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Alsowey AM, Salem AF, Amin MI. Validity of MDCT cholangiography in differentiating benign and malignant biliary obstruction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
MDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Early tumor detection and staging of biliary cancer are key factors for a possible cure by surgical resection. Between December 2019 and October 2020, 69 patients with clinically suspected biliary obstruction were enrolled in the study, subjected to clinical assessment (full history taking and clinical examination) and imaging assessment by MDCT cholangiography. Our findings were correlated to standard reference examinations including operative/ERCP/biopsy and histopathology findings.
Results
The most affected age was between 60 and 70 years old, and males were more affected. The commonest clinical presentation was yellowish discoloration of the skin and sclera followed by biliary colic. Right hypochondrial tenderness was the main clinical finding on clinical examination. Our patients were categorized according to the etiology of biliary obstruction into 7 groups: malignant stricture 52.2% (36 patients), calcular 24.6% (17 patients), iatrogenic 5.8% (4 patients), portahepatis lesions 5.8% (4 patients), benign stricture 4.3% (3 patients), inflammatory 4.3% (3 patients), and congenital 1.4% (1 patient). The malignant group shows dominant mass, moderate biliary obstruction, and arterial and venous enhancement. The overall sensitivity was 94% for malignancy.
Conclusion
MDCT cholangiography is non-invasive, fast, and highly sensitive and specific in the diagnosis of different causes and levels of biliary obstruction and is useful in the characterization of the lesion in cases of malignant obstruction and differentiating it from benign stricture. It can be used as an effective alternative to ERCP or PTC.
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Lee DH. Current Status and Recent Update of Imaging Evaluation for Peri-Hilar Cholangiocarcinoma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:298-314. [PMID: 36238748 PMCID: PMC9431946 DOI: 10.3348/jksr.2021.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
간문주변부의 해부학적 복잡성으로 인해 간문주변부 담관암은 그 진단과 치료가 어려운 질환으로 알려져 있다. 간문주변부 담관암이 의심되는 환자에 있어서, 영상 검사는 이상 소견의 발견 및 감별 진단, 종양의 종축 침범 부위의 파악, 인접 혈관 침범과 원격 전이 유무의 파악, 그리고 최종적으로 수술적 절제 가능 유무의 평가에 있어 핵심적인 역할을 하고 있다. 이 종설에서는 간문주변부 담관암의 분류 및 종양의 평가를 위해 권고되는 표준 영상 검사의 기법과 간문주변부 담관암의 전형적인 영상 소견에 대해 기술할 예정이다. 종축 방향의 종양 침범 파악, 인접 혈관 침범 및 원격 전이 유무의 평가에 있어서 각 영상 검사 소견과 그 진단능에 대해 논의할 예정이다. 이후 전통적인 절제 가능성 평가의 개념에 대해 고찰하고, 최근의 경향을 소개한다.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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3
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Chang HY, Liu B, Wang YZ, Wang WJ, Wang W, Li D, Li YL. Percutaneous transhepatic cholangiography versus endoscopic retrograde cholangiography for the pathological diagnosis of suspected malignant bile duct strictures. Medicine (Baltimore) 2020; 99:e19545. [PMID: 32176109 PMCID: PMC7440087 DOI: 10.1097/md.0000000000019545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To compare the diagnostic performance of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography for the pathological assessment of suspected malignant bile duct stricture, using brush cytology and forceps biopsy.The study group comprised 79 consecutive patients who underwent pathological assessment for suspected malignant biliary stricture, 38 of whom underwent percutaneous transhepatic cholangiography (group A) and the other 41 underwent endoscopic retrograde cholangiography (group B). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. A subset analysis was performed to determine the effect of location and pathological type of the stricture on diagnostic performance, and complications were analyzed.The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.7%, 100%, 100%, 66.7%, and 89.5%, respectively, in group A, and 77.1%, 100%, 100%, 42.9%, and 80.4%, respectively, in group B. For hilar biliary strictures, the sensitivity and accuracy were superior in group A than in group B. Mild complications (transient c and bile leakage) were identified in 7 cases in each group, all resolved spontaneously within 3 to 5 days.Both brush cytology and forceps biopsy performed during percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography provided good diagnostic sensitivity and accuracy. Therefore, both diagnostic approaches can play an important role in planning therapeutic strategy. However, for strictures located at the hilum, pathology sampling via percutaneous transhepatic cholangiography is preferable to endoscopic retrograde cholangiography, as it provides higher sensitivity and accuracy.
