Intrahepatic cholangiocarcinoma: diffusion-weighted MR imaging findings

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1 Intrahepatic cholangiocarcinoma: diffusion-weighted MR imaging findings Poster No.: C-1979 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit S. Schmidt, A. Pomoni, F. Becce, A. Denys, R. Meuli, R. Duran; Lausanne/CH Abdomen, Liver, Biliary Tract / Gallbladder, MR, MR-Diffusion/ Perfusion, Diagnostic procedure, Technology assessment, Neoplasia, Tissue characterisation /ecr2013/C-1979 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose The apparent diffusiom coefficients (ADC's) of focal liver lesions have been reported to be different regarding their mean values. Malignant lesions demonstrate lower ADC values than benign lesions. Data regarding the diffusion-weighted MR imaging (DWI) features in mass-forming intrahepatic cholangiocarcinoma are lacking. The aim of our study is to report the DW-MRI findings in mass-forming intrahepatic cholangiocarcinoma as well as to evaluate the usefulness of ADC values in helping the diagnosis. Images for this section: Fig. 5 Page 2 of 14

3 Methods and Materials Nineteen patients ( 10 men, mean age 63.5 years) were included in our retrospective study between August 2008 and August Nineteen lesions of mass-forming intrahepatic cholangiocarninoma were diagnosed and confirmed by surgery and/or biopsy. All patients underwent an MRI examination in a 3-T MR unit. Our standard protocol was applied which includes the sequences T1 in-out, T2 HASTE, T2FS, TIVIBE before and in arterial, venous and late phase after intravenous injection of Gadolinium. The diffusion-weighted MR-sequences (DWI) were used during superficial breathing (bvalues: 50, 300 and 600 s/mm 2 ) Image analysis was made by two radiologists in consensus that took in consideration lesion characteristics ( size, location), signal intensity (T2), contrast enhancement (SI VIBE VENOUS PHASE- SI VIBE PREGD )/ SI VIBEPREGD, and ADC values. Regarding the analysis of ADCs, a circular region of interest (ROI) was placed on the DW-image with b=600s/mm 2 encompassing the part of the lesion with most pronounced contrats enhancement seen on the T1VIBE.image. The same ROI was then transferred on the ADC map an the resulting ADC mean, ADC min and ADC max values were measured. Statistical analysis was performed using ANOVA system as well as correlation analysis. A p-value was considered significant at <0.05. Images for this section: Page 3 of 14

4 Fig. 2: T2FS weighted image demonstrates mass-forming intrahepatic lesion in the VII segment, slightly hyperintense Page 4 of 14

5 Page 5 of 14

6 Fig. 1: T1VIBE aftre intravenous injection of Gd showing the characteristic centripetal enhancement of the tumor in venous phase. Fig. 3: DWI-SS-EPI image with b=600s/mm2. Page 6 of 14

7 Fig. 4: ADC map.the same ROI from the DW-SS image has been transferred to the ADC map with an ADC mean of 0.85x 10-3s/mm2 Page 7 of 14

8 Results The maximum diameter of the lesions was 71.mm ( range mm). There was no significant correlation demonstrated between the different patterns of contrast enhancement and the lesions ADC's mean (all p>0.05). The mean ADC value of inthahepatic cholangiocarcinoma (ICCA) was estimated 1.30± 0.24 x 10-3 mm 2 /s. The mean ADC measurements did not seem to reflet the typical underlying fibrosis occuring in ICCA. Images for this section: Page 8 of 14

9 Fig. 7: T2HASTE weighted image demonstrating a moderately hyperintense lesion with intrahepatic dilatated biliary ducts in the mass. Page 9 of 14

10 Fig. 8: Contrast enhanced T1 weighted image shows poorly enhancing lesion associated to moderate parenchymal atrophy with capsular retraction Page 10 of 14

11 Fig. 9: DW-SS.EPI image with b=600 s/mm2 with ROI placed in the periphery of the lesion Page 11 of 14

12 Fig. 10: On the corresponding ADC map the lesion shows a low ADC value (1.55 x 10-3 mm/s2) Page 12 of 14

13 Conclusion The ADC mean of intrahepatic mass-forming cholangiocarcinoma (ICCA) is relatively low compared to the ADC mean of most focal liver lesions, thus indicating a malignant origin. However, the ADC mean of ICCA is slighty higher than previously reported ADC values of other malignant lesions, thus in addition to the information obtained by the T2-weighted and T1-weighted contrast-enhanced MR-images, it may be helpful in narrowing the differential diagnosis. Images for this section: Fig. 6 Page 13 of 14

14 References 1.Characterisation of focal liver lesions by ADC measurements using respiratory triggered diffusion-weighted single shot echo-planar MR imaging technique. Brûegel et al, Eur Radiol (2008) 2. Small intrahepatic mass-forming cholangio-carcinoma: target sign on diffusionweighted imaging for differentiation from hepatocellular carcinoma. Hyun Jeong Park et al, Abdom Imaging(2012) 3.The roel of ADC measurement in differential diagnosis of focal hepatic lesions. Mehmet Ruhi Onur et al, Eur Radiol (2012) 4. Varying appearances of cholangiocarcinoma:radiologic-pathologic correlation Yong Eun Chunget al, Radiographics (2009) Personal Information Page 14 of 14