Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging

Fabio Piscaglia, Massimo Iavarone, Marzia Galassi, Sara Vavassori, Matteo Renzulli, Laura Virginia Forzenigo, Alessandro Granito, Veronica Salvatore, Angelo Sangiovanni, Rita Golfieri, Massimo Colombo, Luigi Bolondi

Research output: Contribution to journalArticle

Abstract

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. Aim: 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.

Original languageEnglish
Pages (from-to)735-744
Number of pages10
JournalDigestive Diseases
Volume33
Issue number6
DOIs
Publication statusPublished - Oct 1 2015

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Cholangiocarcinoma
Hepatocytes
Fibrosis
Contrast Media
Magnetic Resonance Imaging
Gadolinium
Gadolinium DTPA
Diagnostic Errors
Hepatocellular Carcinoma
Neoplasms
Magnetic Resonance Spectroscopy
Control Groups

Keywords

  • Cirrhosis
  • Contrast media
  • Differential diagnosis
  • Hepatocellular carcinoma
  • Liver cancer

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cholangiocarcinoma in Cirrhosis : Value of Hepatocyte Specific Magnetic Resonance Imaging. / Piscaglia, Fabio; Iavarone, Massimo; Galassi, Marzia; Vavassori, Sara; Renzulli, Matteo; Forzenigo, Laura Virginia; Granito, Alessandro; Salvatore, Veronica; Sangiovanni, Angelo; Golfieri, Rita; Colombo, Massimo; Bolondi, Luigi.

In: Digestive Diseases, Vol. 33, No. 6, 01.10.2015, p. 735-744.

Research output: Contribution to journalArticle

Piscaglia, F, Iavarone, M, Galassi, M, Vavassori, S, Renzulli, M, Forzenigo, LV, Granito, A, Salvatore, V, Sangiovanni, A, Golfieri, R, Colombo, M & Bolondi, L 2015, 'Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging', Digestive Diseases, vol. 33, no. 6, pp. 735-744. https://doi.org/10.1159/000439097
Piscaglia, Fabio ; Iavarone, Massimo ; Galassi, Marzia ; Vavassori, Sara ; Renzulli, Matteo ; Forzenigo, Laura Virginia ; Granito, Alessandro ; Salvatore, Veronica ; Sangiovanni, Angelo ; Golfieri, Rita ; Colombo, Massimo ; Bolondi, Luigi. / Cholangiocarcinoma in Cirrhosis : Value of Hepatocyte Specific Magnetic Resonance Imaging. In: Digestive Diseases. 2015 ; Vol. 33, No. 6. pp. 735-744.
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AU - Piscaglia, Fabio

AU - Iavarone, Massimo

AU - Galassi, Marzia

AU - Vavassori, Sara

AU - Renzulli, Matteo

AU - Forzenigo, Laura Virginia

AU - Granito, Alessandro

AU - Salvatore, Veronica

AU - Sangiovanni, Angelo

AU - Golfieri, Rita

AU - Colombo, Massimo

AU - Bolondi, Luigi

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N2 - 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. Aim: 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.

AB - 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. Aim: 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.

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