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Affiliation(s)
- Hai-Yang Chang
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Bin Liu
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Yong-Zheng Wang
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wu-Jie Wang
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wei Wang
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Dong Li
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Yu-Liang Li
- Department of Intervention Medicine, the Second Hospital of Shandong University
- Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
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Kim D, Park S, Kim C, Yoon S, Choi J. Ultrasound-guided transhepatic computed tomography cholecystography in beagle dogs. J Vet Sci 2019; 20:e37. [PMID: 31364322 PMCID: PMC6669211 DOI: 10.4142/jvs.2019.20.e37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 02/03/2023] Open
Abstract
This study was performed to evaluate the feasibility of ultrasound-guided computed tomography (CT) cholecystography and to establish an optimal protocol. In 8 healthy beagles, CT cholecystography was conducted using four contrast formulas; two dilution ratios (1:1 vs. 1:3) and two total volumes (8 mL vs. 16 mL) of 300 mgI/kg iohexol after ultrasound-guided percutaneous contrast injection into the gallbladder. CT images were obtained at 3, 10, and 30 min after injection and assessed qualitatively and quantitatively. For all contrast formulas, CT cholecystography showed the gallbladder and the intra- and extrahepatic bile ducts. The volume of the gallbladder and size of bile duct were significantly larger when using a volume of 16 mL iohexol than an 8 mL volume regardless of the dilution ratio. The distinction between the common bile duct and duodenum, the filling of the gallbladder, and the patency of bile duct were effectively assessed using a 16 mL volume of contrast agent with either dilution ratio. Beam-hardening artifacts deteriorated CT image quality for visualizing the biliary system when using the dilution ratio of 1:1. Patency of the bile tract could be easily evaluated using a curvilinear planar reconstruction. There was no significant difference in CT scan time among the different conditions. Minor leakage of contrast agent temporarily occurred after contrast injection in 30% of 32 sets of CT cholecystography. Ultrasound-guided percutaneous cholecystography can visualize both gallbladder and biliary tract with minimal artifacts using a contrast agent volume of 16 mL with a 1:3 dilution ratio.
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Affiliation(s)
- Dongeun Kim
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Seungjo Park
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Cheolhyun Kim
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Sooa Yoon
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
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Joo I, Lee JM, Yoon JH. Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges. Radiology 2018; 288:7-13. [DOI: 10.1148/radiol.2018171187] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ijin Joo
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
| | - Jeong Min Lee
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
| | - Jeong Hee Yoon
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
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Oliveira IS, Kilcoyne A, Everett JM, Mino-Kenudson M, Harisinghani MG, Ganesan K. Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management. Abdom Radiol (NY) 2017; 42:1637-1649. [PMID: 28271275 DOI: 10.1007/s00261-017-1094-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is a relatively uncommon malignant neoplasm with poor prognosis. The distinction between extrahepatic and intrahepatic subtypes is important as epidemiological features, biologic and pathologic characteristics, and clinical course are different for both entities. This review study focuses on the role imaging plays in the diagnosis, classification, staging, and post-treatment assessment of cholangiocarcinoma.
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Affiliation(s)
- Irai S Oliveira
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP, 01308-050, Brazil.
| | - Aoife Kilcoyne
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jamie M Everett
- Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN - Reliance Foundation Hospital, Mumbai, 400004, India
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7
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Wirth TC, Vogel A. Surveillance in cholangiocellular carcinoma. Best Pract Res Clin Gastroenterol 2016; 30:987-999. [PMID: 27938792 DOI: 10.1016/j.bpg.2016.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/28/2016] [Accepted: 11/04/2016] [Indexed: 01/31/2023]
Abstract
Cholangiocellular carcinoma is the most frequent malignant neoplasm originating from the epithelium of intra- or extrahepatic bile ducts. In the past decades, the incidence of cholangiocarcinoma has been shown to increase while overall mortality has remained high with an approximate 5-year overall survival below 20%. Surgery remains the only curative option while systemic treatment is limited to palliative chemotherapy. Therefore, surveillance strategies for patients at risk of developing cholangiocarcinoma are urgently needed, particularly in patients with primary sclerosing cholangitis and patients infected with liver flukes. Here we summarize the currently available data on surveillance of risk populations and methods for the detection of cholangiocarcinoma.
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Affiliation(s)
- Thomas C Wirth
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, 30625 Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, 30625 Hannover, Germany.
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8
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Mathew RP, Moorkath A, Basti RS, Suresh HB. Value and Accuracy of Multidetector Computed Tomography in Obstructive Jaundice. Pol J Radiol 2016; 81:303-9. [PMID: 27429673 PMCID: PMC4928501 DOI: 10.12659/pjr.896680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Objective; To find out the role of MDCT in the evaluation of obstructive jaundice with respect to the cause and level of the obstruction, and its accuracy. To identify the advantages of MDCT with respect to other imaging modalities. To correlate MDCT findings with histopathology/surgical findings/Endoscopic Retrograde CholangioPancreatography (ERCP) findings as applicable. MATERIAL/METHODS This was a prospective study conducted over a period of one year from August 2014 to August 2015. Data were collected from 50 patients with clinically suspected obstructive jaundice. CT findings were correlated with histopathology/surgical findings/ERCP findings as applicable. RESULTS Among the 50 people studied, males and females were equal in number, and the majority belonged to the 41-60 year age group. The major cause for obstructive jaundice was choledocholithiasis. MDCT with reformatting techniques was very accurate in picking a mass as the cause for biliary obstruction and was able to differentiate a benign mass from a malignant one with high accuracy. There was 100% correlation between the CT diagnosis and the final diagnosis regarding the level and type of obstruction. MDCT was able to determine the cause of obstruction with an accuracy of 96%. CONCLUSIONS MDCT with good reformatting techniques has excellent accuracy in the evaluation of obstructive jaundice with regards to the level and cause of obstruction.
