Korean J Radiol.  2013 Oct;14(5):769-775. 10.3348/kjr.2013.14.5.769.

Diffusion-Weighted MRI in Intrahepatic Bile Duct Adenoma Arising from the Cirrhotic Liver

• An C
• Park S
• Choi YJ

• KMID: 1711431
• DOI: http://doi.org/10.3348/kjr.2013.14.5.769

Abstract

A 64-year-old male patient with liver cirrhosis underwent a CT study for hepatocellular carcinoma surveillance, which demonstrated a 1.4-cm hypervascular subcapsular tumor in the liver. On gadoxetic acid-enhanced MRI, the tumor showed brisk arterial enhancement and persistent hyperenhancement in the portal phase, but hypointensity in the hepatobiliary phase. On diffusion-weighted MRI, the tumor showed an apparent diffusion coefficient twofold greater than that of the background liver parenchyma, which suggested that the lesion was benign. The histologic diagnosis was intrahepatic bile duct adenoma with alcoholic liver cirrhosis.

Keyword

Bile duct adenoma; Peribiliary gland hamartoma; Diffusion-weighted imaging; Apparent diffusion coefficient; Gadoxetic acid-enhanced MRI

MeSH Terms

Adenoma, Bile Duct/*diagnosis/etiology
Bile Duct Neoplasms/*diagnosis/etiology
*Bile Ducts, Intrahepatic
Contrast Media/diagnostic use
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging/*methods
Gadolinium DTPA/diagnostic use
Humans
Liver Cirrhosis/*complications/diagnosis
Male
Middle Aged
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Dynamic contrast-enhanced CT images, Gd-EOB-DTPA-enhanced and diffusion-weighted MR images, and pathologic findings in 64-year-old male with intrahepatic bile duct adenoma. Dynamic contrast-enhanced CT images. A. Unenhanced CT scan shows well-defined low density nodule measuring about 1.4 cm in lateral segment of left hepatic lobe (arrow). Note nodular surface and blunted margin of liver, indicative of liver cirrhosis. B. Dynamic contrast-enhanced CT scan reveals arterial enhancement of nodule. C. In portal venous phase, nodule shows persistent enhancement. D. In delayed phase, tumor is not well delineated because of its isodensity to adjacent liver parenchyma. Gd-EOB-DTPA = gadolinium-ethoxybenzyl-diethylene triamine pentaacetic acid. Dynamic Gd-EOB-DTPA-enhanced and diffusion-weighted MR images. E, F. Tumor shows strong enhancement in arterial phase (E), persistent enhancement in portal venous phase, but isointensity in late dynamic phase (F, arrow). G, H. Transverse (G) and coronal (H) hepatobiliary phase images demonstrate that nodule, in its subcapsular location (arrow) shows distinctly low signal intensity. Gd-EOB-DTPA = gadolinium-ethoxybenzyl-diethylene triamine pentaacetic acid. Gross and microscopic appearances of the tumor. I, J. On high b-value (800 s/mm2) DWI (I) and on ADC map (J), lesion (arrow) shows hyperintensity compared to liver parenchyma, indicating that diffusivity within lesion is increased and hyperintensity on DWI is due to T2 shine-through effects. K. Gross specimen shows ill-defined, non-encapsulated, yellowish-white nodule (black arrow) located immediately beneath hepatic capsule (white arrows). Surrounding liver parenchyma is congested and diffusely nodular. L. Microscopically, lesion consists of proliferation of well-formed bile ductules over background of fibrous stroma with several inflammatory cells coursing between ductules. No cellular atypia or mitotic activity is noted (Hematoxylin & Eosin staining, × 200). Gd-EOB-DTPA = gadolinium-ethoxybenzyl-diethylene triamine pentaacetic acid, DWI = diffusion-weighted imaging, ADC = apparent diffusion coefficient

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