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Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: Dynamic Computed Tomography Findings and Histopathologic Correlation

Liu, Qing-Yu MD*; Zhang, Wei-Dong MD; Chen, Jian-Yu MD*; Li, Hai-Gang MD; Liu, Chao MD§; Liang, Bi-Ling MD*

Journal of Computer Assisted Tomography: March-April 2011 - Volume 35 - Issue 2 - p 187-194
doi: 10.1097/RCT.0b013e3182067f2e
Abdominal Imaging

Purpose: This purpose of this study was to analyze the computed tomography (CT) findings of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) and explore their correlations with pathological manifestations.

Methods: The clinical data, CT findings, and pathological manifestations of the 16 HCC patients with BDTT were retrospectively reviewed. All cases were pathologically proven.

Results: Most HCCs showed hyperattenuation at hepatic arterial phase (HAP) (14/16) and hypoattenuation at portal venous phase (PVP) (12/16) and equilibrium phase (9/10), and the presence of rapid washout of contrast material was noted in 11 cases. The BDTT presented as cordlike masses in the dilated bile ducts, and mostly showed hyperattenuation at HAP (12/16) and hypoattenuation at PVP (13/16) and equilibrium phase (10/10), and the presence of rapid washout of contrast material was noted in 10 cases. Four cases of BDTT showed homogeneous enhancement, which were mainly consisted of cancer cells; 9 cases showed heterogeneous enhancement, which were mainly consisted of cancer cells with flakes of necrotic tissues or abundant red blood cells. Bile duct tumor thrombus was composed of 2 different pathological tissues in 3 cases, proximal part of BDTT was composed of tumor tissue, which was uniformly enhanced on dynamic enhanced CT, whereas the distal part was composed of necrotic or debris tissue without enhancement.

Conclusions: Hepatocellular carcinoma lesion and soft-tissue mass in the bile ducts with bilary dilation are usually depicted on dynamic enhanced CT in HCC patients with BDTT. Early enhancement at HAP and rapid washout of contrast material at PVP are the characteristic findings of HCC and BDTT. Dynamic contrast CT examination is very valuable for diagnosing this disease.

From the *Department of Radiology, The Second Affiliated Hospital of Sun Yat-sen University; †Department of Radiology, Cancer Center, Sun Yat-sen University; and Departments of ‡Pathology, and §Hepatobiliary Surgery, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.

Received for publication January 12, 2010; accepted March 15, 2010.

Reprints: Qing-Yu Liu, MD, Department of Radiology, The Second Affiliated Hospital of Sun Yat-sen University, 107 Yan Jiang Xi Rd, Guangzhou, 510120, Guangdong Province, China (e-mail: liu.qingyu@163.com).

© 2011 Lippincott Williams & Wilkins, Inc.