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

Masselli, Gabriele; Manfredi, Riccardo; Vecchioli, A; Gualdi, Gianfranco

doi:10.1007/s00330-008-1004-z

Cited by 96 publications

(58 citation statements)

References 28 publications

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“…In another smaller study, MRCP predicted the extent of biliary ductal involvement in 96% of cases with malignant hilar obstructions [115] . Regarding surrounding structures, MRI has been shown to have 66% accuracy for detection of lymph node metastases [119] , 78% sensitivity and 91% specificity for portal vein invasion, 58%-73% sensitivity [120] and 93% specificity for arterial invasion [121] . In a comparative study the relationship of ICC to the vessels and surrounding organs was more easily evaluated on CT compared to MRI [89] .…”

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

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“…In Maselli's series [32] , MRI correctly predicted vascular involvement in 73% of the cases. MR correctly showed arterial involvement in 88% of the cases (8/9) and had false positive findings in 12% (1/9).…”

Section: Preoperative Staging and Assessement Of Resectabilitymentioning

confidence: 99%

“…Imaging with MDCT or MRI shows a hypovascular infiltrating tumoral mass growing beyond the duct and invading the adjacent liver parenchyma. In Masseli's series [32] , MRI accurately showed a local parenchymal invasion in 80% of the patients (Figure 12). …”

Section: Preoperative Staging and Assessement Of Resectabilitymentioning

confidence: 99%

“…In the paper by Maselli et al [32] , fifteen patients with hilar cholangiocarcinoma underwent radical surgery and preoperative MR imaging. MRCP and gadolinium-enhanced dynamic T1-W images were correlated with surgical findings in the evaluation of the extent of biliary infiltration according to the Bismuth-Corlette classification.…”

Section: Preoperative Staging and Assessement Of Resectabilitymentioning

confidence: 99%

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Radiological diagnosis and staging of hilar cholangiocarcinoma

Valls

Ruíz²,

Martínez³

et al. 2013

WJGO

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Core tip: Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts. Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma. Multidetector computed tomography, magnetic resonance imaging and magnetic resonance cholangiography are useful tools, both to diagnose and stage hilar cholangiocarcinoma. INTRODUCTIONCarcinomas of the extrahepatic biliary tree, commonly known as hilar cholangiocarcinoma (HCCA), Klatskin tumors or perihilar cholangiocarcinomas, are rare malignancies that account for up to 3% of all gastrointestinal cancers. With an incidence rate of 0.5-2.0 cases per 100000, it is estimated that there are between 2500 and 4000 new cases per year in the United States [1] .Although this tumor may potentially affect any location of the biliary tree, tumors involving the biliary confluence, left-hand drive (LHD) and right-hand drive (RHD) (true Klatskin tumors) are most common and account for 40%-60% of all cases. Around 2/3 of cholangiocarcinomas are hilar or extrahepatic and originate from the bile duct epithelium at the level of confluence AbstractHilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts. Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma. However, radical resection requires aggressive surgical strategies that should be tailored optimally according to the location, size and vascular invasion of the tumors. Accurate diagnosis and staging of these tumors is therefore critical for optimal treatment planning and for determining a prognosis. Multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and MR cholangiography are useful tools, both to diagnose and stage hilar cholangiocarcinoma. Modern imaging techniques allow accurate detection of the level of obstruction and the longitudinal and radial spread of the tumor. In addition, high-resolution MDCT and MR provide specific radiographic features to determine vascular involvement of anatomic structures, such as the hepatic artery or the portal vein, which are critical to decide the surgical strategy. Finally, radiological staging allows detection of patients with distant metastasis in the liver or peritoneum who will not benefit from a surgical approach.

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“…3 Preferably, biliary drainage is performed after adequate radiologic staging and resectability assessment with contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI), since plastic or metal biliary stents may cause artifacts and periductal inflammation, thereby affecting evaluation of both bile duct and vascular involvement. 5,6 Importantly, success of biliary drainage has been associated with outcomes in PHC. Initial failure of adequate palliative drainage in patients with unresectable tumors has been shown to result in lower survival.…”

Section: Introductionmentioning

confidence: 99%

Compliance with evidence‐based multidisciplinary guidelines on perihilar cholangiocarcinoma

et al. 2017

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Background: Discrepancies are often noted between management of perihilar cholangiocarcinoma (PHC) in regional hospitals and the eventual treatment plan in specialized centers. Objective: The objective of this article is to evaluate whether regional centers adhere to guideline recommendations following implementation in 2013. Methods: Data were analyzed from all consecutive patients with suspected PHC referred to our academic center between June 2013 and December 2015. Frequency and quality of biliary drainage and imaging at referring centers were assessed as well as the impact of inadequate initial drainage. Results: Biliary drainage was attempted at regional centers in 83 of 158 patients (52.5%), with a technical and therapeutic success rate of 79.5% and 50%, respectively, and a complication rate of 45.8%. The computed tomography protocol was not in accordance with guidelines in 52.8% of referrals. In 45 patients (54.2%) who underwent drainage in regional centers, additional drainage procedures were required after referral. Initial inadequate biliary drainage at a regional center was significantly associated with more procedures and a prolonged waiting time until surgery. A trend toward more drainagerelated complications was observed among patients with inadequate initial drainage (54.7% vs. 39.0%, p ¼ 0.061). Conclusion: Despite available guidelines, suboptimal management of PHC persists in many regional centers and affects eventual treatment strategies.

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

Cited by 96 publications

References 28 publications

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

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

Radiological diagnosis and staging of hilar cholangiocarcinoma

Compliance with evidence‐based multidisciplinary guidelines on perihilar cholangiocarcinoma

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