Cholangiocarcinoma – metastatic disease

Body MRI Case
with FREEZEit
Cholangiocarcinoma – metastatic disease
Distinction with FREEZEit – TWIST-VIBE
www.siemens.com/body-mri-cases
Prof. Günther Schneider, M.D.
Department of Diagnostic and Interventional Radiology
University Hospital Saarland
Homburg (Saar), Germany
Answers for life.
Background
Patient data
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Male
63
Years
Patient History
Extensive tumor of the liver, suspected cholangiocarcinoma.
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
Further question: Is there a pancreatic carcinoma?
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Prehistory
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Examination
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Clinical Images
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Consequences
2
Prehistory
Prior diagnostic
examinations
Differential
diagnosis
Prior CT scan (2/2014), shows
Extensive tumor of the liver, suspect-
lesions sized up to 14 mm x 17 mm
ed cholangiocarcinoma. Further
of the left inferior lobe of the liver.
question: Is there a pancreatic carci-
The available images and case infor-
noma? Are there any hepatic metas-
mation is not sufficient to select the
tases? Patient is referred to MR for
optimal treatment option for the pa-
further clarification.
tient, be it surgery, (neo-)adjuvant
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
radiation- or chemotherapy or a palliative approach. Therefore, the patient is referred to MR for further
clarification.
3
Examination
MR imaging findings
Extensive tumor of the liver, mainly in segments
2, 4 a/b, and 5/8 with an axial extension of
90 mm x 221 mm. Lesion shows a non-homogeneous hypo-intensive signal in T2 and a homogeneous hypo-intensive signal in T1. After contrast-agent administration (MultiHance, 0.05 mmol/
kg body weight), image shows a clear peripheral
contrast-agent uptake in the hepatobiliary phase
and an extensive desmoplastic reaction (considered
typical of CCC). Satellite metastases of the other liver segments, up to 18 mm x 22 mm in segment 2.
Hyperthrophy of the caudate lobe. Obstructive
cholestasis due to central tumor infiltration of the
bile ducts. 6-mm-sized lymph node of the hilar area.
Accessory spleen sized 19 mm x 22 mm.
No suspicious pancreatic lesion.
Multiple, partly confluent lesions of the liver with
distributed satellite disease apposite to cholangiocarcinoma.
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
native
TWIST-VIBE (7s)
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Prehistory
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Examination
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Clinical Images
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Consequences
TWIST-VIBE (10s)
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TWIST-VIBE (13s)
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TWIST-VIBE (31s)
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TWIST-VIBE (38s)
4
Examination
MR imaging findings
Images show peripheral vascularized lesions of the
liver tissue, especially metastases of the left and
right hepatic lobes.
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
TWIST-VIBE (10s)
Even small lesions of just 2-3 mm in size can be
diagnosed with confidence.
Also significant: so-called “target phenomenon“
(dark in the center, light at the margins)
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Prehistory
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Examination
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Clinical Images
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Consequences
In the late phase of 2D Flash VIBE, lesions show
distinct contrast enhancement.
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Flash-VIBE (98:56 min)
5
native
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
6
TWIST-VIBE (7s)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
7
TWIST-VIBE (10s)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
8
TWIST-VIBE (13s)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
9
TWIST-VIBE (31s)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
10
TWIST-VIBE (38s)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
11
Flash-VIBE (performed after 98:56 min)
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
12
Consequences
Consequences and
procedure
Patient is ineligible for surgery.
Further liver resection would not bring
any further benefit for the patient.
Continued chemotherapy .
Therapeutic and
prognostic relevance
MRI has very good soft-tissue contrast,
allowing even small metastases to be
identified (which might easily be
missed in a CT scan). Additionally, with
the high temporal resolution of TWISTVIBE, the wash-in and wash-out can
easily be tracked, which helps “boost
the confidence” of the reader by providing the time point of optimal lesion enhancement and enabling a full picture
of the disease.
Cholangiocarcinoma –
Distinction with FREEZEit – TWIST-VIBE
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Background
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Prehistory
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Examination
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Clinical Images
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Consequences
13
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