A proposal of imaging classification of intrahepatic mass-forming cholangiocarcinoma into ductal and parenchymal types: clinicopathologic significance

  • Hyungjin Rhee
  • Myeong-Jin KimEmail author
  • Young Nyun Park
  • Chansik An



To investigate the clinicopathologic significance of a subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) into ductal and parenchymal types based on magnetic resonance imaging (MRI)


We enrolled 72 consecutive patients, in whom MF-iCCA was diagnosed on preoperative MRI and surgical resection from January 2000 to March 2013. Two readers independently evaluated MRI findings of adjacent bile duct dilation, periductal tumor spread, and presence of diffuse dilatation or abnormality of the intrahepatic bile duct. MF-iCCAs with none of the aforementioned findings were defined as parenchymal type, and those with one or more findings were defined as ductal type. The enhancement pattern in the arterial phase was also evaluated. Clinical and histopathological findings, as well as post-surgical outcomes, were collected from medical records.


Parenchymal-type MF-iCCA (21/78, 27%) exhibited significantly lower serum carbohydrate antigen 19-9 (12.8 vs. 173.8 U/mL) and carcinoembryonic antigen (1.7 vs. 4.2 ng/mL), more frequent viral hepatitis (43% vs. 18%), less frequent biliary intraepithelial neoplasia (0% vs. 26%), and less frequent perineural invasion (0% vs. 59%) and lymph node metastasis (7% vs. 46%), compared with the ductal type (57/78, 73%) (p < 0.05 for all). Parenchymal-type MF-iCCA showed more frequent arterial hypervascularity (p = 0.001) and better overall survival (p = 0.030) than the ductal type.


Subclassification of MF-iCCAs into parenchymal and ductal types may be useful to discriminate clinical and histopathological characteristics and post-surgical outcomes.

Key Points

• We propose subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) as parenchymal and ductal types, on the basis of magnetic resonance imaging findings of biliary abnormality.

• Two types of MF-iCCAs exhibit different clinical and histopathological characteristics and post-surgical outcomes.


Magnetic resonance imaging Bile ducts Prognosis Liver neoplasms Bile duct diseases 



Anti-hepatitis C virus


Biliary intraepithelial neoplasia


Carbohydrate antigen 19-9


Carcinoembryonic antigen


Surface antigen of the hepatitis B virus


Intrahepatic cholangiocarcinoma


Interquartile range


Mass-forming intrahepatic cholangiocarcinoma


Magnetic resonance imaging


Periductal infiltrating iCCA



This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Korea (Grant No. 1520160).

Compliance with ethical standards


The scientific guarantor of this publication is Myeong-Jin Kim.

Conflict of interest

Myeong-Jin Kim is a recipient of a grant from Bayer HealthCare, which is not related to this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Rhee et al [14].


• Retrospective

• Observational

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic RegulationYonsei University College of MedicineSeoulSouth Korea
  3. 3.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulSouth Korea

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