Intrahepatic cholangiocarcinomas in cirrhosis are hypervascular in comparison with those in normal livers

Background and Aims Intrahepatic cholangiocarcinomas (ICCs) are usually adenocarcinomas with fibrotic and hypovascular stroma. Intrahepatic cholangiocarcinomas in cirrhosis and precirrhotic liver (ICC-cirrhosis) are increasingly being diagnosed, and can display hypervascluar enhancement resembling a hepatocellular carcinoma on dynamic imaging. Methods In this study using ICC-cirrhosis (71 cases), ICC with non-specific reactive changes (ICC-reactive) (72 cases) and the cholangiocarcinoma component of combined hepatocellular cholangiocarcinoma (HCC-ICC) (30 cases), we tried to compare the tumour vasculature. Results It was found that ICC-cirrhosis and the cholangiocarcinoma component of HCC-ICC showed a higher density of arteries and microvessels (1.59 +/- 0.58/mm2 (mean +/- SD) and 140 +/- 43/mm2 in ICC-cirrhosis and 1.74 +/- 0.67/mm2 and 131 +/- 46/mm2 in the cholangiocarcinoma component of HCC-ICC) than in ICC-reactive (1.26 +/- 0.61/mm2 and 103 +/- 45/mm2). Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) showed that a majority of ICC-cirrhosis displayed strong hypervascular enhancement, whereas one-third of ICC-reactive each showed strong, weak and no or minimal enhancement respectively. The increased vascular density was positively correlated with enhanced arterial phase of dynamic CT and MRI. Conclusion The density of arteries and microvessels of ICC-cirrhosis was higher than that in ICC-reactive and comparable to that in the cholangiocarcinoma component of HCC-ICC, and the higher density of arteries and microvessels in ICC may be responsible for the hypervascular enhancement of ICC-cirrhosis.