Icteric-type hepatoma: magnetic resonance imaging and magnetic resonance cholangiographic features

Background: We evaluated the imaging features of magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRC) of icteric-type hepatom a and correlated these with the findings of endoscopic retrograde cholangio graphy (ERC), percutaneous cholangiography, and surgery. Methods: Thirteen patients with viral hepatitis complicated by cirrhosis of the liver and obstructive jaundice underwent MRC and dynamic MRI. Five pat ients received percutaneous transhepatic cholangiography and drainage; one of these patients also underwent resection of the left hepatic lobe. Anothe r patient received MRC followed by thrombectomy and T-tube insertion. ERC a nd endoscopic nasobiliary drainage were performed in another patient for bi le diversion. Results: Primary liver tumors and dilatation of biliary system were demonst rated in all patients. No capsule formation could be found in any primary l iver tumors. MRI showed the simultaneous presence of an intraluminal tumor in the portal trunk and common hepatic duct in eight patients. Three differ ent MRC features were found: (a) an oval defect in the hilar bile duct(s) w ith dilated intrahepatic ducts (n = 9), (b) dilated intrahepatic ducts with missing major bile ducts (n = 2), and (c) localized stricture of the hilar bile duct(s) (n = 2). Conclusion: The presence of one or more of the following features in multip lanar MRI and MRC help to identify this rare, specific type of hepatocellul ar carcinoma: (a) the presence of an intraluminal tumor in both the portal trunk and the common hepatic duct, (b) enhancement of the intraluminal tumo r in the common hepatic duct on the arterial phase, (c) type I MRC feature, and (d) hemobilia, blood clot within the gallbladder, and/or type II MRC f eature.