Differentiation of Hepatocellular Carcinoma from Intrahepatic Cholangiocarcinoma as the Cause of Biliary Obstruction: Value of Dynamic CT During the Hepatic Arterial Phase.
10.3348/jkrs.1998.38.4.659
- Author:
June Sik CHO
1
;
Dae Hong KIM
;
Kyung Sook SHIN
;
Jin Keun KWAK
Author Information
1. Department of Diagnostic Radiology, Chungnam University College of Medicine, Korea.
- Publication Type:Original Article
- Keywords:
Liver neoplasms, CT;
Bile ducts, stenosis or obstruction;
Computed tomography(CT), contrast enhancement
- MeSH:
Carcinoma, Hepatocellular*;
Cholangiocarcinoma*;
Humans;
Liver;
Retrospective Studies;
Tomography, Spiral Computed;
Tomography, X-Ray Computed
- From:Journal of the Korean Radiological Society
1998;38(4):659-666
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate the usefulness of dynamic CT during the hepatic arterial phase with rapid IV injection ofcontrast material in distinguishing hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICAC) asthe cause of biliary obstruction. MATERIALS AND METHODS: We retrospectively reviewed two-phase dynamic incrementalCT or helical CT findings in 22 patients with intrahepatic duct obstruction secondary to pathologically provenHCCs (n=12) or ICACs (n=10). Two-phase CT scans were obtained 20-45 seconds (hepatic arterial phase) or 2 minutes(equilibrium phase) after the initiation of a bolus injection of contrast material (5 mL/sec, 150 mL). Theenhancement patterns of tumors, as seen on two-phase images, were classified as hypo-, iso-, or hyperattenuated,relative to surrounding liver parenchyma. Two-phase images were compared and correlated with pathologic findings. RESULTS: During the hepatic arterial phase, diffuse high-enhancement was seen in nine HCCs (75%) and partialenhancement in three (25%); five (50%) of the ten ICACs were hypodense and five (50%) were hypodense withperipheral enhancement. During the equilibrium phase, however, all HCCs were hypodense and capsular enhancementwas seen in four cases (33.3%). All ICACs were hypodense with mild peripheral or central heterogeneousenhancement. Contrast enhancement patterns of HCCs during the hepatic arterial phase were significantly different(P<.0001) from those of ICACs. CONCLUSION: Our results suggest that dynamic CT during the hepatic arterial phase,with rapid IV injection of contrast material, is useful for the differentiation of HCC from ICAC as the cause ofbiliary obstruction.
