Management implications of fluorodeoxyglucose positron emission tomography/magnetic resonance in untreated intrahepatic cholangiocarcinoma

Eur J Nucl Med Mol Imaging. 2020 Jul;47(8):1871-1884. doi: 10.1007/s00259-019-04558-3. Epub 2019 Nov 8.


Purpose: Intrahepatic cholangiocarcinoma (ICC) is associated with a poor prognosis with surgical resection offering the best chance for long-term survival and potential cure. However, in up to 36% of patients who undergo surgery, more extensive disease is found at time of operation requiring cancellation of surgery. PET/MR is a novel hybrid technology that might improve local and whole-body staging in ICC patients, potentially influencing clinical management. This study was aimed to investigate the possible management implications of PET/MR, relative to conventional imaging, in patients affected by untreated intrahepatic cholangiocarcinoma.

Methods: Retrospective review of the clinicopathologic features of 37 patients with iCCC, who underwent PET/MR between September 2015 and August 2018, was performed to investigate the management implications that PET/MR had exerted on the affected patients, relative to conventional imaging.

Results: Of the 37 patients enrolled, median age 63.5 years, 20 (54%) were female. The same day PET/CT was performed in 26 patients. All patients were iCCC-treatment-naïve. Conventional imaging obtained as part of routine clinical care demonstrated early-stage resectable disease for 15 patients and advanced stage disease beyond the scope of surgical resection for 22. PET/MR modified the clinical management of 11/37 (29.7%) patients: for 5 patients (13.5%), the operation was cancelled due to identification of additional disease, while 4 "inoperable" patients (10.8%) underwent an operation. An additional 2 patients (5.4%) had a significant change in their operative plan based on PET/MR.

Conclusions: When compared with standard imaging, PET/MR significantly influenced the treatment plan in 29.7% of patients with iCCC.

Trial registration: 2018P001334.

Keywords: Cholangiocarcinoma; Clinical management; PET/MR; Staging.

MeSH terms

  • Bile Duct Neoplasms* / diagnostic imaging
  • Bile Duct Neoplasms* / pathology
  • Bile Duct Neoplasms* / surgery
  • Cholangiocarcinoma* / diagnostic imaging
  • Cholangiocarcinoma* / pathology
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Radiopharmaceuticals
  • Retrospective Studies


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18