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Affiliation(s)
- Rishi Philip Mathew
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
| | - Abdunnisar Moorkath
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
| | - Ram Shenoy Basti
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
| | - Hadihally B Suresh
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
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9
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Esnaola NF, Meyer JE, Karachristos A, Maranki JL, Camp ER, Denlinger CS. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma. Cancer 2016; 122:1349-69. [PMID: 26799932 DOI: 10.1002/cncr.29692] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinomas are rare biliary tract tumors that are often challenging to diagnose and treat. Cholangiocarcinomas are generally categorized as intrahepatic or extrahepatic depending on their anatomic location. The majority of patients with cholangiocarcinoma do not have any of the known or suspected risk factors and present with advanced disease. The optimal evaluation and management of patients with cholangiocarcinoma requires thoughtful integration of clinical information, imaging studies, cytology and/or histology, as well as prompt multidisciplinary evaluation. The current review focuses on recent advances in the diagnosis and treatment of patients with cholangiocarcinoma and, in particular, on the role of endoscopy, surgery, transplantation, radiotherapy, systemic therapy, and liver-directed therapies in the curative or palliative treatment of these individuals. Cancer 2016;122:1349-1369. © 2016 American Cancer Society.
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Affiliation(s)
- Nestor F Esnaola
- Department of Surgery, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Andreas Karachristos
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer L Maranki
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
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Taheri A, Rostamzadeh A, Gharib A, Fatehi D. Efficacy of Multidetector-Row Computed Tomography as a Practical Tool in Comparison to Invasive Procedures for Visualization of the Biliary Obstruction. Acta Inform Med 2016; 24:257-260. [PMID: 27708488 PMCID: PMC5037983 DOI: 10.5455/aim.2016.24.257-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/25/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction: Recently, multidetector computed tomography (MDCT) has been introduced into clinical practice. MDCT has become the noninvasive diagnostic test of choice for detailed evaluation of biliary obstruction. Aim: the main objective of the present study was to evaluate the diagnostic value of MDCT compared to invasive procedures for detecting biliary obstruction causes. Material and Methods: Since February 2009 until May 2011 fifty biliary obstruction patients based on clinical, laboratory or ultrasonographic findings, were evaluated by Multidetector-row computed tomography. The causes of biliary obstruction, which was identified using. MDCT were classified into three categories: calculus, benign stricture, and malignancy. Final diagnosis was conducted based on percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography, biopsy, or surgery. The MDCT diagnosis and were compared with the final diagnosis. Results: A correct diagnosis of causes of biliaryobstruction was made on the basis of MDCT findings for 44 of the total 50 patients. Two patients with chronic pancreatitis were incorrectly diagnosed with a pancreatic head adenocarcinoma on the basis of MDCT findings. One patient with biliary stone was incorrectly diagnosed with a periampullary adenocarcinoma on the basis of MDCT findings. The Sensitivity, specificity and accuracy of MDCT in the diagnosis of causes of biliary obstruction were 94.12% and87.87% and94.6% respectively. Conclusion: Based on the findings of this study MDCT has an excellent image quality, providing valuable information about the biliary tree and other abdominal organs. The use of advanced image processing, including maximum intensity projection and multiplanar reconstruction (especially coronal or sagittal reformatted images), allows superior visualization of the biliary tree and vascular structures. Three-dimensional reconstruction images complement axial images by providing a more anatomically meaningful display of the lesion and its relationship to adjacent structures, and accurate determining the craniocaudal extent of the lesion. High accuracy, wide availability and ease of use, make the MDCT the imaging modality of choice for evaluation of biliary obstruction.
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Affiliation(s)
- Abdolmajid Taheri
- Department of Radiology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ayoob Rostamzadeh
- Department of Anatomy and Neuroscience, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Alireza Gharib
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Daryoush Fatehi
- Department of Medical Physics, Shahrekord University of Medical Sciences, Shahrekord, Iran
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12
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Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: A review. World J Radiol 2015; 7:28-44. [PMID: 25729485 PMCID: PMC4326732 DOI: 10.4329/wjr.v7.i2.28] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/14/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in the form of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions.
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Imaging bile duct tumors: pathologic concepts, classification, and early tumor detection. ACTA ACUST UNITED AC 2014; 38:1334-50. [PMID: 23925840 DOI: 10.1007/s00261-013-0027-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinoma is the most common primary malignancy of the bile ducts which has several predisposing factors such as hepatolithiasis and primary sclerosing cholangitis, and can develop from precancerous conditions such as biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. As surgical resection of early stage cholangiocarcinoma or precancerous lesions may provide better prognosis, early detection of those lesions is very important. Imaging studies play important roles in the diagnosis of bile duct tumors followed by appropriate management. Indeed, not only diagnosis of cholangiocarcinoma but also appropriate categorization of bile duct tumors based on their morphologic features and location on cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, is important to predict their biologic behaviors, and choose relevant treatment strategies. We herein review the classification system of the bile duct tumors with their radiologic and pathologic findings as well as role of imaging in the early detection of bile duct tumors.
