Fig. 2. A 80-year-old male with intrahepatic cholangiocarcinoma.

A. Contrast-enhanced CT showed a 8 cm intrahepatic cholangiocarcinoma (arrows) in the left lobe of liver. B. A lymph node (arrowhead) with a short-axis diameter of 6 mm was noted on CT in the paraaortic area. This lymph node was assessed as benign and overall resectability was considered to be probably resectable by both reviewers. C–E. This lymph node (arrowheads) showed similar degree of enhancement on contrast-enhanced MRI (C), avid diffusion restriction on diffusion-weighted imaging (D), and increased fluorodeoxyglucose uptake on PET imaging (E), compared with adjacent normal lymph nodes. After additional review of PET/MRI, this lymph node was determined as metastasis and overall resectability was revised as definitely unresectable by both reviewers. The patient underwent exploratory laparotomy and frozen section diagnosis confirmed metastatic lymph node in the paraaortic area.