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Lopes Vendrami C, Thorson DL, Borhani AA, Mittal PK, Hammond NA, Escobar DJ, Gabriel H, Recht HS, Horowitz JM, Kelahan LC, Wood CG, Nikolaidis P, Venkatesh SK, Miller FH. Imaging of Biliary Tree Abnormalities. Radiographics 2024; 44:e230174. [PMID: 39024175 DOI: 10.1148/rg.230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Pathologic conditions of the biliary system, although common, can be difficult to diagnose clinically. Challenges in biliary imaging include anatomic variants and the dynamic nature of the biliary tract, which can change with age and intervention, blurring the boundaries of normal and abnormal. Choledochal cysts can have numerous appearances and are important to diagnose given the risk of cholangiocarcinoma potentially requiring surgical resection. Choledocholithiasis, the most common cause of biliary dilatation, can be difficult to detect at US and CT, with MRI having the highest sensitivity. However, knowledge of the imaging pitfalls of MRI and MR cholangiopancreatography is crucial to avoid misinterpretation. Newer concepts in biliary tract malignancy include intraductal papillary biliary neoplasms that may develop into cholangiocarcinoma. New paradigms in the classification of cholangiocarcinoma correspond to the wide range of imaging appearances of the disease and have implications for prognosis. Accurately staging cholangiocarcinoma is imperative, given expanding curative options including transplant and more aggressive surgical options. Infections of the biliary tree include acute cholangitis or recurrent pyogenic cholangitis, characterized by obstruction, strictures, and central biliary dilatation. Inflammatory conditions include primary sclerosing cholangitis, which features strictures and fibrosis but can be difficult to differentiate from secondary causes of sclerosing cholangitis, including more recently described entities such as immunoglobulin G4-related sclerosing cholangitis and COVID-19 secondary sclerosing cholangitis. The authors describe a wide variety of benign and malignant biliary tract abnormalities, highlight differentiating features of the cholangitides, provide an approach to interpretation based on the pattern of imaging findings, and discuss pearls and pitfalls of imaging to facilitate accurate diagnosis. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Camila Lopes Vendrami
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Deanna L Thorson
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Amir A Borhani
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Pardeep K Mittal
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Nancy A Hammond
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - David J Escobar
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Helena Gabriel
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Hannah S Recht
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Jeanne M Horowitz
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Linda C Kelahan
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Cecil G Wood
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Paul Nikolaidis
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Sudhakar K Venkatesh
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Frank H Miller
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
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Huang P, Wei G, Kirkpatrick JD, Lin Y, Tan L, Matta H, Nasser I, Huang M, Chen L, Petitjean M, Skelton-Badlani D, Gao W, Vaid K, Zhao S, Lugovskoy A, Alenzi M, Chen X, Gores GJ, Popov YV. Transposon-based oncogene integration in Abcb4(Mdr2)-/- mice recapitulates high susceptibility to cholangiocarcinoma in primary sclerosing cholangitis. J Hepatol 2024:S0168-8278(24)02423-1. [PMID: 39089631 DOI: 10.1016/j.jhep.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND AIMS Cholangiocarcinoma (CCA) is a dreaded complication of primary sclerosing cholangitis (PSC), difficult to diagnose and associated with high mortality. Lack of animal models of CCA recapitulating the hepatic microenvironment of sclerosing cholangitis hinders development of novel treatments. Here we sought to develop such PSC-associated CCA model in mice. METHODS Ten-week-old Mdr2-/- mice with congenital PSC-like disease, and healthy wild-type littermates were subjected to either modified retrograde biliary instillation or hydrodynamic tail vein injection of sleeping beauty transposon-transposase plasmid system with activated AKT (myr-AKT) and Yap (YapS127A) protooncogenes (SB AKT/YAP1). The role of TGFβ was interrogated via ALK5 inhibitor (SB-525334) administration. Tumor phenotype, burden and desmoplastic reaction were analyzed histologically and via RNA-seq. RESULTS While SB AKT/YAP1 plasmids via retrograde biliary injection caused tumors in Mdr2-/-, only 26.67% (4/15) of these tumors were CCA. Alternatively, hydrodynamic tail vein injection of SB AKT/YAP1 resulted