CT Imaging Differences Between Mass-Forming Intrahepatic Cholangiocarcinoma and Poorly-Differentiated Hepatocellular Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAOYi-jun ¹ , ZHENGLi-rong ¹ , YANGFan ² , ZHANGWei ¹ ,  CHENWei-xia ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Radiology, The First People's Hospital of Chengdu City, Chengdu 610041, Sichuan Province, China;

Corresponding author：

CHENWei-xia, Email: wxchen25@126.com

Keywords：

Intrahepatic cholagiocarcinoma; Hepatocellular carcinoma; Computed tomography; Liver

DOI：

10.7507/1007-9424.20150164

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To discuss the CT imaging differences between mass-forming intrahepatic cholangiocarcinoma (ICC) and poorly-differentiated hepatocellular carcinoma (HCC). Method The clinical and CT data of 28 patients with mass-forming ICC (mass-forming ICC group) and 27 patients with poorly-differentiated HCC (poorly-differentiated HCC group), who were confirmed by pathological diagnosis in the West China Hospital from February 2014 to August 2014, were collected and analyzed retrospectively. Results The contour, margin, enhancement patterns in the arterial phase and portal vein phase of the tumor had significant differences between the mass-forming ICC group and poorlydifferentiated HCC group (P < 0.05), in other words, the lobulated shape (15/28, 53.6%), indistinct margin (17/28, 60.7%), peripheral enhancement in the arterial phase (21/28, 75.0%) and prolonged enhancement in the portal vein phase (14/28, 50.0%) were more often seen in the mass-forming ICC group, while the poorly-differentiated HCC group were mainly the round shape (17/27, 63.0%), partially well-defined margin (18/27, 66.7%), diffuse heterogeneous enhancement in arterial phase (20/27, 74.1%) and wash out in the portal vein phase (18/27, 66.7%). The presence of bile duct dilatation in the the mass-forming ICC group was significantly higher than that in the poorly-differentiated HCC group﹝57.1% (16/28) versus 14.8% (4/27), P=0.001﹞. The size and enhancement degree of lymph node in the mass-forming ICC group were significantly bigger or higher than those in the poorly-differentiated HCC group (average lymph node size: 1.7 cm versus 1.3 cm, P=0.009; average enhancement degree of lymph node: 62.6 HU versus 51.8 HU, P=0.031). Conclusion CT features, such as tumor contour, margin, enhancement characteristics, the presence of bile duct dilatation, and the size and enhancement degree of lymph node, might help for differentiating mass-forming ICC from poorly-differentiated HCC, so that more timely selection of appropriate treatment strategies would be made.

Citation： ZHAOYi-jun, ZHENGLi-rong, YANGFan, ZHANGWei, CHENWei-xia. CT Imaging Differences Between Mass-Forming Intrahepatic Cholangiocarcinoma and Poorly-Differentiated Hepatocellular Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(5): 628-632. doi: 10.7507/1007-9424.20150164 Copy

