductal dilatation distal as well as proximal to the tumor. Detection of the obstructing mass on CT depends on the size of the tumor. CT could not depict tumors smaller than 1 cm, whereas all tumors larger than 1 cm could be detected on CT. Therefore, a careful trace of the dilated duct is essential in depicting the obstructing mass. The attenuation of the tumor was slightly lower than that of the hepatic parenchyma, even on good quality two-phase helical CT. According to previous reports, cholangiocarcinomas tend to have increased contrast enhancement on delayed CT scans [11,12]. However, in our study, this enhancement pattern was not seen. Intraductal papillary tumors do not have fibrotic stroma, which is the cause of delayed enhancement in classic peripheral cholangiocarcinomas. The attenuation of the dilated duct was determined by the presence of tumor casts or diffuse spreading of the papillary tumor itself. Although the hyperattenuation of the dilated ducts is a valuable clue that can lead to correct diagnosis, there are some conditions that can have the same finding. Focal stricture with subsequent cholangitis in dilated ducts can cause hyperattenuation of the duct caused by inflammatory cells and necrotic material. Partial volume-averaging artifact can also cause some hyperattenuation of ducts; however, hyperattenuation is not seen within ducts running perpendicular to the CT plane. Another possible diagnosis is the biliary invasion of the hepatocellular carcinoma. Presence of radiologic features of chronic liver disease, elevated levels of -fetoprotein, and the hypervascular nature of the tumor might be clues to the correct diagnosis.

After curative surgery, the prognosis was good in our series (15 survivors out of 16 patients; 36.1 months of mean follow-up) as in previous reports [4,5,6,7, 9]. Because surgical resection can be curative, early and accurate diagnosis is important in this disease. When we find lobar or segmental ductal dilatation, especially with higher attenuation on CT, careful trace of the bile duct to find any obstructing lesion is mandatory. Although CT plays an important role in differentiating the cause of ductal dilatation, it still has limitations in detecting small tumors or differentiating tumor casts from bile sludge or "muddy" stones. In these cases, direct cholangiography and bile cytology would be diagnostic. Because this type of tumor tends to have diffuse superficial spreading along the ductal surface (10/16, 62.5% in our series) [4,5,6,7, 9], accurate preoperative mapping of the tumor is necessary before planning surgical resection. Even the state-of-the-art percutaneous transhepatic cholangiogram cannot depict the true extent of the tumor in some instances. Choledochoscopy-guided biopsy might be needed to know the exact extent of the tumor [4,5, 7].

In conclusion, segmental or lobar dilatation of intrahepatic bile ducts with higher attenuation is the characteristic CT finding in intraductal intrahepatic cholangiocarcinomas. The obstructing mass larger than 1 cm can be depicted as a low-attenuation mass in the distal end of dilated ducts on CT.

References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. Ros PR, Buck JL, Goodman ZD, Ros AMV, Olmsted WW. Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation. Radiology 1988;167:689 -693[Abstract/Free Full Text]
2. Choi BI, Park JH, Kim YI, et al. Peripheral cholangiocarcinoma and clonorchiasis: CT findings. Radiology 1988;169:149 -153[Abstract/Free Full Text]
3. Liver Cancer Study Group of Japan. Classification of primary liver cancer, 1st English ed. Kanehara, Tokyo, 1997: 6-7
4. Sano T, Kamiya J, Nagino M, et al. Macroscopic classification and preoperative diagnosis of intrahepatic cholangiocarcinomas in Japan. J Hepatobiliary Pancreat Surg 1999;6:101 -107[Medline]
5. Sasaki A, Aramaki M, Kawano K, et al. Intrahepatic peripheral cholangiocarcinoma: mode of spread and choice of surgical treatment. Br J Surg 1998;85:1206 -1209[Medline]
6. Isaji S, Kawarada Y, Taoka H, Tabata M, Suzuki H, Yokoi H. Clinicopathological features and outcome of hepatic resection for intrahepatic cholangiocarcinoma in Japan. J Hepatobiliary Pancreat Surg 1999;6:108 -116[Medline]
7. Yamamoto M, Takasaki K, Yoshikawa T, Ueno K, Nakano M. Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma? J Surg Oncol 1998;69:162 -167[Medline]
8. Kim TK, Choi BI, Han JK, Jang HJ, Cho SG, Han MC. Peripheral cholangiocarcinoma of the liver: two-phase helical CT findings. Radiology 1997;204 : 539-543[Abstract/Free Full Text]
9. Kim YI, Yu ES, Kim ST. Intraductal variant of peripheral cholangiocarcinoma of the liver with Clonorchis sinensis infection. Cancer 1989;63:1562 -1566[Medline]
10. Ohta T, Nagakawa T, Ueda N, et al. Mucosal dysplasia of the liver and intraductal variant of peripheral cholangiocarcinoma in hepatolithiasis. Cancer 1991;68:2217 -2223[Medline]
11. Lacomis JM, Baron RL, Oliver JH, Nalesnik MA, Federle MP. Cholangiocarcinoma: delayed CT contrast enhancement patterns. Radiology 1997;203:98 -104[Abstract/Free Full Text]
12. Loyer EM, Chin HC, DuBrow RA, David CL, Efteknari F, Charnsangavej C. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinomas: enhancement patterns with quadruple phase helical CT—a comparative study. Radiology 1999;212:866 -875[Abstract/Free Full Text]

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This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, J. W. Articles by Kim, S. W. Search for Related Content PubMed PubMed Citation Articles by Lee, J. W. Articles by Kim, S. W. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?