Gadoxetic acid magnetic-enhanced resonance imaging in the diagnosis of cholangiocarcinoma

Figure 4 Distal cholangiocarcinoma. A case of distal cholangiocarcinoma (white arrow) involving the common bile duct in a 52-year-old male patients with primary sclerosing cholangitis and ulcerative colitis. The patients underwent magnetic resonance cholangiopancreatography with axial. A: Coronal; B: T2-weighted images and a maximum intensity projection reconstruction of the 3D respiratory-triggered heavily T2-weighted FSE sequences; C: Then contrast-enhanced Computed Tomography; D: For staging the disease. Moreover, a percutaneous transhepatic biliary drainage for diagnostic confirmation with tissue collection was performed; E: And finally, PET scan; F and G: It was used to resolve a diagnostic dilemma about a pulmonary nodule. The patient underwent surgery; H and I: It was reported the surgical resection specimen at histology stained with hematoxylin and eosin respectively at 2 × and 10 ×: The tumor was an adenocarcinoma, with an invasion of the wall of the bile duct for 6 mm with also perilesional papillary epithelial dysplasia, the final stage according to the VIII edition of the Union for International Cancer Control is T2, N0. L: The maximum intensity projection reconstruction of the 3D respiratory-triggered heavily T2-weighted FSE sequences, 6 mo after the surgery: The irregular dilatation of the intrahepatic biliary tract persists (in patients with primary sclerosing cholangitis) and the patency of the biliodigestive anastomosis is highlighted with the white arrow.