Differentiation of Extrahepatic Bile Duct Cholangiocarcinoma from Benign Stricture: Findings at MRCP versus ERCP

Park, Mi‐Suk; Kim, Tae Kyoung; Kim, Kyung Won; Park, Sung Won; Lee, Jeong Kyung; Kim, Jung Sun; Lee, Jean Hwa; Kim, Kyoung Ah; Kim, Ah Young; Kim, Pyo Nyun; Lee, Moon Gyu; Ha, Hyun Kwon

doi:10.1148/radiol.2331031446

Cited by 255 publications

(145 citation statements)

References 19 publications

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“…2) [47][48][49][50]. In contrast, findings more likely to suggest cholangiocarcinoma are strictures longer than 12 mm, asymmetric narrowing segments, indistinct outer margins, and hyperenhancement relative to the liver during the venous phase [51,52]. When the biliary stricture of ISC involves the intra-and extrahepatic bile ducts, it may mimic PSC.…”

Section: Ct/mrmentioning

confidence: 99%

IgG4-related sclerosing cholangitis: all we need to know

2016

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Our knowledge and experience of IgG4-related sclerosing cholangitis (ISC) have expanded in the last decade. ISC is one of the common organ manifestations of IgG4-related disease (IgG4-RD); approximately 60 % of patients with this systemic condition have ISC in the proximal and/or distal bile ducts. ISC needs to be discriminated from primary sclerosing cholangitis, cholangiocarcinoma, and other rare forms of lymphoplasmacytic cholangiopathy (e.g., follicular cholangitis and sclerosing cholangitis with granulocytic epithelial lesions). Its diagnosis requires a multidisciplinary approach, in which serology, histology, and imaging play crucial roles. Treatments with high-dose corticosteroids typically lead to the rapid and consistent induction of disease remission. Another promising therapeutic approach is B-cell depletion with rituximab. Although disease relapse is relatively common, provided that appropriate treatments are administered, ISC is considered a ''benign'' disease with a low risk of liver failure and biliary malignancy. Its molecular pathology is characterized by Th2-dominant immune reactions, regulatory T-cell activation, and CCL1-CCR8 interactions. Particular subsets of B cells such as plasmablasts and regulatory B cells also expand. A recent global proteomic study demonstrated that three significantly activated immunological cascades in ISC were all B-cell-or immunoglobulin-related (Fc-gamma receptormediated phagocytosis, B-cell receptor signaling pathway, and Fc-epsilon receptor I signaling pathway), suggesting the crucial roles of B cells in the underlying immune reactions. Despite the expansion of our knowledge of the pathophysiology of ISC, the exact role of IgG4 remains unclear. A better understanding of its immunopathology will offer some potential drug targets for this emerging biliary disease.

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Section: Ct/mrmentioning

confidence: 99%

IgG4-related sclerosing cholangitis: all we need to know

2016

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“…In experienced hands, colour Doppler US is very useful in assessing proximal biliary extension of the tumor and vascular invasion, but has limited value in distinguishing HCCA from inflammatory lesions [5] . Contrast enhanced C T a n d M R i m a g i n g ( M R I ) p r ov i d e i m p o r t a n t infor mation regarding resectability and vascular involvement [6][7][8] . Furthermore, these cross-sectional imaging modalities are accurate in detecting a tumor mass and signs of lymphadenopathy, although both features may also be present in benign diseases.…”

Section: Jj Et Al Differentiation Of Proximal Bile Duct Strictures mentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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“…Then, the reviewers assessed the level of obstruction and the extent of disease according to the diagnostic criteria, i.e., loss of continuity of the bile duct, an abrupt and irregular narrowing of a distal segment with prestenotic dilatation, and irregularly shaped intraluminal filling defects (5,6,8). A hilar obstruction was one that occurred at the confluence of the hepatic ducts, in which both the right hepatic and the left hepatic ducts were affected.…”

Section: Image Analysismentioning

confidence: 99%

“…In contrast, MR cholangiopancreatography (MRCP) is an evolving, noninvasive, and highly accurate method of imaging the biliary tree and pancreatic duct (5)(6)(7)(8)(9)(10)(11)(12). Current MRCP techniques typically utilize thick section single-shot rapid acquisition with relaxation enhancement (RARE) and thin section multislice half-Fourier RARE techniques to produce images of the pancreaticobiliary system (11,12).…”

mentioning

confidence: 99%

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

Choi

Lee

et al. 2007

Magnetic Resonance Imaging

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Purpose:To compare the diagnostic accuracy of navigatortriggered isotropic three-dimensional (3D) MR cholangiopancreatography (MRCP) using parallel imaging for malignant biliary obstruction with direct cholangiography. Materials and Methods:A total of 23 patients with malignant biliary obstruction underwent MRCP and endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography (PTC). Two observers retrospectively evaluated 3D-MRCP and ERCP/PTC and recorded the level of obstruction and extent of tumor along with their confidence. The quality of images and morphologic appearance of stricture were also evaluated by two reviewers. The results of MRCP and ERCP/PTC were compared with surgical and histopathological data.Results: 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in three patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/ PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. Conclusion: 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction.

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Differentiation of Extrahepatic Bile Duct Cholangiocarcinoma from Benign Stricture: Findings at MRCP versus ERCP

Abstract: Accuracy of MRCP is comparable with that of ERCP. Regardless of modality, a lengthy segment of extrahepatic bile duct stricture with irregular margin and asymmetric narrowing suggests cholangiocarcinoma, and a short segment with regular margin and symmetric narrowing suggests benign cause.

Cited by 255 publications

References 19 publications

IgG4-related sclerosing cholangitis: all we need to know

IgG4-related sclerosing cholangitis: all we need to know

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

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