Intrahepatic peripheral cholangiocarcinoma: two-phased dynamic incremental CT and pathologic correlation

To elucidate the characteristic CT findings of intrahepatic peripheral cholangiocarcinoma, two-phased dynamic incremental CT scans of 20 cholangiocarcinomas in 16 patients were carefully analyzed. Dynamic incremental CT scanning was performed after intravenous administration of 100 ml iodinated contrast medium at a rate of 2 ml/s using a power injector. The CT scans (8-16 sections) were obtained during 45-110 s (early phase) and 6-7 min (delayed phase) after commencement of the injection of the contrast medium. On CT, 55% (11 of 20) of intrahepatic peripheral cholangiocarcinomas appeared hypodense in both phases. Most of the tumors (80%) appeared hypodense in the early phase and had increased CT numbers in their delayed images. Lymphadenopathy was observed in 69% (11 of 16) of patients whose main tumors exceeded 3 cm in diameter. All tumors appeared irregular or indistinct. Twenty percent (4 of 20) of the cholangiocarcinomas were difficult to distinguish from hepatocellular carcinomas or hemangiomas.