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Large centro-hepatic cholangiocarcinoma

Case Study
Prof. Valette, Pierre-Jean, M.D. Lyon South Hospital, Hospices Civils de Lyon • France

Patient history

A 54-year-old male is admitted for jaundice. CT revealed a large centro-hepatic mass but the local extension to hilar structures could not be determined precisely.

MR examination

The exam was performed on Ingenia 3.0T with dS Torso coil solution, patient feet first, arms up.

The Ingenia’s dS Torso coil solutionhas a large coverage. With this coil, whole abdomen acquisition is a single step for most patients. So, it is much faster to perform, for instance, bowel MRI for inflammatory diseases or tumors.


ExamCard used:

Images

 T2W T1 mDIXON arterial phase T1W mDIXON portal phase
T2W
T1 mDIXON arterial phase
T1W mDIXON portal phase
 DWI MIP bile ducts VRT bile ducts and portal vein
DWI
MIP bile ducts
VRT bile ducts and portal vein


The T2-weighted image shows a large well-defined mass in segment IV.

T1-weighted images at arterial and portal phase show late heterogeneous enhancement of the lesion suggesting a fibrous component and possibly mucinous content or central necrosis.

DWI demonstrates restriction predominantly at the peripheral part of the mass. No evidence of adjacent lesions into the liver.

The MIP and VRT MRCP views confirm the hilar bile duct invasion, of which details are clarified on reformatted views in an axial plane. There is no associated compression of portal branches.

Diagnosis

Final diagnosis is hepatic cholangiocarcinoma invading the convergence of the bile ducts with prominent extension of the right side. Resectability may be considered in the absence of portal damage, but was not attempted because of insufficient left lobe volume.

Clinical impact of Ingenia 3.0T

MRI helps in maing the diagnosis of cholangiocarcinoma by allowing analysis of tissue components of the lesion. It also clarifies the conditions of resectability of this large liver mass showing the relationship of the lesion with the elements of the hilum.

Ingenia’s wide 70 cm bore enables to improve imaging strategy by implementing the high dS SENSE speedup in RL direction with arms-up patient positioning. This allows using a narrowed acquisition volume without the patient’s arms causing artifacts. This provides shorter breath hold times, higher resolution and sharper images because of reduced blurring in TSE and less distortion in DWI. This positioning is accepted by almost every patient, but requires an examination time not exceeding 20 to 25 minutes. The use of high RL dS SENSE factors in combination with armsup provides a real advantage. So often with MR, when you change something, you lose something somewhere else. In this case, it is just advantages.


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Mar 6, 2014

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Case Study
Ingenia 3.0T
Body, cholangiocarcinoma, dS SENSE, dS Torso coil solution, dStream, Liver, Oncology
 

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