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Typical and Atypical Imaging Findings of Intrahepatic Cholangiocarcinoma Using Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid–Enhanced Magnetic Resonance Imaging

Kim, So Hee MD; Lee, Chang Hee MD, PhD; Kim, Baek Hui MD; Kim, Wan Bae MD; Yeom, Suk Keu MD; Kim, Kyeong Ah MD; Park, Cheol Min MD

Journal of Computer Assisted Tomography: November/December 2012 - Volume 36 - Issue 6 - p 704–709
doi: 10.1097/RCT.0b013e3182706562

Purpose The objective of this study was to examine the imaging features of classic mass-forming intrahepatic cholangiocarcinoma (MICC) and nonclassic hypervascular MICC on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid–enhanced magnetic resonance imaging.

Methods Twenty pathologically confirmed MICCs were included. Two radiologists retrospectively reviewed the imaging characteristics on T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced images, and hepatobiliary phase (HBP) of each MICC. For the morphologic feature of defect, HBP signal intensity (SI) ratio was calculated by dividing the SI of the MICC by nearby normal liver parenchyma SI.

Results Classic MICCs (n = 14) showed classic rim or peripheral enhancement at arterial dominant phase with centripetal enhance in the delayed phases. Hypervascular MICCs (n = 6) showed complete (n = 4) or near-complete (n = 2) arterial enhancement and washout (n = 6) on delayed phases. On HBP, 13 classic MICCs (93%) and 2 hypervascular MICCs (33%) showed cloud-like SI in the center (“EOB cloud”) with peripheral defect. Mean SI ratio was 0.77 in classic MICCs and 0.59 in hypervascular MICC (P = 0.057).

Conclusions Classic MICCs (70%) frequently showed progressive centripetal enhancement on dynamic phase, and central EOB-cloud appearance with distinct peripheral defect on HBP. Nonclassic hypervascular MICCs comprised 30% of the MICCs in this study. Compared with classic MICCs, hypervascular MICCs showed wash-in on arterial dominant phase and washout on delayed phase.

From the Departments of *Radiology, †Pathology, ‡Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul; and §Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea.

Received for publication June 28, 2012; accepted August 22, 2012.

Reprints: Chang Hee Lee, MD, PhD, Department of Radiology, Korea University Guro Hospital,, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea (e-mail:

The authors report no conflicts of interest.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.