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14
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Zhang Q, Eagleson R, Peters TM. Volume visualization: a technical overview with a focus on medical applications. J Digit Imaging 2011; 24:640-64. [PMID: 20714917 DOI: 10.1007/s10278-010-9321-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
With the increasing availability of high-resolution isotropic three- or four-dimensional medical datasets from sources such as magnetic resonance imaging, computed tomography, and ultrasound, volumetric image visualization techniques have increased in importance. Over the past two decades, a number of new algorithms and improvements have been developed for practical clinical image display. More recently, further efficiencies have been attained by designing and implementing volume-rendering algorithms on graphics processing units (GPUs). In this paper, we review volumetric image visualization pipelines, algorithms, and medical applications. We also illustrate our algorithm implementation and evaluation results, and address the advantages and drawbacks of each algorithm in terms of image quality and efficiency. Within the outlined literature review, we have integrated our research results relating to new visualization, classification, enhancement, and multimodal data dynamic rendering. Finally, we illustrate issues related to modern GPU working pipelines, and their applications in volume visualization domain.
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Affiliation(s)
- Qi Zhang
- Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada.
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Skipworth JRA, Olde Damink SWM, Imber C, Bridgewater J, Pereira SP, Malago’ M. Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. Aliment Pharmacol Ther 2011; 34:1063-78. [PMID: 21933219 PMCID: PMC3235953 DOI: 10.1111/j.1365-2036.2011.04851.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of patients with cholangiocarcinoma present with advanced, irresectable tumours associated with poor prognosis. The incidence and mortality rates associated with cholangiocarcinoma continue to rise, mandating the development of novel strategies for early detection, improved resection and treatment of residual lesions. AIM To review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma. METHODS A search strategy incorporating PubMed/Medline search engines and utilising the key words biliary tract carcinoma; cholangiocarcinoma; management; surgery; chemotherapy; radiotherapy; photodynamic therapy; and radiofrequency ablation, in various combinations, was employed. RESULTS Data on neo-adjuvant and adjuvant techniques remain limited, and much of the literature concerns palliation of inoperable disease. The only opportunity for long-term survival remains surgical resection with negative pathological margins or liver transplantation, both of which remain possible in only a minority of selected patients. Neo-adjuvant and adjuvant techniques currently provide only limited success in improving survival. CONCLUSIONS The development of novel strategies and treatment techniques is crucial. However, the shortage of randomised controlled trials is compounded by the low feasibility of conducting adequately powered trials in liver surgery, due to the large sample sizes that are required.
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Affiliation(s)
- JRA Skipworth
- Department of Surgery and Interventional Science, University College London, London
| | - SWM Olde Damink
- Department of Surgery and Interventional Science, University College London, London,Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London,Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - C Imber
- Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London
| | | | - SP Pereira
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, and Institute of Hepatology, University College London Medical School, London, UK
| | - M Malago’
- Department of Surgery and Interventional Science, University College London, London,Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London
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Sasaki R, Kondo T, Oda T, Murata S, Wakabayashi G, Ohkohchi N. Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma. Am J Surg 2011; 202:441-8. [PMID: 21861978 DOI: 10.1016/j.amjsurg.2010.06.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/04/2010] [Accepted: 06/28/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND A detailed evaluation of portal triad structures, especially the biliary anatomy at the hepatic hilus, is essential to ensure curative resection for hilar cholangiocarcinoma. METHODS Patients underwent 3-dimensional analysis using multidetector row computed tomography cholangioportography preoperatively. The number of bile duct orifices in the cut end of the hilar plate was estimated and compared with the actual number of bile ducts. Furthermore, the estimated length of the surgical margin and its relationship to the pathological margin status was evaluated. RESULTS The number of bile duct orifices was correctly estimated in 14 of 19 patients. Of 18 hepatic ducts in which the estimated length of the hepatic side surgical margin was calculated 17 hepatic ducts (94.4%) were diagnosed pathologically as margin negative. CONCLUSIONS This investigatory technique has the advantages of precise visualization of anatomic structures and multidirectional assessment of biliary branches and vessels, allowing improved operative planning for the treatment of hilar cholangiocarcinoma.
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Affiliation(s)
- Ryoko Sasaki
- Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.
