CT of Neural Plexus Invasion in Common Bile Duct Carcinoma

Abstract

The location and spread of neural plexus invasion in common bile duct carcinoma are characteristic and can be diagnosed by CT.

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part II): Imaging of pancreatic carcinoma nerve invasion

“…CT has been used to study the extrapancreatic neural plexus invasion in common bile duct carcinoma [8,24,25] and pancreatic carcinoma [26] . �iura [24] reported that a mass-like lesion located between the medial portion of the uncinate process and the ��A or celiac artery could diagnose extrapancreatic neural plexus invasion around the SMA and celiac artery with an accuracy of 63% on CT using 5 mm slice table incremental CE-CT, when performed on eight patients with pancreatic head carcinoma.…”

Diagnosis and non-surgical treatment of bile duct carcinoma: developments in the past decade

“…Although dynamic CT is useful in assessing liver metastases and paraaortic lymph node metastases, it cannot sufficiently demonstrate tumor extent in the hepatoduodenal ligament. 20 Fukuda et al 21 reported, in an interesting article, that dynamic CT was useful for the assessment of neural invasion in common bile duct carcinoma. Although angiography can be used to assess tumor invasion to the portal vein and the hepatic artery, its diagnostic capacity is inadequate because it cannot demonstrate the tumor and the vessel simultaneously.…”

The local spread of lower bile duct cancer: evaluation by thin-section helical CT

“…c Microscopic photograph of the CBD mass infiltrating the pancreas (white arrows) and the peripancreatic fat (small arrows). d High-power field microscopic photograph of the direct infiltration of adenocarcinoma (arrow) to the peripancreatic fat Pancreaticobiliary malignancies commonly invade the retroperitoneal tissues including the extrapancreatic nerve plexus which has gained importance in malignancies because it is believed to be the cause of recurrence after surgical intervention [9,10,24]. Both second portion of the extrapancreatic nerve plexus and small bowel mesentery invasion are therefore important factors that affect surgical strategy and prognosis [25].…”

“…Both second portion of the extrapancreatic nerve plexus and small bowel mesentery invasion are therefore important factors that affect surgical strategy and prognosis [25]. In a recent publication by Fukuda et al neural invasion in distal bile duct carcinoma has tendency to extend along the pancreatic plexus and presents as an irregular mass or an area of increased attenuation of retroperitoneal fat adjacent to the medial aspect of the uncinate process on CT, and as the tumor grows, neural invasion spreads medially toward the superior mesenteric artery or celiac axis, giving the vessel a thickened appearance [10]. The CT findings of infiltration of periarterial fat around the celiac and superior mesenteric arteries are said to be reliable for predicting surgical resectability while lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability [3].…”

“…Tumor histology and differentiation, local invasion, lymph node invasion, vascular invasion, and neural invasion are factors that affect treatment and prognosis in patients with distal bile duct cancer. To date, few studies have been done on the local spread of lower bile duct cancer and no generally accepted system of staging and classification by radiological means has been set [3,4,5,6,7,8,9,10]. This study focuses on determining the local spread, neural, small bowel mesentery, and vascular invasion of lower bile duct cancer.…”