MRI scan of liver tumor showing target lesion, emphasizing diagnostic precision in differentiating liver tumors.

Decoding Liver Tumors: How to Tell the Difference Between IMT and Cholangiocarcinoma

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"A Deep Dive into MRI Scans and What They Reveal About Inflammatory Myofibroblastic Tumors and Cholangiocarcinoma"

The liver, a vital organ responsible for numerous bodily functions, can sometimes be affected by tumors. Among these, inflammatory myofibroblastic tumors (IMTs) and intrahepatic cholangiocarcinomas (ICCs) present unique diagnostic challenges. Both can manifest as 'target lesions' on imaging, making it difficult to distinguish between them. Accurate differentiation is critical, as IMTs are often benign and can even regress spontaneously, while ICCs require prompt and aggressive treatment.

Traditionally, distinguishing between IMTs and ICCs has relied on a combination of imaging techniques, clinical evaluation, and, in many cases, biopsies. However, imaging modalities like gadoxetic acid-enhanced magnetic resonance imaging (MRI) have shown promise in improving diagnostic accuracy. Gadoxetic acid, a contrast agent used in MRI, highlights differences in the way these tumors absorb and release the substance, potentially revealing key characteristics that differentiate them.

Recent research has focused on identifying specific MRI features that can reliably distinguish between IMTs and ICCs presenting as target lesions. By analyzing the timing and pattern of contrast enhancement, signal intensity, and other morphological characteristics, radiologists aim to improve diagnostic precision and reduce the need for invasive procedures.

MRI Findings: Spotting the Subtle Differences

MRI scan of liver tumor showing target lesion, emphasizing diagnostic precision in differentiating liver tumors.

A study published in "Abdominal Radiology" sought to determine the differential features of IMTs and ICCs manifesting as target appearances on gadoxetic acid-enhanced MRI. The study involved 27 patients with 36 IMTs and 34 patients with 34 ICCs, all of whom underwent gadoxetic acid-enhanced MRI. Researchers evaluated the morphology, signal intensity, and enhancement patterns of the tumors on various MRI sequences, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and gadoxetic acid-enhanced imaging.

The key finding was that IMTs often demonstrate an "early" target appearance characterized by specific features. This early appearance is crucial in differentiating IMTs from ICCs.

Peripheral Hypointense Rim: IMTs commonly showed a hypointense rim on unenhanced T1WI.
Central Enhancement: Followed by a centrally enhanced area with a hypointense rim during the arterial and portal venous phases.
Transitional Phase Stability: This pattern typically persisted into the transitional phase.

In contrast, ICCs typically exhibited a "late" target appearance with different characteristics. These differences can help radiologists distinguish between the two types of tumors:

The Future of Liver Tumor Diagnosis

Gadoxetic acid-enhanced MRI holds significant promise for improving the differentiation between IMTs and ICCs, especially when they present as target lesions. Recognizing the nuances in early versus late target appearance can lead to more accurate diagnoses, potentially reducing the need for invasive procedures and ensuring that patients receive the most appropriate and timely treatment.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00261-018-1847-y, Alternate LINK

Title: Differentiation Between Inflammatory Myofibroblastic Tumor And Cholangiocarcinoma Manifesting As Target Appearance On Gadoxetic Acid-Enhanced Mri

Subject: Urology

Journal: Abdominal Radiology

Publisher: Springer Science and Business Media LLC

Authors: Amy Inji Chang, Young Kon Kim, Ji Hye Min, Jisun Lee, Honsoul Kim, Soon Jin Lee

Published: 2018-12-04

Everything You Need To Know

What are the key differences between Inflammatory Myofibroblastic Tumors (IMTs) and Intrahepatic Cholangiocarcinomas (ICCs), and why is this distinction important?

Inflammatory Myofibroblastic Tumors (IMTs) are often benign tumors that can sometimes resolve on their own. Intrahepatic Cholangiocarcinomas (ICCs), on the other hand, are a form of liver cancer that require prompt and aggressive treatment. Accurate diagnosis is crucial because the treatments differ significantly. Misdiagnosis can lead to unnecessary interventions or delayed, inadequate treatment, impacting patient outcomes.

How do MRI scans with gadoxetic acid help in distinguishing between IMTs and ICCs?

MRI scans use a contrast agent called gadoxetic acid to highlight differences between tumors. This agent affects how Inflammatory Myofibroblastic Tumors (IMTs) and Intrahepatic Cholangiocarcinomas (ICCs) absorb and release the substance, revealing characteristics that help distinguish them. Features like signal intensity, enhancement patterns, and morphological characteristics on sequences like T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and gadoxetic acid-enhanced imaging are examined to improve diagnostic precision.

What specific MRI characteristics are used to differentiate IMTs from ICCs?

IMTs often show an "early" target appearance on gadoxetic acid-enhanced MRI. This includes a peripheral hypointense rim on unenhanced T1WI, followed by a centrally enhanced area with a hypointense rim during the arterial and portal venous phases. This pattern tends to persist into the transitional phase. In contrast, ICCs typically have a "late" target appearance, which is a key difference helping radiologists differentiate between the two tumor types. These detailed observations help avoid invasive procedures and ensure proper treatment.

Why is it difficult to diagnose liver tumors, and what makes differentiating between IMTs and ICCs so challenging?

The main challenge lies in differentiating between Inflammatory Myofibroblastic Tumors (IMTs) and Intrahepatic Cholangiocarcinomas (ICCs). Both can present as target lesions on imaging, making visual distinction difficult. However, IMTs are often benign and may spontaneously regress, while ICCs are cancerous and require immediate treatment. Correct identification prevents unnecessary interventions for IMTs and ensures timely treatment for ICCs.

What is the significance of using gadoxetic acid-enhanced MRI in diagnosing liver tumors?

Gadoxetic acid-enhanced MRI is a valuable tool because it can improve the differentiation between Inflammatory Myofibroblastic Tumors (IMTs) and Intrahepatic Cholangiocarcinomas (ICCs), especially when they appear as target lesions. By analyzing specific MRI features, radiologists can potentially reduce the need for invasive procedures like biopsies and provide the most appropriate and timely treatment for patients. This approach can significantly impact patient care by providing accurate diagnoses and facilitating effective management strategies.