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Kim SW, Shin HC, Kim HC, Hong MJ, Kim IY. Diagnostic performance of multidetector CT for acute cholangitis: evaluation of a CT scoring method. Br J Radiol 2011; 85:770-7. [PMID: 21791504 DOI: 10.1259/bjr/72001875] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to retrospectively assess the diagnostic performance of multidetector CT (MDCT) for the diagnosis of acute cholangitis using a new scoring method. METHODS Of 80 patients with suspected biliary disease who underwent biphasic CT and endoscopic retrograde cholangiography, 39 were diagnosed as having acute cholangitis (Group 1) and 41 patients were classified as suspected biliary disease (Group 2). 100 age-matched patients without evidence of biliary disease were selected randomly as a control group (Group 3). Each patient's axial scan was scored by two independent radiologists for the extent of transient hepatic attenuation difference, the presence of biliary dilatation and identification of a biliary obstructive lesion. The difference in the scores among the three groups was evaluated and the optimal cut-off score for the diagnosis of acute cholangitis was determined. Interobserver agreement was also evaluated. RESULTS The total scores (mean ± standard deviation) for Groups 1, 2 and 3 were 7.0 ± 2.0, 4.4 ± 2.4 and 0.9 ± 1.2, respectively, for Reviewer 1 and 7.2 ± 2.7 and 0.7 ± 1.1, respectively, for Reviewer 2. Significant differences were found for the subscores and the total scores among the three groups (p < 0.001). Using a cut-off score of ≥ 5, the sensitivity and specificity for diagnosing acute cholangitis were 84.6% and 83.7%, respectively, for Reviewer 1 and 89.7% and 83.7%, respectively, for Reviewer 2. Agreement for the subscores between readers was good to excellent (κ = 0.74-0.86). CONCLUSION Based on dynamic MDCT and the described CT scoring method, the diagnosis of acute choangitis can be made with high sensitivity and specificity.
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Affiliation(s)
- S W Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Zhang ZY, Wang D, Ni JM, Yu XR, Zhang L, Wu WJ, Gong L, Hu MH. Comparison of three-dimensional negative-contrast CT cholangiopancreatography with three-dimensional MR cholangiopancreatography for the diagnosis of obstructive biliary diseases. Eur J Radiol 2011; 81:830-7. [PMID: 21377820 DOI: 10.1016/j.ejrad.2011.02.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of our study was to compare three-dimensional (3D) negative-contrast CT cholangiopancreatography (3D-nCTCP) with 3D MR cholangiopancreatography (3D-MRCP) for the diagnosis of obstructive biliary diseases. MATERIALS AND METHODS 3D-nCTCP and 3D-MRCP were performed on seventy clinically documented obstructive biliary diseases patients. The accuracy of each technique in determining the location and cause of biliary obstruction was evaluated compared with the final clinical diagnoses. RESULTS Both methods achieved 100% of accuracy in the diagnosis of the presence and location of biliary obstruction, and had a similar sensitivity, specificity, accuracy in differentiating benign from malignant biliary obstruction or calculous from noncalculous biliary obstruction (p>0.05). At 3D-nCTCP, six patients with stones were misinterpreted as cholangitis (N=2), papillitis (N=3), or bile duct adenocarcinoma (N=1); two metastases were mistaken as acute pancreatitis or pancreatic head carcinomas, and one intrahepatic cholangiocarcinoma was misled as bile duct adenoma. At 3D-MRCP, one small stone, one ampullary adenoma, and one intrahepatic cholangiocarcinoma were mistaken as cholangitis, ampullary stone, and intrahepatic bile duct stone, respectively, and three gallbladder carcinomas and another intrahepatic cholangiocarcinoma were misdiagnosed as hilar cholangiocarcinoma (N=3) or common hepatic duct stone (N=1); four metastases were mistaken as pancreatic head carcinomas (N=3) or distal cholangiocarcinoma (N=1). The overall accuracy in making specific diagnosis of the cause of biliary obstruction was 87.1% for 3D-nCTCP and 84.3% for 3D-MRCP, respectively, (p>0.05). CONCLUSION 3D-nCTCP has the similar effects as 3D-MRCP for the diagnosis of biliary obstruction and, the location and the cause of biliary obstruction. In view of selected cases contraindications for MRI, 3D-nCTCP is a potential substitute.
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Affiliation(s)
- Zhui-Yang Zhang
- Department of Radiology, Wuxi Second Hospital Affiliated to Nanjing Medical University, 68 Zhong Shan Road, Wuxi, Jiangsu Province 214002, China.
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Evaluation of Biliary Malignancies Using Multidetector-Row Computed Tomography. J Comput Assist Tomogr 2010; 34:496-505. [DOI: 10.1097/rct.0b013e3181d34532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Arikawa S, Uchida M, Kunou Y, Uozumi J, Abe T, Hayabuchi N, Ishida Y, Kaji R, Okabe Y, Murotani K. Comparison of sclerosing cholangitis with autoimmune pancreatitis and infiltrative extrahepatic cholangiocarcinoma: multidetector-row computed tomography findings. Jpn J Radiol 2010; 28:205-13. [PMID: 20437131 DOI: 10.1007/s11604-009-0410-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 12/04/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to compare multidetector-row computed tomography (MDCT) findings between cases of sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and infiltrative extrahepatic cholangiocarcinoma (IEC). MATERIALS AND METHODS We retrospectively assessed MDCT findings from 16 IEC cases and 13 SC-AIP cases. MDCT findings were analyzed with regard to location, length, wall thickness, contour, stricture wall enhancement pattern, proximal duct diameter, and the presence of diffuse concentric thickening in the proximal duct and gallbladder wall thickness. RESULTS Stricture length, stricture wall thickness, and proximal duct diameter were significantly smaller for SC-AIP than for IEC: 19.3 +/- 8.7 vs. 31.8 +/- 12.0 mm (P = 0.004), 2.1 +/- 1.3 vs. 4.1 +/- 1.3 mm (P < 0.001), and 9.2 +/- 3.9 vs. 13.3 +/- 5.0 mm (P = 0.012), respectively. SC-AIP was correlated with stricture location in both the intrapancreatic and hilar hepatic bile ducts, concentric stricture contour (P < 0.001), and diffuse concentric thickening of the proximal bile duct (P = 0.010). Overall values of sensitivity, specificity, and accuracy used to distinguish between SC-AIP and IEC for stricture wall thickness of <3.0 mm and concentric contour were 76.9%, 93.8%, and 86.2%, respectively, and 100%, 87.5%, 93.1%, respectively. CONCLUSION Concentric contour and stricture wall thicknesses of <3.0 mm may help distinguish between SC-AIP and IEC.
