Malignant Hilar and Perihilar Biliary Obstruction: Use of MR Cholangiography to Define the Extent of Biliary Ductal Involvement and Plan Percutaneous Interventions

Lopera, Jorge E.; Soto, Jorge A.; Múnera, Felipe

doi:10.1148/radiology.220.1.r01jl3990

Cited by 110 publications

(48 citation statements)

References 29 publications

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“…Therefore, MRI along with MRCP is considered the radiological modality of choice for evaluating patients with suspected CC [113] . MRCP/MRI allows definition of the anatomy and extent of CC within the hepatobiliary system [108,110,114] vascular invasion, local lymphadenopathy and distant metastases [108,113,115] . Ideally, MRCP should be performed before decompressing the biliary tree [86] .…”

Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

253

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

253

190

View full text Add to dashboard Cite

show abstract

“…In patients who are potential candidates for surgical resection, the role of diagnostic imaging is to identify the level of bile duct obstruction, presence/absence of vascular invasion, intrahepatic tumour spread and lymph node involvement [7][8][9][10]. Howevers, CCCs have the tendency to spread between the hepatocyte plates, along the duct walls and adjacent to nerves [11]; in particular, perineural invasion is found in as many as 81% of reported cases [12].…”

Section: Introductionmentioning

confidence: 99%

MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings

et al. 2008

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The primary aim was to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma (CCC) and consequently to determine the capability of MRI/MRCP for staging CCC. Fifteen patients that underwent MRI/MRCP and surgical treatment were retrospectively included. Two radiologists evaluated MR images to assess delayed periductal enhancement, extent of bile duct stenosis, liver parenchymal and vascular involvement and presence of liver atrophy. An agreement between delayed enhancement of the bile duct walls and perineural neoplastic spread showed a very good correlation factor (0.93). The overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (p<0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the cases. The number of overall correctly assessed patients with regard to resectability was 11 true positive, 1 false positive and 3 true negative. The combination of MRI/MRCP is a reliable diagnostic method for staging hilar cholangiocarcinomas. Delayed periductal enhancement is accurate in the evaluation of neoplastic perineural spread, and it can improve diagnostic accuracy to identify resectable and unresectable tumours.

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“…Use of MR cholangiography is increasing for the evaluation of choledocholithiasis, ductal anatomy and ductal abnormality in many biliary diseases [7][8][9][10][11][12]. For this reason, radiologists frequently encounter gallbladder diseases during the evaluation of the MR cholangiography.…”

Section: Introductionmentioning

confidence: 99%

Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern

Jung

Lee

et al. 2004

Eur Radiol

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The aim of this study was to correlate MR findings of gallbladder wall thickening with pathologic findings on the basis of the layered pattern and to evaluate the diagnostic value of MR imaging in gallbladder disease. We retrospectively evaluated the source images of HASTE sequences for MR cholangiography in 144 patients with gallbladder wall thickening. The layered pattern of thickened wall was classified into four patterns. Type 1 shows two layers with a thin hypointense inner layer and thick hyperintense outer layer. Type 2 has two layers of ill-defined margin. Type 3 shows multiple hyperintense cystic spaces in the wall. Type 4 shows diffuse nodular thickening without layering. MR findings of a layered pattern of thickened gallbladder were well correlated with histopathology. Chronic cholecystitis matched to type 1, acute cholecystitis corresponded to type 2, adenomyomatosis showed type 3, and the gallbladder carcinomas showed type 4. All four layered patterns were associated with PPV of 73% or greater, sensitivity of 92% or greater and specificity of 95% or greater. Our results indicate that MR findings of gallbladder wall thickening are characteristic in each entity and correlate well with pathologic findings. The classification of the layered pattern may be valuable for interpreting thickened gallbladder wall.

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Malignant Hilar and Perihilar Biliary Obstruction: Use of MR Cholangiography to Define the Extent of Biliary Ductal Involvement and Plan Percutaneous Interventions

Abstract: The high accuracy of MR cholangiography for defining extent of ductal involvement in patients with malignant hilar and perihilar obstruction allows adequate planning of percutaneous interventions in a majority of patients.

Cited by 110 publications

References 29 publications

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings

Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern

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