A Comparison Study of Computed Tomographic Characteristics of Portal vein Involvement of Mass-forming Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma in Udonthani Hospital

Abstract

Background and Objectives:  Portal vein involvement is a crucial finding for diagnosis, cancer    staging, prognosis and treatment in mass-forming intrahepatic cholangiocarcinoma (mass-forming ICCA) and hepatocellular carcinoma (HCC). The primary objective of this study was to evaluate and compare computed tomographic (CT) characteristics of portal vein involvement in these two cancer. The secondary objective of this study was to evaluate and compare other CT characteristics in these two cancers.

Methods: Of 59 patients at Udonthani hospital who were enrolled from January 2009 to December   2012 in this retrospective descriptive study, 36 patients were mass-forming ICCA and 23 patients were HCC. Demographic data and CT characteristics between the two groups were evaluated and analyzed. The Pearson Chi-Square test and Fisher’s Exact test were used for statistical analysis. 

Results: HCC was more likely to have portal vein involvement than mass-forming ICCA (39.1%          and 19.4%, p=0.08). HCC showed intraluminal portal vein involvement more than extraluminal portal vein involvement (88.9% and 11.1%). Mass-forming ICCA showed extraluminal portal vein involvement more than intraluminal portal vein involvement (85.7% and 14.3%). HCC showed intraluminal portal  vein involvement significantly more than  mass-forming ICCA (p < 0.001). Mass-forming ICCA showed extraluminal  portal vein involvement significantly more than HCC (p < 0.001). Bile duct dilatation   (88.9%), lobar atrophy (38.9%), capsular retraction (47.2%), intratumoral calcification (16.7%), heterogenous enhancement on arterial and portovenous phases (100%) and heterogenous enhancement with centripetal fill-in of contrast material on delayed phase (100%) were seen in mass-forming ICCA significantly more than HCC (p < 0.05). Intratumoral vessels (91.3%) and hypervascular enhancement        on arterial phase (100%) and rapid wash out of contrast material on portovenous phase (100%) were   found in HCC significantly more than mass-forming ICCA (p < 0.05).  

 Conclusion:  HCC was more likely to have portal vein involvement than mass-forming ICCA.  HCC showed intraluminal portal involvement more than extraluminal portal vein involvement.  Mass-forming ICCA showed extraluminal portal vein involvement more than intraluminal portal vein involvement.                                                                                                                                                               Key words: portal vein involvement, mass-forming intrahepatic cholangiocarcinoma, hepatocellular carcinoma