in robust tumorigenesis in all fibrotic Mdr2-/- mice with high CCA burden compared to healthy mice. Tumors phenotypically resembled human CCA, expressed multiple CCA (but not hepatocellular carcinoma) markers, and exhibited a profound desmoplastic reaction. RNA-seq analysis revealed profound transcriptional changes in CCA evolving in PSC-like context, with specific alterations in multiple immune pathways. Pharmacological TGFβ inhibition led to enhanced immune cell tumor infiltration, reduced tumor burden and suppressed desmoplastic collagen accumulation compared to placebo CONCLUSION: We established a new high-fidelity cholangiocarcinoma model in mice, termed SB CCA.Mdr2-/-, which recapitulates the increased susceptibility to CCA in the setting of biliary injury and fibrosis observed in PSC. Through transcriptomics and pharmacological studies, we show dysregulation of multiple immune pathways and TGFβ signaling as potential drivers of CCA in PSC-like microenvironment. IMPACT AND IMPLICATIONS There is a lack of animal models for primary sclerosing cholangitis (PSC) related cholangiocarcinoma (PSC-CCA). We have developed and characterized a new mouse model of PSC-CCA, termed SB CCA.Mdr2-/-, which features reliable tumor induction in PSC-like background of biliary injury and fibrosis. Global gene expression alterations were identified and standardized tools, including automated whole slide image analysis methodology for tumor burden and feature analysis, were established to enable systematic research into PSC-CCA biology and formal pre-clinical drug testing.
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Affiliation(s)
- Pinzhu Huang
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Colon and Rectum Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangyan Wei
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jesse D Kirkpatrick
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA,USA
| | - Yi Lin
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Gastroenterology and Hepatology, Fujian Provincial Hospital, Fuzhou, China
| | - Li Tan
- Division of Gastroenterology and Hepatology, Department of Medicine; Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Heansika Matta
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Imad Nasser
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mingzhe Huang
- Department of Colon and Rectum Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | | | - Wen Gao
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Kahini Vaid
- Division of Gastroenterology and Hepatology, Department of Medicine
| | | | - Alicia Lugovskoy
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Maram Alenzi
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Xin Chen
- University of Hawaii Cancer Center, Honolulu, HI USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Yury V Popov
- Division of Gastroenterology and Hepatology, Department of Medicine.
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Catanzaro E, Gringeri E, Burra P, Gambato M. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers (Basel) 2023; 15:4947. [PMID: 37894314 PMCID: PMC10604939 DOI: 10.3390/cancers15204947] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Cholangiocarcinoma (CCA) is the most common malignancy in patients with primary sclerosing cholangitis (PSC), accounting for 2-8% of cases and being the leading cause of death in these patients. The majority of PSC-associated CCAs (PSC-CCA) develop within the first few years after PSC diagnosis. Older age and male sex, as well as concomitant inflammatory bowel disease (IBD) or high-grade biliary stenosis, are some of the most relevant risk factors. A complex combination of molecular mechanisms involving inflammatory pathways, direct cytopathic damage, and epigenetic and genetic alterations are involved in cholangiocytes carcinogenesis. The insidious clinical presentation makes early detection difficult, and the integration of biochemical, radiological, and histological features does not always lead to a definitive diagnosis of PSC-CCA. Surveillance is mandatory, but current guideline strategies failed to improve early detection and consequently a higher patient survival rate. MicroRNAs (miRNAs), gene methylation, proteomic and metabolomic profile, and extracellular vesicle components are some of the novel biomarkers recently applied in PSC-CCA detection with promising results. The integration of these new molecular approaches in PSC diagnosis and monitoring could contribute to new diagnostic and surveillance strategies.
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Affiliation(s)
- Elisa Catanzaro
- Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplantation Center, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
| | - Patrizia Burra
- Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
| | - Martina Gambato
- Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
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