What is the role of MRI in the workup of cholangiocarcinoma?

Updated: Apr 13, 2018
  • Author: Mahesh Kumar Neelala Anand, MBBS, DNB, FRCR; Chief Editor: John Karani, MBBS, FRCR  more...
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The intrahepatic mass is seen as a hypointense lesion relative to normal liver on T1-weighted images. T2-weighted images show predominant isointensity or slight hyperintensity relative to the liver parenchyma in about 64% of cases and marked hyperintensity in 36% of cases. These alterations in signal intensity are seen in the periphery of the tumor mass, with a hypointense area in the center of the mass. [13, 14, 15]

Pathologic correlation with MR appearances reveal that the isointense or slightly hyperintense areas on T2-weighted images are due to the abundant fibrous content of these tumors and that the hyperintense areas on T2-weighted images are due to mucous secretion within the lesion. The intravenous administration of gadolinium-based contrast material results in concentric contrast enhancement. [16]

Gadolinium-based contrast agents have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory.

MRI demonstrates vascular encasement, focal liver atrophy, or dilatation of intrahepatic ducts in about 70% of cases. Although MR features are well correlated with the pathologic changes, the appearances are nonspecific for a definitive diagnosis.

Conventional MRI, MRCP (MR cholangiopancreatography), and MR angiography have been applied to evaluate malignant biliary obstruction. These techniques can demonstrate the features of cholangiocarcinoma. The clinical application of the data and expertise with the use of MR imaging alone, compared with the application and use of helical CT and endoscopic US, are still evolving.

MRCP images may show a variety of artifacts and normal variants that mimic cholangiocarcinoma-like lesions. An experienced radiologist should be able to recognize such pitfalls.

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