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Affiliation(s)
- Shunji Arikawa
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
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Aljiffry M, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009. World J Gastroenterol 2009; 15:4240-62. [PMID: 19750567 PMCID: PMC2744180 DOI: 10.3748/wjg.15.4240] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.
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Zhang ZY, Li JP, Hu CH, Ding Z, Wang D, Shen YL, Hu MH, Zhang L, Ma JY. Improvement in imaging time and quality of 3D negative-contrast computed tomography cholangiography with minimum intensity projections: application of vari-slice manual cut and erosion functions. Clin Imaging 2009; 33:213-20. [DOI: 10.1016/j.clinimag.2008.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 09/26/2008] [Indexed: 12/14/2022]
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Akamatsu N, Sugawara Y, Osada H, Okada T, Itoyama S, Komagome M, Shin N, Ishida T, Ozawa F, Hashimoto D. Preoperative evaluation of the longitudinal spread of extrahepatic bile duct cancer using multidetector computed tomography. ACTA ACUST UNITED AC 2009; 16:216-22. [PMID: 19214370 DOI: 10.1007/s00534-009-0045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Accepted: 05/13/2008] [Indexed: 01/02/2023]
Abstract
BACKGROUND/PURPOSE The aim of this study was to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and direct cholangiography in evaluating the longitudinal spread of extrahepatic bile duct cancer. METHODS Images obtained from a 16-detector row scanner (MDCT) and from direct cholangiography (via either endoscopic naso-biliary drainage or percutaneous transhepatic biliary drainage) of 47 patients with histopathologically proven extrahepatic bile duct cancer were retrospectively interpreted. Differences between measures of longitudinal tumor spread determined by each modality and measures of macroscopic spread in resected specimens were assessed and compared. RESULTS Assessments carried out using MDCT differed significantly less from the macroscopic measurements than those made using direct cholangiography (P < 0.0001). Provided the diagnosis was defined as being accurate, based on a diagnostic difference of within +/-5 mm, the diagnostic accuracy of MDCT (96%) was significantly higher than that of direct cholangiography (70%) (P = 0.028). Preoperative evaluation with direct cholangiography resulted in a 30% underestimation of the incidence. CONCLUSION MDCT is superior to direct cholangiography for evaluating the preoperative longitudinal extent of bile duct cancer. Consequently, the utility of MDCT for preoperative evaluation of extrahepatic bile duct cancer warrants further examination.
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Affiliation(s)
- Nobuhisa Akamatsu
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Sainani NI, Catalano OA, Holalkere NS, Zhu AX, Hahn PF, Sahani DV. Cholangiocarcinoma: current and novel imaging techniques. Radiographics 2008; 28:1263-87. [PMID: 18794305 DOI: 10.1148/rg.285075183] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The radiologic manifestations of cholangiocarcinomas are extremely diverse, since these tumors vary greatly in location, growth pattern, and histologic type. Familiarity with the imaging manifestations of cholangiocarcinomas is important for accurate detection and characterization of these tumors and assessment of resectability. Advances in imaging techniques have led to the availability of an array of modalities that, used independently or in combination, can aid in the accurate diagnosis and evaluation of cholangiocarcinomas in preparation for advanced surgical procedures and treatment planning. Response to novel targeted therapies can also be assessed with newer imaging tools. Hence, knowledge of current and emerging imaging applications is essential for correct diagnosis and appropriate management of these tumors.
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Affiliation(s)
- Nisha I Sainani
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
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Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 2008; 191:1448-57. [PMID: 18941084 DOI: 10.2214/ajr.07.3992] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the roles of sonography, MDCT, MRI, and direct cholangiography in the evaluation of hilar cholangiocarcinoma. CONCLUSION Hilar cholangiocarcinoma is a primary malignant tumor typically located at the confluence of the right and left ducts within the porta hepatis. Staging of hilar cholangiocarcinoma with various imaging techniques is crucial for management, and a comprehensive approach is needed for accurate preoperative assessment.
