Cholangiocarcinoma: spectrum of appearances on Gd-EOB-DTPA-enhanced MR imaging and the effect of biliary function on signal intensity.

Shi-Ting Feng,Yanji Luo,Zhi Dong,Zi-Ping Li,Huasong Cai,Tao Chan,Ling Wu,Keguo Zheng

doi:10.1186/s12885-015-1039-x

Abstract

BackgroundTo describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the RSI.Methods25 patients with pathologically-proven cholangiocarcinoma underwent Gd-EOB-DTPA-enhanced MRI. The visualization of the biliary system during biliary phase (BP) was observed. RSIs of the abdominal aorta (A), portal vein (V), liver (L), and spleen (S) were measured.ResultsOn hepatocellular phase (HP), exophytic tumors (n =10) and infiltrative tumors (n =10) were hypointense, polypoid tumors (n = 2) were hypointense, and combined type tumors (n = 3) had mixed appearances. While patients with normal TB levels (≤22 μmol/L, n = 12) had clear visualization of the biliary tree during BP, those with elevated TB levels (>22 μmol/L, n = 13) had obscured or no visualization. In addition, patients with normal TB levels had higher RSIA, RSIV and RSIS than those with elevated TB levels on all dynamic phases (P <0.001), and lower RSIA, RSIV and RSIS on HP and BP (P <0.001). Patients with normal TB levels had higher RSIL than those with elevated TB levels on all phases (P <0.001).ConclusionsRSIs of major abdominal organs reflected underlying biliary function. Cholangiocarcinoma patients with elevated TB levels had delayed excretion of Gd-EOB-DTPA compared with patients with normal TB levels.

Highlights

To describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the relative signal intensity (RSI)
The primary aim of this study is to describe the Gd-EOB-DTPA-enhanced MR imaging appearances of different types of cholangiocarcinoma that might differ from previously known features on gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) -enhanced MR imaging, and to quantitatively evaluate the relative signal intensity (RSI) of major abdominal organs during different phases and investigate the effect of total bilirubin (TB) levels on the RSI
All the subjects did not demonstrate evidence of diffuse liver diseases such as hepatic steatosis and cirrhotic morphology on in and out of phase imaging (Figure 2c,d), On dynamic MR imaging, 23 of 25 (92%) patients had minimal or moderate contrast enhancement at the periphery of the tumor on arterial phase (AP), with progressive or concentric filling on portal venous phase (PVP) and equilibrium phase (EP)

Summary

Introduction

To describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the RSI. The typical growth pattern of cholangiocarcinoma can be categorized into four types: exophytic (mass-forming), infiltrative (periductal), polypoid (intraductal), and combined (a combination of the above) [1]. It is the most common primary malignancy of the biliary tree, accounting for 15% of all liver cancers [2,3]. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is an amphipathic derivative of Gd-DTPA (i.e., Gd-DTPA with a covalently bound lipophilic ethoxybenzyl moiety) [9]. It combines the features of conventional extracellular contrast agents and hepatocyte-specific contrast agents. While biliary excretion of Gd-EOB-DTPA is known to provide positive T1-weighted intrabiliary contrast imaging [16,17,18], only a

Objectives

Methods

Results

Discussion

Conclusion