Abstract
Background
Small hepatocellular carcinoma (sHCC) with bile duct tumor thrombi (BDTT) is rare and easily misdiagnosed as cholangiocarcinoma. This study was to analyze the imaging features of sHCC with BDTT.
Patients and methods
CT and/or MRI examinations were performed on seven patients who had sHCC with BDTT. One patient received CT scan, one received CT and MR scan, and five received MR scan. Magnetic resonance cholangiopancreatography (MRCP) was performed in five patients. The diagnosis of sHCC with BDTT was based on surgical specimens in all patients.
Results
The sHCC lesions and BDTT were presented on CT or MRI scans in all the seven cases. The BDTT is presented as soft tissue mass in the bile duct with biliary dilatation above the obstruction. In the two patients who had received dynamic contrast CT scan, the sHCC lesions showed atypical enhancement pattern of HCC. The BDTT showed similar enhancement pattern as sHCC in one of the two patients. The sHCC and BDTT showed homogenous hypointense signals on T1W images and hyperintense signals on T2W images in all six cases. In the three patients who had received dynamic enhancement MR scan, the enhancement patterns of sHCC lesions and BDTT were similar. Early enhancement of sHCC lesion and BDTT at hepatic arterial phase with hyperintense signals was observed in one patient, while two other patients had no early enhancement. All sHCC lesions and BDTT showed hypointense signals at portal venous phase, equilibrium phase, and delayed phase. Six patients showed hyperintense signal of hemorrhage in the dilated bile ducts on both T1W and T2W images. Five cases of BDTT presented as filling defect in the bile ducts on MRCP. The BDTT were directly connected with sHCC lesions in all the seven patients, without bile duct wall thickening or extra-bile duct invasion.
Conclusion
CT or MRI is a safe, reliable, and valuable method for the detection and diagnosis of sHCC with BDTT.
Similar content being viewed by others
References
Monzawa S, Ichikawa T, Nakajima H, et al. (2007) Dynamic CT for detecting small hepatocellular carcinoma: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–153
Efremidis SC, Hytiroglou P, Matsui O (2007) Enhancement patterns and signal-intensity characteristics of small hepatocellular carcinoma in cirrhosis: pathologic basis and diagnostic challenges. Eur Radiol 17:2969–2982
Yamashita Y, Mitsuzaki K, Yi T, et al. (1996) Small hepatocellular carcinoma in patients with chronic liver damage: prospective comparison of detection with dynamic MR imaging and helical CT of the whole liver. Radiology 200:79–84
Huang GT, Lee PH, Tsang YM, et al. (2005) Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma: a prospective study. Ann Surg 242:36–42
Chen MS, Li JQ, Zheng Y, et al. (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328
Soyer P, Laissy JP, Bluemke DA, et al. (1995) Bile duct involvement in hepatocellular carcinoma: MR demonstration. Abdom Imaging 20:118–121
Liu Q, Chen J, Li H, et al. (2009) Hepatocellular carcinoma with bile duct tumor thrombi: correlation of magnetic resonance imaging features to histopathologic manifestations. Eur J Radiol [Epub ahead of print]
Gabata T, Terayama N, Kobayashi S, et al. (2007) MR imaging of hepatocellular carcinomas with biliary tumor thrombi. Abdom Imaging 32:470–474
Edmondson HA, Steiner PE (1954) Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 7:462–503
Qin LX, Tang ZY (2003) Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. World J Gastroenterol 9:385–391
Qin LX, Ma ZC, Wu ZQ, et al. (2004) Diagnosis and surgical treatments of hepatocellular carcinoma with tumor thrombosis in bile duct: experience of 34 patients. World J Gastroenterol 10:1397–1401
Shiomi M, Kamiya J, Nagino M, et al. (2001) Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery 129:692–698
Ise N, Andoh H, Sato T, et al. (2004) Three cases of small hepatocellular carcinoma presenting as obstructive jaundice. HPB (Oxford) 6:21–24
Ueda M, Takeuchi T, Takayasu T, et al. (1994) Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. Hepatogastroenterology 41:349–354
Tseng JH, Hung CF, Ng KK, et al. (2001) Icteric-type hepatoma: magnetic resonance imagings and magnetic resonance cholangiographic features. Abdom Imaging 26:171–177
Bolondi L, Gaiani S, Celli N, et al. (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34
Jung AY, Lee JM, Choi SH, et al. (2006) CT features of an intraductal polypoid mass: differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 30:173–181
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liu, QY., Huang, SQ., Chen, JY. et al. Small hepatocellular carcinoma with bile duct tumor thrombi: CT and MRI findings. Abdom Imaging 35, 537–542 (2010). https://doi.org/10.1007/s00261-009-9571-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-009-9571-2