Cholangiocellular carcinoma

Cholangiocellular carcinoma (CCC): Intrahepatic cholangiocarcinoma is a rare neoplasm representing less than 10% of primary liver tumors. Most cases of cholangiocarcinomas arise from central branches of biliary system and cause painless jaundice. Some cholangiocarcinomas arise from peripheral intrahepatic ducts and cause intrahepatic liver masses. In these cases clinical presentation and imaging features may overlap those of HCC and hepatic metastases. The 5-year survival rate in patients with incomplete resection is below 5% Therefore, the most accurate modality should be chosen to maybe improve the patients prognosis.

MRI appearance of a CCC without (pre-contrast) and with Primovist^®

Peripheral CCCs have low signal intensity on T1-weighted images and moderate signal hyperintensity (bright areas) on T2-weighted images. Dilatation of peripheral bile duct is a hallmark (black arrow). CCCs show irregular borders with the presence of satellite metastases and shrinking of the affected liver lobe. On T2-weighted images intrahepatic CCCs can show central necrosis with hyperintense signal intensity (white arrow) (left-hand-side).

During the liver-specific phase, CCCs show no hepatocyte-selective uptake in the lesion and, therefore, appear hypointense (dark areas) on T1-weighted postcontrast sequences (right-hand-site).

Precontrast: Precontrast, T2-weighted sequence

After Primovist^® injection, T1-weighted sequence liver-specific phase

Therapy

CCCs are usually surgically removed and/or irradiated; chemotherapy has generally not been successful. Tumors are considered unresectable if they transcend one of the liver lobes, penetrate the intrahepatic ducts, encase the common hepatic artery or portal vein and its branches, display extrahepatic metastases or infiltrate the caudate lobe. Palliative treatments include surgical bypass or drainage, percutaneous drainage, and internal stenting.