Intratumoral artery on contrast-enhanced computed tomography imaging: differentiating intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma

• Published in: Abdominal imaging Vol. 40; no. 6; pp. 1492 - 1499
• Main Authors: Tsunematsu, Seiji, Chuma, Makoto, Kamiyama, Toshiya, Miyamoto, Noriyuki, Yabusaki, Satoshi, Hatanaka, Kanako, Mitsuhashi, Tomoko, Kamachi, Hirofumi, Yokoo, Hideki, Kakisaka, Tatsuhiko, Tsuruga, Yousuke, Orimo, Tatsuya, Wakayama, Kenji, Ito, Jun, Sato, Fumiyuki, Terashita, Katsumi, Nakai, Masato, Tsukuda, Yoko, Sho, Takuya, Suda, Goki, Morikawa, Kenichi, Natsuizaka, Mitsuteru, Nakanishi, Mitsuru, Ogawa, Koji, Taketomi, Akinobu, Matsuno, Yoshihiro, Sakamoto, Naoya
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2015; Springer Nature B.V
• Subjects: Adult; Aged; Bile Duct Neoplasms - diagnostic imaging; Bile Ducts, Intrahepatic - diagnostic imaging; Carcinoma, Hepatocellular - diagnostic imaging; Cholangiocarcinoma - diagnostic imaging; Contrast Media; Diagnosis, Differential; Female; Gastroenterology; Hepatic Artery; Hepatology; Humans; Imaging; Liver - diagnostic imaging; Liver Neoplasms - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Portal Vein - diagnostic imaging; Radiographic Image Enhancement; Radiology; Reproducibility of Results; Tomography, X-Ray Computed; Contrast-enhanced CT; Poorly differentiated hepatocellular carcinoma; Intratumoral artery; Differential diagnosis; Intrahepatic cholangiocarcinoma
• ISSN: 0942-8925; 2366-004X; 1432-0509; 2366-0058
• DOI: 10.1007/s00261-015-0352-9

Aim Differentiating intrahepatic cholangiocarcinoma (ICC) from poorly differentiated hepatocellular carcinoma (p-HCC) is often difficult, but it is important for providing appropriate treatments. The purpose of this study was to examine the features differentiating ICC from p-HCC on contrast-enhanced dynamic-computed tomography (CT). Methods This study examined 42 patients with pathologically confirmed ICC ( n  = 19) or p-HCC ( n  = 23) for which contrast-enhanced dynamic CT data were available. CT images were analyzed for enhancement patterns during the arterial phase, washout pattern, delayed enhancement, satellite nodules, capsular retraction, lesion shape, and presence of an intratumoral hepatic artery, intratumoral hepatic vein, intratumoral portal vein, and bile duct dilation around the tumor, portal vein tumor thrombus, lobar atrophy, or lymphadenopathy. Results Univariate analysis revealed the presence of rim enhancement ( p  = 0.037), lobulated shape ( p  = 0.004), intratumoral artery ( p  < 0.001), and bile duct dilation ( p  = 0.006) as parameters significantly favoring ICC, while a washout pattern significantly favored p-HCC ( p  < 0.001). Multivariate analysis revealed intratumoral artery as a significant, independent variable predictive of ICC ( p  = 0.037), and 15 ICCs (78.9%) showed this feature. Washout pattern was a significant, independent variable favoring p-HCC ( p  = 0.049), with 15 p-HCCs (65.2%) showing this feature. Conclusion The presence of an intratumoral artery in the arterial phase on contrast-enhanced dynamic CT was a predictable finding for ICC, and the presence of a washout pattern was a predictable finding for p-HCC, differentiating between ICC and p-HCC.