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Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase
E M Loyer1, H Chin, R A DuBrow
1Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. eloyer@di.mdacc.tmc.edu
Insights
Quadruple phase helical computed tomography (CT) reveals distinct hemodynamic features for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. The delayed phase of contrast enhancement is crucial for differentiating these liver tumors.
Area of Science:
- Radiology
- Hepatobiliary Imaging
- Oncology
Background:
- Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver malignancies with distinct origins.
- Accurate characterization of these tumors is essential for appropriate treatment planning.
- Distinguishing between HCC and ICC based on imaging features can be challenging.
Purpose of the Study:
- To define the hemodynamic features of HCC and ICC using quadruple-phase helical CT.
- To evaluate the utility of these hemodynamic features in characterizing liver tumors.
- To determine if contrast enhancement patterns can differentiate between HCC and ICC.
Main Methods:
- Helical CT scans of the liver were performed in 45 patients with newly diagnosed HCC or ICC.
- Scans were acquired before and at multiple time points after contrast injection (25s, 70s, 2-6 min).
- Contrast uptake intensity, spatial distribution, and time-attenuation curves were analyzed to assess lesion conspicuity and diagnostic confidence.
Main Results:
- Hepatocellular carcinoma typically showed early peak enhancement followed by a decrease in attenuation.
- Intrahepatic cholangiocarcinoma demonstrated increasing tumor attenuation during the delayed phase.
- Lesion conspicuity and diagnostic confidence improved with the use of the delayed phase for both tumor types.
Conclusions:
- Temporal variations in contrast enhancement patterns are sufficiently different between HCC and ICC to serve as a diagnostic criterion.
- The delayed phase of contrast enhancement is particularly valuable for amplifying these differences and improving diagnostic accuracy.
- Quadruple-phase helical CT provides useful hemodynamic information for differentiating between HCC and ICC.
Purpose:
To define the hemodynamic features of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma by using quadruple phase helical computed tomography (CT) and determine the value of this information in characterizing tumors.
Materials And Methods:
Helical CT of the liver was performed in 45 patients with newly diagnosed HCC or peripheral cholangiocarcinoma. Scans were obtained before and 25 seconds, 70 seconds, and 2-6 minutes after the start of the contrast material injection. The intensity and spatial distribution of contrast material uptake were evaluated during all phases. Time-attenuation curves were established for each lesion. Relative attenuation and lesion conspicuity were assessed. A diagnostic confidence level was assigned to each lesion.
Results:
In the majority of HCC lesions, a single, early peak of enhancement followed by a continuous decrease in tumor attenuation over time was seen. The greatest tumor conspicuity occurred during the delayed phase. In cholangiocarcinoma, tumor attenuation increased during the delayed phase. In the majority of lesions, the greatest tumor conspicuity was seen during the portal venous phase. In both tumor types, the diagnostic confidence level improved when the delayed phase was used.
Conclusion:
The variation over time in the intensity of contrast enhancement in HCC and cholangiocarcinoma differs sufficiently to make this a useful diagnostic criterion. The delayed phase is particularly important because it amplifies this difference.