CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

Abstract

OBJECTIVE. The objective of our study was to determine useful CT findings for differentiating cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis.MATERIALS AND METHODS. CT images of 30 patients with hepatolithiasis and pathologically proven cholangiocarcinoma (n = 14) or periductal fibrosis (n = 16) were retrospectively reviewed. Helical CT scans were obtained before, 30 seconds after, and 65 seconds after the start of contrast material injection. Analysis of CT findings included evaluation for the presence of periductal soft-tissue density, bile duct wall thickening at the stricture site, ascites, portal vein obliteration, lymph node enlargement, and a duct stone; assessment of the degree of ductal dilatation; and evaluation of the enhancement pattern of periductal lesions, thickened ductal wall, and hepatic parenchyma. The CT attenuation coefficients of the thickened ductal wall and adjacent normal-looking bile duct were measured on images obtained during each phase. Among these findings, statistically significant variables were determined using the Fisher's exact test and Student's t test. Sensitivity and specificity values of the CT criteria were also calculated.RESULTS. The presence of periductal soft-tissue density (p = 0.002), higher enhancement of the duct than adjacent bile duct on portal venous phase images (p = 0.008), ductal wall thickening (p = 0.026), portal vein obliteration (p = 0.031), and lymph node enlargement (p = 0.031) were found to be the significant findings for differentiating cholangiocarcinoma from fibrosis in patients with hepatolithiasis. When any two or more of these five criteria were used in combination, we could identify 100% of the patients with cholangiocarcinoma but only 12.5% of the patients with fibrosis.

Multimodality imaging of intrahepatic cholangiocarcinoma

“…Because the majority of these are present near the hilum, they usually cause segmental dilatation of the biliary tree (45,52). Segmental or lobar biliary ductal dilatation is an important differentiating feature from periportal lymphangitic metastases arising from an extrahepatic source.…”

“…Segmental or lobar biliary ductal dilatation is an important differentiating feature from periportal lymphangitic metastases arising from an extrahepatic source. In contrast to periductal-infiltrating cholangiocarcinomas, lymphangitic metastases will not cause lobar or segmental ductal dilatation (23,45).…”

Varying Appearances of Cholangiocarcinoma: Radiologic-Pathologic Correlation

“…Combined infected bile stasis and gallstones has been suggested as a cause of malignant change in the remaining bile duct (21). obliteration, hepatic lobe atrophy, and cholangitic abscess can also occur (13,14). In patients who undergo surgery for intrahepatic stone disease without cholangiocarcinoma, biliary intraepithelial neoplasia (BilIN) is commonly seen in the surgical specimen (Fig 3).…”

“…At CT and MR imaging, diffuse periductal thickening and increased enhancement due to tumor infiltration can be seen, with an abnormally dilated or irregularly narrowed duct and peripheral ductal dilatation (Fig 9). This type of tumor is rare in intrahepatic cholangiocarcinoma, but most hilar cholangiocarcinomas are of this type (Fig 10) (13,55,56). In the periphery of the liver, a combination of the periductal and mass-forming types is more common than a purely periductal infiltrating lesion.…”

Characterization of mesothelioma and tissues present in contrast‐enhanced thoracic CT scans

“…Tissue characterization captures the HU distribution of pixels for a given tissue. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Many computer-aided diagnostic techniques for thoracic imaging require some level of image segmentation. The goal of the present study was to quantify the physical basis for difficulties encountered when a gray-level thresholding technique alone ͑which has been a common approach͒ is attempted for the purpose of segmenting tissues present within thoracic CT scans.…”