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Delayed-Phase Dynamic CT Enhancement as a Prognostic Factor for Mass-forming Intrahepatic Cholangiocarcinoma¹

¹ From the Departments of Clinical Radiology (Y.A., K.Y., H.I., T.T., A.N., M.H., T.N., D.K., H.H.), Surgery and Science (A.T.), and Anatomic Pathology (S.A.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. From the 2004 RSNA Annual Meeting. Received October 13, 2004; revision requested December 22; revision received January 27, 2005; accepted February 28; final version accepted March 18. Address correspondence to Y.A. (e-mail: asayama{at}radiol.med.kyushu-u.ac.jp).

View larger version (162K): [in a new window]   Figure 1a: Transverse CT scans in a 67-year-old man with ICC. (a) Scan obtained 45 seconds after the administration of contrast material shows early peripheral enhancement of the tumor (arrows). (b) Scan obtained 300 seconds after the injection of contrast material shows progressive and concentric filling. Because more than two-thirds of the tumor showed delayed enhancement, the patient was placed in group 1. A pathology specimen (not shown) obtained from the area of delayed enhancement exhibited a cluster of carcinoma cells with abundant fibrous stroma accompanied by inflammatory cell infiltration.

View larger version (160K): [in a new window]   Figure 1b: Transverse CT scans in a 67-year-old man with ICC. (a) Scan obtained 45 seconds after the administration of contrast material shows early peripheral enhancement of the tumor (arrows). (b) Scan obtained 300 seconds after the injection of contrast material shows progressive and concentric filling. Because more than two-thirds of the tumor showed delayed enhancement, the patient was placed in group 1. A pathology specimen (not shown) obtained from the area of delayed enhancement exhibited a cluster of carcinoma cells with abundant fibrous stroma accompanied by inflammatory cell infiltration.

View larger version (132K): [in a new window]   Figure 2a: Transverse CT scans in a 57-year-old woman with ICC in the right lobe of the liver. (a) Scan obtained 60 seconds after the administration of contrast material shows early enhancement of most of the tumor (arrows). (b) Scan obtained 300 seconds after the injection of contrast material shows washout of contrast material. Because less than two-thirds of the tumor showed delayed enhancement, the patient was placed in group 2.

View larger version (91K): [in a new window]   Figure 2b: Transverse CT scans in a 57-year-old woman with ICC in the right lobe of the liver. (a) Scan obtained 60 seconds after the administration of contrast material shows early enhancement of most of the tumor (arrows). (b) Scan obtained 300 seconds after the injection of contrast material shows washout of contrast material. Because less than two-thirds of the tumor showed delayed enhancement, the patient was placed in group 2.

View larger version (25K): [in a new window]   Figure 3: Graph shows survival curves for groups 1 and 2. The survival rate of patients in group 1 was significantly poorer than that in group 2.