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

Abstract

Cholangiocarcinoma, the second most common hepatobiliary malignancy after hepatocellular carcinoma, is a heterogeneous disease entity with widely varying radiologic features, clinical behavior, and treatment approaches. In the detection, characterization, staging, and resectability assessment of cholangiocarcinoma, imaging studies are indispensable. Herein, an overview of the state-of-the-art imaging techniques is presented for the evaluation of intrahepatic and perihilar cholangiocarcinoma, as well as complementary multimodality and multiparametric imaging approaches for a more comprehensive evaluation. In addition, classification systems, new pathologic concepts in cholangiocarcinogenesis and premalignant lesions, and current trends in treatment approaches, which are vital to the imaging interpretation of cholangiocarcinoma, will be discussed. RSNA, 2018.

Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge

“…In comparison, the most common morphological type of hilar CC is periductal-infiltrating type [32]. It usually manifests a narrowed hilar bile duct with irregular wall thickening or sometimes obliterated, which typically shows progressively delayed enhancement [15,33]. A combination of the periductal and mass-forming mixed types could also be found in hilar area.…”

“…Most of the HBDTT might mimic hilar cholangiocarcinoma (hilar CC) in clinical presentation because they share the same symptoms such as obstructive jaundice and upper abdomen pain. On the other hand, both HCC with BDTT and hilar CC have similar image features like hilar neoplasm, obstructed hilar bile duct and upstream bile duct dilatation [3,9,11,14,15]. However, it is important to distinguish HCC with HBDTTs from hilar CCs preoperatively as different surgical procedures are required.…”

Metastasis of missed cholangiocarcinoma in the left lobethrough abdominal wall laparoscopic port-site and umbilicus after laparoscopic cholecystectomy: case report and literature review

“…Nodular type of cholangiocarcinoma has less missed diagnosis probability. The imaging features of the latter two are not typical, that may lead to higher risk of missed and misdiagnosis [20]. Hepatic capsular shrinkage is also an imaging feature of cholangiocarcinoma with a low speci city for both benign and malignant liver lesions can occur [21].…”

Differenzialdiagnosen von Gallenwegerkrankungen

“…Die native Phase kann für die Detektion intraduktaler Konkremente und deren Differenzierung zu Tumoren hilfreich sein. Neben einer arteriellen und venösen Phase ist eine Spätphase 3-5 min nach Kontrastmittelapplikation zur besseren Abgrenzung von hilären Cholangiokarzinomen hilfreich [7]. Nachbearbeitungstechniken wie multiplanare Rekonstruktionen und Maximum-Intensitäts-Projektionen (MIP) erleichtern die Beurteilung der Gefäßanatomie und der Ausdehnung einer tumoralen Invasion in die Leberarterie, die Pfortader und das Leberparenchym.…”