Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP

MRI system scoring for differentiation of malignant versus benign stricture of the common bile duct

“…CE-MRI can improve detection rate of cholangiocarcinomas, which usually hyperenhance on equilibrium phase images [2,4,17]. In the present study we did not find any statistical difference of enhancing pattern on CE-MRI between benign and malignant strictures; we believe this is due to heterogeneity of malignant tumors in our series, which included hypovascular tumors, such as cholangiocarcinomas and pancreatic ductal carcinomas, as well as hypervascular neoplasms, such as periampullary and neuroendocrine neoplasms.…”

“…MRCP provides noninvasive images comparable to those obtained by direct retrograde or transhepatic cholangiography, and can provide indirect evidence of a malignant lesion, such as irregularity of the inner border, abrupt stenosis, and stenosis length. Although these findings are highly sensitive, they are not specific for malignancy [1,2,4]. Dilatation of the biliary tree is an epiphenomenon of biliary strictures and depends more on the duration and degree rather than the cause of the stenosis, although such dilatation is more frequently observed in cases of malignancy [1,4,13]; therefore this sign has an ancillary value only, and should be always considered as a part of the complete radiologic picture.…”

“…However, conspicuity of lesions on portal and/or equilibrium phases (hyperenhancing pattern for desmoid tumors and hypoenhancing for hypervascular neoplasms) significantly differs between the two groups in our series. The diagnostic value of CE-MRI is further highlighted by its ability to delineate thickness and outer borders of a bile duct wall or a periductal lesion, both of which are predictors for malignancy [2,4].…”

Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges

“…1.5 mm) wall, luminal irregularity or asymmetry, and incremental enhancement may favor a malignant stricture (Fig 3), while benign strictures often involve short segments and a smooth transition (155)(156)(157)(158). Although periductal infiltrating type CC can show skipped lesions, it is more frequently observed in benign sclerosing cholangitis such as IgG4-related sclerosing cholangitis (156,159). DWI can show diffusion restriction in malignant strictures and it would provide additional value for differentiating malignant from benign strictures in extrahepatic CC (160,161).…”

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

“…Increased thickness of the stricture and hyper-enhancement in portal venous and equilibrium phases were significantly associated with malignancy. Similar stricture characteristics can be found with the use of multiphasic helical CT. 63,64 MRCP was compared to endoscopic retrograde cholangiopancreatography (ERCP) for distinguishing between benign and malignant extrahepatic biliary structures and was found that MRCP has similar sensitivity, specificity and accuracy compared to ERCP (81%, 70%, 76% and 74%, 70%, 72%, respectively). 65 Dual-time point PET-CT has been shown to be useful in differentiating malignant from benign extrahepatic disease.…”