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Objective: The objective of this report was to describe the CT features of intraductal intrahepatic cholangiocarcinoma., Conclusion: Segmental or lobar dilatation of the intrahepatic bile ducts associated with or without intraductal polypoid mass, amorphous structures, or both with slight hyperattenuation are common CT findings of intraductal intrahepatic cholangiocarcinoma. The size of the intraductal mass determines the visibility on CT.

Intrahepatic cholangiocarcinomas are usually categorized as peripheral cholangiocarcinoma or hilar cholangiocarcinoma on the basis of the site of origin. Clonorchiasis is a trematodiasis caused by chronic infestation of liver flukes, which are largely confined to the Orient, from Japan to Vietnam. The close relationship between clonorchiasis and cholangiocarcinoma has long been emphasized. This paper discusses the efficacy and possible roles of MRI for imaging clonorchiasis and cholangiocarcinoma of the liver. Although sonography, CT, and direct cholangiography have been used traditionally to diagnose these diseases, the role of MRI has been increasing rapidly with dramatic progress of the MRI techniques. We review MRI findings of clonorchiasis and cholangiocarcinoma and discuss the potential usefulness of MRI.

Hilar cholangiocarcinoma, a highly lethal tumor, is difficult to diagnose with conventional computed tomography (CT) because of its small size. Spiral CT allows more effective evaluation of these small lesions and better demonstrates the status of the hepatic arterial or portal venous circulation. Among 27 patients with hilar cholangiocarcinoma (infiltrative in 21, exophytic in two, polypoid in one, diffuse in three), thin-section spiral CT allowed identification of each tumor as an area of focal wall thickening that obliterated the lumen. Seventeen of the infiltrative tumors (81%) showed high attenuation. Identification of the level of biliary obstruction was possible in 63% of the patients (17 of 27). The level of obstruction was underestimated in six patients and overestimated in four. Spiral CT is a valuable method for diagnosis of hilar cholangiocarcinoma; however, spiral CT is less accurate in evaluation of intraductal tumor extent because of the limited z-axis resolution.

Purpose: To determine characteristic features of peripheral cholangiocarcinoma on two-phase spiral computed tomographic (CT) scans., Materials and Methods: Thirty-four patients with peripheral cholangiocarcinoma underwent two-phase spiral CT. Hepatic arterial phase and portal venous phase images were obtained 30 and 65 seconds, respectively, after the start of contrast material infusion., Results: Thin, mild, incomplete rimlike contrast enhancement at the tumor periphery was seen on CT scans from both phases in 23 patients. Thick, continuous rimlike contrast enhancement and marked homogeneous contrast enhancement were present on scans in four patients and one patient, respectively. No definite contrast enhancement pattern was seen on scans in six patients. Other findings included increased lobar or segmental hepatic attenuation in adjacent normal liver during the arterial phase (n = 10), markedly low attenuation with amorphous areas of slightly high attenuation in the tumor during both phases (n = 33), internal septumlike linear structures (n = 8), narrowing or obstruction of the portal vein as it traversed the tumor (n = 16), and a patent hepatic vein (n = 4)., Conclusion: Thin, mild, incomplete rimlike contrast enhancement at the tumor periphery and markedly low intratumoral attenuation with amorphous areas of slightly high attenuation during both scanning phases are typical findings of peripheral cholangiocarcinoma.

To evaluate the clinical utility of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of peripheral cholangiocarcinoma of the liver, 11 patients with pathologically proven peripheral cholangiocarcinoma were examined with both CT and MRI. On CT scans in 10 cases, the tumors appeared as irregular, low-attenuation masses with a wide variation in heterogeneity. Contrast enhancement of the tumors was mild in nine cases and moderate in one case, at the periphery. Tumor was not identified in one case. On T1-weighted MRIs, the tumors showed low intensity in eight cases and isointensity in three cases. On T2-weighted images, the tumors showed high intensity in all 11 cases. Focal dilatation of the intrahepatic bile ducts around the tumor was seen in one case on MRIs and in four cases on CT scans. Portal vein invasion of the tumors was seen in one case, and lymphadenopathy was seen in four cases on both MRIs and CT scans. MRI was slightly superior to CT in detecting the tumors, was inferior to CT in delineating focal ductal dilatation around the tumors, and was equal to CT in assessing extent of the tumors.

A case of cystic peripheral cholangiocarcinoma is presented. Both sonography and computed tomography (CT) demonstrated a large intrahepatic cystic neoplasm containing an enhancing solid portion. Despite the very rare incidence of this tumor, we believe that cystic degeneration of peripheral cholangiocarcinoma should be considered with these radiologic findings.

To evaluate the characteristics of combined hepatocellular and cholangiocarcinoma of the liver by imaging techniques, six patients (five male and one female), aged 46-60 years, with proved combined tumors were selected for this study from the review of 500 resected specimens of liver tumors. Images obtained from sonography, computed tomography (CT), angiography, and CT after intraarterial injection of iodized oil (iodized-oil CT) were retrospectively reviewed and correlated with the appearance of pathologic specimens. Sonographic findings were round or ovoid hypoechoic masses with central hyperechoic area (target appearance) in all patients. On CT scans, tumors were relatively well-defined low-and/or iso-attenuation masses in all patients. Angiography showed hypovascular masses in five patients. In one patient, the tumor appeared as a hypovascular mass with a central hypervascular area. On iodized-oil CT scans, all patients showed partial retention of iodized oil in tumors. Echogenicity in tumors at sonography or attenuation in tumors at CT could not be correlated with histologic difference in tumors at pathologic specimens. However, the hypervascular area at angiography and the compact retention areas of iodized oil at iodized-oil CT corresponded to portions of hepatocellular carcinoma within the combined tumor. On the basis of our results, imaging features, including target appearance at sonography, hypovascular mass with central hypervascular portions at angiography, and partial retention of iodized oil in tumors at iodized-oil CT, might be helpful in making accurate diagnosis of these rare tumors.

The article presents information on intrahepatic intraductal cholangiocarcinoma. Most intrahepatic peripheral cholangiocarcinomas (PCCs) develop in the small peripheral bile ducts and grow in a nodular or a diffuse pattern in some cases, polypoid or papillary cholangiocarcinomas arise from the peripheral duct, and tumor growth is confined to within the bile duct. These tumors form tumor casts along the peripheral tributaries of the bile duct. This type of tumor is referred to as an intraductal variant of PCC or intraductal growing cholangiocarcinoma by the Liver Cancer Study Group of Japan. Unlike ordinary PCCs, this tumor has an indolent biologic behavior and a better prognosis.

Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man. [ABSTRACT FROM AUTHOR]