Imaging of cholangiolocellular carcinoma of the liver

See article on page 639 

The close relation between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) continues to provide more questions than answers. The prevalence of IBD in patients with PSC is about 55–75%, and PSC occurs in patients with ulcerative colitis at a frequency of 2.5–7.5%.1 2 PSC is found less often in Crohn’s disease where it is usually associated with colonic involvement. Recent studies have found an increased prevalence of colonic dysplasia and cancer in patients with PSC and ulcerative colitis compared with ulcerative colitis alone.3 4 The mechanism by which PSC increases the risk of colonic neoplasia is unknown. The increased long term survival of patients with both PSC and ulcerative colitis after liver transplantation may therefore put these patients at an increased risk of developing colorectal cancer in view of the increased neoplastic potential as a result of the immunosuppressive therapy required after liver transplantation. Indeed, some studies have suggested that there may be a higher incidence of colorectal cancer in the first two years after liver transplantation.5-7 This may reflect the higher doses of immunosuppression …

https://gut.bmj.com/content/gutjnl/43/5/595.full.pdf

The colon and PSC: new liver, new danger?

B-flow is a non-Doppler-based technology for visualizing blood flow and has a high spatial resolution. The aim of this study is to evaluate the blood flow information of liver tumors using B-flow in comparison with color Doppler sonography (CDS). Seventy-nine patients with 82 hepatic nodules were studied using B-flow and CDS. The study group included 45 HCC nodules, 23 liver metastasis nodules, four intrahepatic cholangiocarcinomas (ICC), and 13 hemangiomas. The visualized vascularity and morphological findings of the hepatic tumor vessel were evaluated. B-flow showed multiple vessels in 48 nodules (58.5 %) and a single vessel in 13 nodules (15.9 %). CDS showed multiple vessels in 44 nodules (53.7 %) and a single vessel in 23 nodules (28.0 %). Multivariate analysis showed basket pattern was significant for HCC (OR 49.263; p = 0.0002), and penetrating vessel was significant for liver metastasis or ICC (OR 14.545; p < 0.0001). B-flow detects hepatic tumor blood flow with sensitivity as high as that of CDS. Vascular structure information obtained using B-flow could be potentially used to diagnose liver tumors.

B-flow imaging of vascular structure for the diagnosis of liver tumor

Hepatic sarcoidosis with atypical radiological manifestations: A case report.

Gastrointestinal Angiography, 3rd Edition, Vol. 1, in Saunders Monographs in Clinical Radiology

Background: Although intratumoral patent portal vein (ITPV) is one of the characteristic features of benign hepatic lesions, ITPVs can be demonstrated in malignant tumors. We present the spectrum of MR and CT findings of ITPV identified in intrahepatic cholangiomas with pathological correlations. Methods: The ultrasound, CT and/or MRI findings of pathologically-confirmed intrahepatic cholangiomas were reviewed and correlated with surgical specimen or autopsy findings. Results: Intratumoral patent vessels were radiographically-demonstrated in 5 patients with intrahepatic cholangiomas. All intratumoral vessels were secondary or tertiary order portal vein branches. Some wall thickening was identified on pathological examinations. Conclusion: The radiological demonstration of intratumoral portal vein is not a specific sign of benignity. In the case of a hepatic tumor with a patent portal tract, cholangioma should be considered, as well as benign tumors or lymphoma.

Radiologically identifiable intratumoral portal vein in intrahepatic cholangiomas: a diagnostic pitfall

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Radiologically identifiable intratumoral portal vein in intrahepatic cholangiomas: a diagnostic pitfall