4Radiological diagnosis in cholangiocarcinoma: Application of computed tomography, magnetic resonance imaging, and positron emission tomography
Section snippets
Radiological imaging in cholangiocarcinoma
Cholangiocarcinoma (CCA) is the second most prevalent liver cancer after hepatocellular cancer (HCC) and accounts for approximately 3% of all gastrointestinal tumours [1]. According to the localization, CCA can be distinguished into intra- and extrahepatic origin, whereby the latter includes hilar tumours, a particular tumour entity owing to its localization which is also referred to as Klatskin tumour [2]. The main purpose of noninvasive radiological imaging in patients with suspected or known
Imaging features and characterization of cholangiocarcinoma
Based on morphologic growth characteristics, CCA can be classified as either mass-forming, periductal infiltrating or intraductal type, as suggested by the Liver Cancer Study Group of Japan [19], with each type having its own characteristic imaging features [4]. Imaging, be it CT, MRI or PET, is recommended before invasive biliary procedures (e.g. stent placement), as any manipulation can cause mild inflammation of the bile duct walls and subsequently increased contrast enhancement, which may
Initial tumour detection
While in the era of single slice CT reported sensitivities for tumour detection were only up to 69% [37], [38], current MDCT with isotropic submillimeter voxel sizes allow for reliable detection of essentially all lesions larger than 1 cm. Valls and colleagues reviewed the CT scans of 24 patients with peripheral CCA ranging from 1.2 to 17 cm. All lesions were visible at CT; associated bile duct dilatation was present in 13 patients (52%) and retraction of the liver capsule in nine patients
Staging
Radiological staging in patients with CCA includes assessment of local tumour extension and intrahepatic spread, as well as detection of lymph node metastasis (N-staging) and distant tumour spread (M-staging). In case of intrahepatic CCA it has been shown that preoperative staging may fail to detect satellite lesions in up to 37% [52].
When the local resectability is assessed, the detection of lymph node metastasis needs to be addressed. Lymphadenopathy of the portocaval and porta hepatis nodes
Current imaging guidelines
According to the current International Liver Cancer Association (ILCA) guideline on CCA, radiological studies are necessary for assessment of local tumour extent, regional or distant spread and staging and resectability, which is best accomplished using CT and/or MRI [68]. In non-cirrhotic patients in whom a decision has been made to proceed with surgical resection, a presumed radiographic diagnosis (CT or MRI) is sufficient (recommendation B1). However, in most patients a pathological
Conflict of interest
FW: institutional research support not related to the topic: DFG, BMBF, Siemens Healthcare, Promedicus Ltd.
Acknowledgement
None.
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Feasibility of magnetic resonance imaging-based radiomics features for preoperative prediction of extrahepatic cholangiocarcinoma stage
2021, European Journal of CancerCitation Excerpt :Ercolani et al. [10] have reported the overall 5-year survival rates for CCAs according to T stage (T1–T2, 33%; T3–T4, 25%) and portal vein invasion (absent, 31%; present, 8%). Magnetic resonance imaging (MRI) is non-invasive and is considered the main imaging modality to assess biliary obstruction, tumor infiltration, microvascular invasion, and staging in eCCA [11,12]. Conventional radiographic assessment of eCCA depends primarily on visual examination of largely qualitative features, such as the tumor density or intensity, the characteristics of enhancement, the features of the tumor margins, and the anatomic relationship to adjacent tissues [13].
Radiomics model of magnetic resonance imaging for predicting pathological grading and lymph node metastases of extrahepatic cholangiocarcinoma
2020, Cancer LettersCitation Excerpt :Moreover, PET/CT and MRI have been proposed to predict DD of CCA [26,27]. However, these conventional imaging modalities based on morphologic criteria or metabolic activity also have limits, such that they are often unable to completely meet clinical needs [28]. In contrast, radiomics can overcome these shortcomings.
Surveillance in cholangiocellular carcinoma
2016, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :A prospective study suggested that the sensitivity and specificity of EUS-FNA-guided tissue sampling could be superior to ERCP [60] indicating that EUS provides a powerful tool that should be used more frequently for the staging of CCA patients. Contrast-enhanced magnetic resonance imaging is one of the most frequently used imaging modalities used for the detection of cholangiocellular carcinoma and for preoperative staging [41,43,61,62]. Using liver-specific contrast agents, MRI is well-suited to detect both hepatic and biliary lesions and to discriminate between benign and malignant lesions.
Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management
2016, Cancer LettersCitation Excerpt :The most common sites for metastasis are the lymph nodes, the peritoneum, the lungs and pleura. CT and MRI may have some value in identifying metastatic tumors in these sites, while positron emission tomography with fluorodeoxyglucose (FDG-PET) scanning may play an important role in preoperative evaluation for detecting occult metastatic disease [54]. Similarly, Doppler ultrasound can be useful in preoperative assessment to identify gross vascular invasions of the tumor to the portal vein and the hepatic artery with high sensitivity and specificity, which is comparable to angiography and CT arteriogram.