Abstract
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy, with mass-forming growth pattern being the most common. The typical imaging appearance of mass-forming ICC (mICC) consists of irregular ring enhancement in the arterial phase followed by the progressive central enhancement on portal venous and delayed phases. However, atypical imaging presentation in the form of hypervascular mICC might also be seen, which can be attributed to distinct pathological characteristics. Ancillary imaging features such as lobular shape, capsular retraction, segmental biliary dilatation, and vascular encasement favor the diagnosis of mICC. Nevertheless, these radiological findings may also be present in certain benign conditions such as focal confluent fibrosis, sclerosing hemangioma, organizing hepatic abscess, or the pseudosolid form of hydatid disease. In addition, a few malignant lesions including primary liver lymphoma, hemangioendothelioma, solitary hypovascular liver metastases, and atypical forms of hepatocellular carcinoma (HCC), such as scirrhous HCC, infiltrative HCC, and poorly differentiated HCC, may also pose a diagnostic dilemma by simulating mICC in imaging studies. Diffusion-weighted imaging and the use of hepatobiliary contrast agents might be helpful for differential diagnosis in certain cases. The aim of this manuscript is to provide a comprehensive overview of mICC imaging features and to describe useful tips for differential diagnosis with its potential mimickers.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary malignant liver tumor after hepatocellular carcinoma (HCC) [1]
The typical imaging appearance of mass-forming ICC consists of irregular ring enhancement in the arterial phase followed by the progressive central enhancement on portal venous and delayed phases
The aim of this manuscript is to provide a comprehensive overview of mass-forming ICC (mICC) imaging features and to describe useful tips for differential diagnosis with its potential mimickers
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary malignant liver tumor after hepatocellular carcinoma (HCC) [1]. In order to provide better understanding of varying imaging appearances of mICC and its correlation with clinicopathological features, Kim et al have proposed new dichotomous imaging classification introducing “parenchymal” and “ductal” types of mICC [8] This is in accordance with the new histological classification that divides ICC into small duct and large duct types [9]. Hayashi et al have shown that large bile duct type was more commonly associated with poor differentiation due to the rich fibrous stroma in contrast to the small duct type, which had better postsurgical outcomes [12,13] Recognition of this different imaging appearances of mICC provides additional clinical information regarding the prognosis and clinical outcome, which may influence treatment decisions in certain cases [8]. Useful tips for the differentiation of mICC from its potential mimickers are highlighted
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