1.	Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma. Lancet, 2005, 366(9493):1303-1314.
2.	Lim JH. Cholangiocarcinoma:morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol, 2003, 181(3):819-827.
3.	Yamasaki S. Intrahepatic cholangiocarcinoma:macroscopic type and stage classification. J Hepatobiliary Pancreat Surg, 2003, 10(4):288-291.
4.	Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5):1208-1236.
5.	Kim SA, Lee JM, Lee KB, et al. Intrahepatic mass-forming cholangiocarcinomas:enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern-correlation with clinicopathologic findings. Radiology, 2011, 260(1):148-157.
6.	Loyer EM, Chin H, Dubrow RA, et al. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma:enhancement patterns with quadruple phase helical CT-a comparative study. Radiology, 1999, 212(3):866-875.
7.	Valls C, Gumà A, Puig I, et al. Intrahepatic peripheral cholangiocarcinoma:CT evaluation. Abdom Imaging, 2000, 25(5):490-496.
8.	Asayama Y, Yoshimitsu K, Nishihara Y, et al. Arterial blood supply of hepatocellular carcinoma and histologic grading:radiologic-pathologic correlation. AJR Am J Roentgenol, 2008, 190(1):W28-W34.
9.	Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US:comparison with histologic differentiation. Radiology, 2007, 244(3):898-906.
10.	Chung YE, Kim MJ, Park YN, et al. Varying appearances of cholangiocarcinoma:radiologic-pathologic correlation. Radiographics, 2009, 29(3):683-700.
11.	Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol, 2001, 35(3):421-430.
12.	Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis, 2004, 24(2):189-199.
13.	Kaneko K, Adachi E, Onitsuka H, et al. Histopathologic correlation of two-phased dynamic incremental CT in hepatocellular carcinomas using multivariate analysis. Radiat Med, 1994, 12(1):16-24.
14.	Kim KJ, Hong SW, Lee YS, et al. Tumor margin histology predicts tumor aggressiveness in papillary thyroid carcinoma:a study of 514 consecutive patients. J Korean Med Sci, 2011, 26(3):346-351.
15.	蒋涛, 刘光华, 李慎江.利用肝移植标本对肝癌边缘CT征象的研究.肝胆外科杂志, 2005, 13(4):265-268.
16.	Kozaka K, Sasaki M, Fujii T, et al. A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement growth pattern and a resemblance to reactive proliferating bile ductules: 'bile ductular carcinoma'. Histopathology, 2007, 51(3):390-400.
17.	Chong YS, Kim YK, Lee MW, et al. Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol, 2012, 67(8):766-773.
18.	阳宁静, 宋彬, 吴苾, 等.胆管细胞性肝癌与肝细胞性肝癌侵犯胆管的CT及MRI影像学特征分析.四川大学学报:医学版, 2009, 40(3):525-528.
19.	Ko YL, Sun CS, Chung KM, et al. Manifestations of perihepatic lymph nodes in acute flare of chronic hepatitis B:association with HBeAg status and with HBeAg seroconversion. PLoS One, 2015, 10(2):e0117590.
20.	Sato M, Hikita H, Hagiwara S, et al. Potential associations between perihepatic lymph node enlargement and liver fibrosis, hepatocellular injury or hepatocarcinogenesis in chronic hepatitis B virus infection. Hepatol Res, 2014 May 22. doi:10.1111/hepr.12361.[Epub ahead of print].
21.	Soresi M, Bonfissuto G, Magliarisi C, et al. Ultrasound detection of abdominal lymph nodes in chronic liver diseases. A retrospective analysis. Clin Radiol, 2003, 58(5):372-377.
22.	Honda H, Ochiai K, Adachi E, et al. Hepatocellular carcinoma:correlation of CT, angiographic, and histopathologic findings. Radiology, 1993, 189(3):857-862.
23.	Lee JH, Lee JM, Kim SJ, et al. Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT:comparison with pathological differentiation. Br J Radiol, 2012, 85(117):e573-e583.
24.	Nakachi K, Tamai H, Mori Y, et al. Prediction of poorly differentiated hepatocellular carcinoma using contrast computed tomography. Cancer Imaging, 2014, 14:7.
25.	Kawamura Y, Ikeda K, Hirakawa M, et al. New classification of dynamic computed tomography images predictive of malignant characteristics of hepatocellular carcinoma. Hepatol Res, 2010, 40(10):1006-1014.
26.	Tsunematsu S, Chuma M, Kamiyama T, et al. Intratumoral artery on contrast-enhanced computed tomography imaging:differentiating intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma. Abdom Imaging, 2015 Jan 13.[Epub ahead of print].
27.	Zhou XD, Tang ZY, Fan J, et al. Intrahepatic cholangiocarcinoma:report of 272 patients compared with 5 829 patients with hepatocellular carcinoma. J Cancer Res Clin Oncol, 2009, 135(8):1073-1080.

1. Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma. Lancet, 2005, 366(9493):1303-1314.
2. Lim JH. Cholangiocarcinoma:morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol, 2003, 181(3):819-827.
3. Yamasaki S. Intrahepatic cholangiocarcinoma:macroscopic type and stage classification. J Hepatobiliary Pancreat Surg, 2003, 10(4):288-291.
4. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5):1208-1236.
5. Kim SA, Lee JM, Lee KB, et al. Intrahepatic mass-forming cholangiocarcinomas:enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern-correlation with clinicopathologic findings. Radiology, 2011, 260(1):148-157.
6. Loyer EM, Chin H, Dubrow RA, et al. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma:enhancement patterns with quadruple phase helical CT-a comparative study. Radiology, 1999, 212(3):866-875.
7. Valls C, Gumà A, Puig I, et al. Intrahepatic peripheral cholangiocarcinoma:CT evaluation. Abdom Imaging, 2000, 25(5):490-496.
8. Asayama Y, Yoshimitsu K, Nishihara Y, et al. Arterial blood supply of hepatocellular carcinoma and histologic grading:radiologic-pathologic correlation. AJR Am J Roentgenol, 2008, 190(1):W28-W34.
9. Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US:comparison with histologic differentiation. Radiology, 2007, 244(3):898-906.
10. Chung YE, Kim MJ, Park YN, et al. Varying appearances of cholangiocarcinoma:radiologic-pathologic correlation. Radiographics, 2009, 29(3):683-700.
11. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol, 2001, 35(3):421-430.
12. Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis, 2004, 24(2):189-199.
13. Kaneko K, Adachi E, Onitsuka H, et al. Histopathologic correlation of two-phased dynamic incremental CT in hepatocellular carcinomas using multivariate analysis. Radiat Med, 1994, 12(1):16-24.
14. Kim KJ, Hong SW, Lee YS, et al. Tumor margin histology predicts tumor aggressiveness in papillary thyroid carcinoma:a study of 514 consecutive patients. J Korean Med Sci, 2011, 26(3):346-351.
15. 蒋涛, 刘光华, 李慎江.利用肝移植标本对肝癌边缘CT征象的研究.肝胆外科杂志, 2005, 13(4):265-268.
16. Kozaka K, Sasaki M, Fujii T, et al. A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement growth pattern and a resemblance to reactive proliferating bile ductules: 'bile ductular carcinoma'. Histopathology, 2007, 51(3):390-400.
17. Chong YS, Kim YK, Lee MW, et al. Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol, 2012, 67(8):766-773.
18. 阳宁静, 宋彬, 吴苾, 等.胆管细胞性肝癌与肝细胞性肝癌侵犯胆管的CT及MRI影像学特征分析.四川大学学报:医学版, 2009, 40(3):525-528.
19. Ko YL, Sun CS, Chung KM, et al. Manifestations of perihepatic lymph nodes in acute flare of chronic hepatitis B:association with HBeAg status and with HBeAg seroconversion. PLoS One, 2015, 10(2):e0117590.
20. Sato M, Hikita H, Hagiwara S, et al. Potential associations between perihepatic lymph node enlargement and liver fibrosis, hepatocellular injury or hepatocarcinogenesis in chronic hepatitis B virus infection. Hepatol Res, 2014 May 22. doi:10.1111/hepr.12361.[Epub ahead of print].
21. Soresi M, Bonfissuto G, Magliarisi C, et al. Ultrasound detection of abdominal lymph nodes in chronic liver diseases. A retrospective analysis. Clin Radiol, 2003, 58(5):372-377.
22. Honda H, Ochiai K, Adachi E, et al. Hepatocellular carcinoma:correlation of CT, angiographic, and histopathologic findings. Radiology, 1993, 189(3):857-862.
23. Lee JH, Lee JM, Kim SJ, et al. Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT:comparison with pathological differentiation. Br J Radiol, 2012, 85(117):e573-e583.
24. Nakachi K, Tamai H, Mori Y, et al. Prediction of poorly differentiated hepatocellular carcinoma using contrast computed tomography. Cancer Imaging, 2014, 14:7.
25. Kawamura Y, Ikeda K, Hirakawa M, et al. New classification of dynamic computed tomography images predictive of malignant characteristics of hepatocellular carcinoma. Hepatol Res, 2010, 40(10):1006-1014.
26. Tsunematsu S, Chuma M, Kamiyama T, et al. Intratumoral artery on contrast-enhanced computed tomography imaging:differentiating intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma. Abdom Imaging, 2015 Jan 13.[Epub ahead of print].
27. Zhou XD, Tang ZY, Fan J, et al. Intrahepatic cholangiocarcinoma:report of 272 patients compared with 5 829 patients with hepatocellular carcinoma. J Cancer Res Clin Oncol, 2009, 135(8):1073-1080.

Previous Article
意外胆囊癌的处理和分析（附11例报道）
Next Article
Research Advance of Photodynamic Therapy on Cholangiocarcinoma

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

CT Imaging Differences Between Mass-Forming Intrahepatic Cholangiocarcinoma and Poorly-Differentiated Hepatocellular Carcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content