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Abstract
Cholangiocarcinoma (CC) is a devastating cancer arising from biliary epithelia. Unfortunately, the incidence of this disease is increasing in Western countries. These tumors progress insidiously, and liver failure, biliary sepsis, malnutrition and cancer cachexia are general modes of death associated with this disease. To date, no established therapy for advanced disease has been established or validated. However, our knowledge in tumor biology is increasing dramatically and new drugs are under investigation for treatment of this notorious tumor. In clinical practice, there are better diagnostic tools in use to facilitate an earlier diagnosis of CC, at least in those patients with known risk factors. CC is resectable for cure in only a small percentage of patients. Preoperative staging for vascular and biliary extension of CC is very important in this tumor. Laparoscopy and recently endosonography seem to protect against unnecessary laparotomies in these patients. During the last 15 years, aggressive surgical approaches, including combined liver resections and vascular reconstructive surgical expertise, have improved survival in patients with CC. Surgery is contraindicated in CC cases having primary sclerosing cholangitis (PSC). Although CC was previously considered a contraindication to liver transplantation, new cautious protocols, including neo-adjuvant chemoradiation therapies and staging procedures before the transplantation, have made it possible to achieve long-term survival after liver transplantation in this disease. New ablative therapies with photodynamic therapy, intraductal high-intensity ultrasonography and chemotherapy-impregnated plastic biliary endoprosthesis are important steps in the palliative management of extra-hepatic CCs. Radiofrequency and chemo-embolization methods are also applicable for intra-hepatic CCs as palliative modes of treatment. We need more prospective randomized controlled trials to evaluate the role of the new emerging therapies for CC patients.
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Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg 2008; 208:134-47. [PMID: 19228515 DOI: 10.1016/j.jamcollsurg.2008.09.007] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/04/2008] [Accepted: 09/09/2008] [Indexed: 12/14/2022]
Affiliation(s)
- Murad Aljiffry
- Department of Surgery, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Cho ES, Park MS, Yu JS, Kim MJ, Kim KW. Biliary ductal involvement of hilar cholangiocarcinoma: multidetector computed tomography versus magnetic resonance cholangiography. J Comput Assist Tomogr 2007; 31:72-8. [PMID: 17259836 DOI: 10.1097/01.rct.0000230013.24091.8e] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance cholangiography (MRC) in evaluating the extent of biliary involvement of hilar cholangiocarcinoma. METHODS Images of 16-detector MDCT, MRC, and direct cholangiography of 33 patients with pathologically proven hilar cholangiocarcinoma were retrospectively interpreted independently by 2 radiologists according to the Bismuth classification. In the operated 14 patients, the diagnostic accuracies of MDCT and MRC were calculated according to surgical and pathological records. In nonoperated 19 patients, the agreement of MDCT and MRC with direct cholangiography was calculated. RESULTS In the operated patients, the diagnostic accuracy of MDCT was 64.3%, and that of MRC was 71.4%, without statistical difference (P = 0.93). In nonoperated patients, the agreement of MDCT with direct cholangiography was 73.7%, and that of MRC was 94.7%, without statistical difference (P = 0.58). CONCLUSIONS In evaluating the biliary ductal extension of hilar cholangiocarcinoma, MDCT and MRC showed similar accuracies and agreements.
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Affiliation(s)
- Eun-Suk Cho
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Yongdong Severance Hospital, Seoul, Republic of Korea
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Kim HJ, Park DI, Park JH, Cho YK, Sohn CI, Jeon WK, Kim BI, Kim SK. Multidetector computed tomography cholangiography with multiplanar reformation for the assessment of patients with biliary obstruction. J Gastroenterol Hepatol 2007; 22:400-5. [PMID: 17295774 DOI: 10.1111/j.1440-1746.2006.04503.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We sought to evaluate the diagnostic use of multidetector computed tomography (MDCT) cholangiography with multiplanar reformation (MPR) for the assessment of patients with biliary obstruction. METHODS MDCT cholangiography with the MPR technique was performed in 58 patients who were thought to have biliary obstruction. No cholangiographic contrast agent was administered. MRCP in 24 patients, Endoscopic retrograde cholangiopancreatography (ERCP) in 46 patients and percutaneous transhepatic cholangiography (PTC) in 24 patients were performed. Eighteen patients underwent biopsy or surgery. The findings on MDCT cholangiography were compared with those of MRCP, ERCP, PTC, biopsy or surgery. RESULTS The findings of MDCT cholangiography were as follows: choledocholithiasis (n = 34, 56.7%), malignant stricture (n = 14, 23.3%), benign stricture (n = 1, 1.7%), and cholelithiasis (n = 11, 18.3%). A small common bile duct (CBD) stone in one patient could not be detected on MDCT cholangiography. One patient with a small stone in distal CBD detected on MDCT cholangiography had no stone on ERCP. Two patients with initial diagnoses of CBD stones by MDCT cholangiography were disclosed to have malignant bile duct stricture by reference examination. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stones were 96.9% and 96.2%, respectively. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stricture were 85.7% and 100%, respectively. The overall accuracy of MDCT cholangiography for the diagnoses of the causes of biliary obstruction was 89.8%. CONCLUSION MDCT cholangiography with the MPR technique is a fast and non-invasive technique with relatively high sensitivity and specificity for the diagnoses of the causes of biliary obstruction.
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Affiliation(s)
- Hong Joo Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea.
