Magnetic Resonance Cholangiopancreatography (MRCP) by Riccardo Manfredi & Roberto Pozzi Mucelli

Author:Riccardo Manfredi & Roberto Pozzi Mucelli
Language: eng
Format: epub
Publisher: Springer Milan, Milano

5.3.2 Periductal-Infiltrating Cholangiocarcinoma

Periductal-infiltrating cholangiocarcinoma grows along the bile duct without mass formation, and causes a concentric thickening of the wall with elongated, speculated or branch-like appearance.

Most hilar cholangiocarcinomas have this appearance, while they are rarely located inside the liver. The hepatic parenchyma and the hilum are invaded in the latter stage only, when the tumor becomes exophytic. At this stage a focal wall thickening of the bile duct, with secondary dilatation of the proximal bile ducts, is usually observed. At imaging, the ducts appear abnormally dilated or irregularly narrowed because of the periductal thickening (Fig. 5.12). When located at the periphery of the liver, a periductal-infiltrating cholangiocarcinoma is more often a mass-forming type of tumor. The adjacent hepatic artery or portal vein can be encased by a dense fibroblastic reaction. Vascular invasion is not very common, but vessels may be involved by adherence and fibrosis. On the other hand, intrahepatic and extrahepatic bile ducts are often involved.

Fig. 5.12Periductal-infiltrating cholangiocarcinoma. a The MR cholangiopancreatography image shows mild dilatation of the intrahepatic bile ducts up to the common hepatic duct, which shows a luminal stenosis (arrow). b On the coronal T1-weighted contrast-enhanced magnetic resonance image, the walls of the common hepatic duct are thickened concentrically (arrow), and this results in complete stenosis of the lumen of the bile duct. Axial computed tomography scans, before (c) and after (d) contrast medium administration, confirm the strong enhancement of the newly formed tissue (arrow)

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