Open Access

Major and ancillary features according to LI-RADS in the assessment of combined hepatocellular-cholangiocarcinoma

Vincenza Granata
Vincenza Granata
, 
Roberta Fusco
Roberta Fusco
, 
Sergio Venanzio Setola
Sergio Venanzio Setola
, 
Fabio Sandomenico
Fabio Sandomenico
, 
Maria Luisa Barretta
Maria Luisa Barretta
, 
Andrea Belli
Andrea Belli
, 
Raffaele Palaia
Raffaele Palaia
, 
Fabiana Tatangelo
Fabiana Tatangelo
, 
Roberta Grassi
Roberta Grassi
, 
Francesco Izzo
Francesco Izzo
 and 
Antonella Petrillo
Antonella Petrillo
   | May 28, 2020
Radiology and Oncology's Cover Image
About this article
Previous Article
Next Article
Cite
Article Category: Research Article
Published Online: May 28, 2020
Page range: 149 - 158
Received: Feb 06, 2020
Accepted: Apr 22, 2020
DOI: https://doi.org/10.2478/raon-2020-0029
© 2020 Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Fabio Sandomenico, Maria Luisa Barretta, Andrea Belli, Raffaele Palaia, Fabiana Tatangelo, Roberta Grassi, Francesco Izzo, Antonella Petrillo, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Man 56 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule is iso-hyperintense (arrow) in T2-W sequence (A), with inhomogeneous hypervascular appearance (arrow) during arterial phase of contrast study (B), without wash-out or capsule appearance (arrow) during portal phase of contrast study (C). The nodule shows restricted (arrow) diffusion (D, E and F) in diffusion weighted imaging (DWI) sequences.
Man 56 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule is iso-hyperintense (arrow) in T2-W sequence (A), with inhomogeneous hypervascular appearance (arrow) during arterial phase of contrast study (B), without wash-out or capsule appearance (arrow) during portal phase of contrast study (C). The nodule shows restricted (arrow) diffusion (D, E and F) in diffusion weighted imaging (DWI) sequences.

Figure 2

Woman 68 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. Multidetector computed tomography (MDCT) study. The nodule shows hypervascular appearance (arrow) during arterial phase of contrast study (A), with wash-out appearance (arrow) and without capsule appearance (arrow) during portal and late phase of contrast study (B and C).
Woman 68 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. Multidetector computed tomography (MDCT) study. The nodule shows hypervascular appearance (arrow) during arterial phase of contrast study (A), with wash-out appearance (arrow) and without capsule appearance (arrow) during portal and late phase of contrast study (B and C).

Figure 3

Woman 58 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on IV-V-VIII hepatic segment. MRI study. Pre surgical radiological diagnosis was cholangiocarcinoma (CCA). The lesion shows inhomogeneous hyperintense signal (arrow) in T2-W sequence (A) with central more hyperintense area. In T1-W in-out phase sequence (B and C) the lesion is inhomogeneous hypointense (arrow). During contrast study (D: arterial phase, E: portal phase; F: late phase) the lesion shows progressive contrast enhancement (arrow). In diffusion weighted imaging (DWI) (G, H and I) it shows restricted diffusion (arrow).
Woman 58 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on IV-V-VIII hepatic segment. MRI study. Pre surgical radiological diagnosis was cholangiocarcinoma (CCA). The lesion shows inhomogeneous hyperintense signal (arrow) in T2-W sequence (A) with central more hyperintense area. In T1-W in-out phase sequence (B and C) the lesion is inhomogeneous hypointense (arrow). During contrast study (D: arterial phase, E: portal phase; F: late phase) the lesion shows progressive contrast enhancement (arrow). In diffusion weighted imaging (DWI) (G, H and I) it shows restricted diffusion (arrow).

Figure 4

Man 71 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule shows hyperintense signal (arrow) in T2-W sequence (A) and target like pattern of enhancement (arrow) during arterial (B) and portal (C) phase of contrast study. Restricted diffusion (arrow) in diffusion weighted imaging (DWI) (D, E and F) sequence.
Man 71 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule shows hyperintense signal (arrow) in T2-W sequence (A) and target like pattern of enhancement (arrow) during arterial (B) and portal (C) phase of contrast study. Restricted diffusion (arrow) in diffusion weighted imaging (DWI) (D, E and F) sequence.

Figure 5

Man 69 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule shows inhomogeneous hyperintense signal (arrow) in T2-W sequence (A) and progressive pattern of enhancement (arrow) during arterial (B) and portal (C) phase of contrast study. In (D, E and F) arrow shows a nodule satellite. Restricted diffusion (arrow) in diffusion weighted imaging (DWI) (G, H and I) sequence.
Man 69 y with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) on VI hepatic segment. MRI study. The nodule shows inhomogeneous hyperintense signal (arrow) in T2-W sequence (A) and progressive pattern of enhancement (arrow) during arterial (B) and portal (C) phase of contrast study. In (D, E and F) arrow shows a nodule satellite. Restricted diffusion (arrow) in diffusion weighted imaging (DWI) (G, H and I) sequence.

Characteristics of the 62 selected patients

DescriptionNumbers (%)/ range
GenderMen 48 (77.4%) Women 14 (22.6%)
Age63 y; range. 38–80 y
Number of hepatic nodules
          Single nodule62 (100%)
          Multiple nodules/
Nodule size (mm)median range size 10-190 46.0 mm mm;
Risk factor for HCC
          Chronic hepatitis B; HBV-related liver cirrhosis37 (59.7%)
          Chronic hepatitis C; HCV-related liver cirrhosis23 (37.1)
          Alcoholic liver cirrhosis2 (3.2%)
          Child–Pugh Classification
              A62 (100%)
              B

Imaging features in study population

True HCC (n 51)cHCC-CCA (n 11)P value*
Arterial hyperenhancement
        Yes35 (68.6%)4 (36. 4%)
        No3 (5.8%)0 (0%)0.04
Inhomogeneous13 (25.5%)7 (63.6%)
Wash-out appearance
        Yes37 (72.5%)6 (54.5%)
        No5 (17.6%)1 (9.1%)0.38
        Inhomogeneous9 (17.6%)4 (35.4%)
Capsule appearance
        Yes31 (60.8%)2 (18.2%)
        No19 (37.2%)9 (81.8%)0.03
        Inhomogeneous1 (1.9%) alo-sign
MR features167
T2-W hyperintensity
        Yes15 (93.7%)5 (71.4%)0.14
        Inhomogeneous1 (6.2%)2 (28.6%)
Diffusion restricted
        Yes15 (100%)7 (100%)-
        No
Median ADC1210 x 10-3mm2/s880.7 x 10-3mm2/s0.03
Progressive enhancement contrast2 (3.9%)7 (63.6%)<<0.001
Satellite nodules3 (5.9%)7 (63.6%)<<0.001
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Journal RSS Feed