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Park MS, Lee DK, Kim MJ, Lee WJ, Yoon DS, Lee SJ, Lim JS, Yu JS, Cho JY, Kim KW. Preoperative staging accuracy of multidetector row computed tomography for extrahepatic bile duct carcinoma. J Comput Assist Tomogr 2006; 30:362-7. [PMID: 16778607 DOI: 10.1097/00004728-200605000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE This study sought to evaluate the accuracy of multidetector computed tomography (MDCT) for preoperative staging of extrahepatic bile duct (EHD) carcinoma and to assess the value of coronal reformations from isotropic voxels. MATERIALS AND METHODS Thirty patients with surgically proven EHD cancer underwent dynamic MDCT with coronal reformation. Two experienced radiologists independently evaluated contrast-enhanced dynamic transverse CT images (axial approach) and combined transverse and coronal images (combined approach). The radial extent (TNM staging) and the vertical extent of tumors were assessed and correlated with pathological findings of surgical specimen. RESULTS All of primary tumors were detected by axial and combined CT imaging (100%). Overall accuracy of the T staging was 73% (22/30) with axial and 77% (23/30) with combined CT imaging (P>0.05). The accuracy of N staging was 57% (17/30) with axial and 63% (19/30) with combined CT imaging (P>0.05). The accuracy of M staging was 97% (29/30) with both axial and combined CT imaging. Upper margin accuracy was 97% (29/30) for axial and 100% for combined CT imaging (P>0.05), whereas that of the lower margin was 90% (27/30) for axial and 93% (28/30) for combined CT imaging (P>0.05). CONCLUSIONS Multidetector computed tomography was sufficiently accurate for evaluating the vertical extents, but radial extents of EHD cancer. The addition of coronal reformatted images did not improve the accuracy for staging of EHD cancer.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology, YongDong Severance Hospital, and Department of General Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
Different imaging modalities recently underwent considerable improvements for the visualization of ductal gallstones. The declining significance of endoscopic retrograde cholangiopancreatography (ERCP) has been accepted unanimously. This paradigm shift is mostly due to improvements in transabdominal ultrasound, the increased availability of endoscopic ultrasound, and the use of magnetic resonance cholangiopancreatography (MRCP). In particular, MRCP is limited only in visualizing very small intraductal gallstones due to spatial resolution restrictions, whereas the detection rate of larger concretions is comparable to that with ERCP and endoscopic ultrasound. Patients with biliary pancreatitis benefit greatly from noninvasive MRCP visualization, establishing it as the preferred imaging modality. Particularly if ductal gallstones requiring further intervention are highly suspected, ERCP is preferable to other imaging modalities. If that suspicion is moderate, MRCP would be the imaging modality of choice, and transabdominal ultrasound would be performed if ductal gallstones are considered improbable. In up to 90% of cases, removal can be achieved endoscopically. Using a percutaneous approach smaller concretions can be extracted directly. However, larger gallstones need to be broken down into smaller fragments. For lithotripsy, either cholangioscopically-guided laser or electrohydraulic procedures are easy and effective. In case of strictures due to biliodigestive anastomoses, additional papillary balloon dilatation may be required.
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Affiliation(s)
- H-J Brambs
- Abteilung Diagnostische Radiologie, Universitätsklinikum Ulm.
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Abstract
PURPOSE OF REVIEW Cholangiocarcinoma is an enigmatic malignancy of the biliary tract that has recently been shown to be increasing in incidence globally. There has been recent progress in identifying potential risk factors for the tumor, and in the use of emerging technologies for diagnosis and palliative treatment. RECENT FINDINGS Hepatitis B and C, cirrhosis and alcohol have been described as risk factors for cholangiocarcinoma. A morphology-based classification for cholangiocarcinoma is proposed that will facilitate future descriptive epidemiology, diagnosis and comparative therapeutic studies. Diagnosis may be improved by new approaches to enhance the diagnostic yield and utility of biliary cytology. The role of new imaging approaches such as positron emission tomography scanning, endoscopic ultrasound or optical coherence tomography for diagnosis are being examined and defined. Long-term results for transplantation protocols for curative intent in non-resectable localized disease have been described. Photodynamic therapy looks extremely promising for adjunct therapy of intrahepatic mass lesions. SUMMARY Recent advances in the epidemiology, classification, diagnosis and therapy of cholangiocarcinoma are expected to enhance the evaluation and management of patients with this devastating malignancy.
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Affiliation(s)
- Pankaj Singh
- Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, 76508, USA
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Kamel IR, Liapi E, Fishman EK. Liver and Biliary System: Evaluation by Multidetector CT. Radiol Clin North Am 2005; 43:977-97, vii. [PMID: 16253658 DOI: 10.1016/j.rcl.2005.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CT commonly is indicated for the evaluation of suspected hepatic and biliary pathology. The recent introduction of multidetector CT (MDCT) provides unique capabilities that are valuable especially in hepatic volume acquisitions, combining short scan times, narrow collimation, and the ability to obtain multiphase data. These features result in improved lesion detection and characterization. Concomitant advances in computer software programs have made three-dimensional applications practical for a range of hepatic image analyses and displays. This article discusses the specific areas of hepatic and biliary pathology where MDCT has a significant diagnostic impact.
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Affiliation(s)
- Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Affiliation(s)
- Richard S Kwon
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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