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

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

Open Access
|May 2020

Figures & Tables

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
DOI: https://doi.org/10.2478/raon-2020-0029 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 149 - 158
Submitted on: Feb 6, 2020
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Accepted on: Apr 22, 2020
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Published on: May 28, 2020
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 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 Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.