Case 345:   Metastasis - Cholangiocarcinoma

Diagnostic Category:

Clinical Presentation:

32 year old man with right upper quadrant pain and abnormal LFT's.

MR: Hypovascular; restricted diffusion versus T2 shine through effect, with THIDs

Imaging Findings:

MR shows multiple hypovascular metastases, hypointense on T1, hyperintense on T2, with restricted diffusion: note the difference between the centrally necrotic areas, which show high DWI signal and high ADC signal ("T2 shine through effect"), while the cellular periphery of the tumors is mildly hyperintense on DWI with low ADC values, representing restricted diffusion.

Note perifocal transient hepatic intensity differences (THID) on arterial phase, caused by the "sump" or "siphon" effect due the metastases.