MR imaging findings of early bile duct cancer

Abstract

Purpose: To retrospectively evaluate the MR imaging features of early bile duct cancer and to correlate them with the clinicopathologic findings. Materials and Methods:This retrospective study was approved by our institutional review board, and informed consent was waived. Seventeen patients with surgically proven early bile duct cancer who had undergone preoperative MR cholangiopancreatography with gadolinium-enhanced MR imaging, were included in this study. Two, experienced radiologists evaluated the MR images in consensus regarding the following findings: tumor number and morphology; signal intensity of the tumor; sharpness of the outer border of the bile duct wall; enhancement pattern of the tumor; and the presence of enlarged peribiliary lymph nodes. Another radiologist measured the SNR of the tumor and bile duct wall on gadolinium-enhanced MRI during the dynamic phases to evaluate the tumor enhancement degree. Results:In all patients, MR imaging demonstrated single or multiple intraluminal bile duct masses showing a sharply defined outer margin. The most common enhancement pattern of the biliary lesions showed heterogeneous amorphous enhancement or heterogeneous enhancement with central, dot-like structures or vascular structures (76.5%, 13/17 patients). The difference of SNR between bile duct and tumor was greatest in the equilibrium phase (P Ͻ 0.05). Conclusion:MRCP combined with dynamic contrast-enhanced MRI can be useful for detecting early bile duct cancers. Common MR findings of early bile duct cancer include one or more inhomogeneously enhancing intraductal masses with clear outer margins and preservation of the bile duct wall.

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

“…For detecting the involvement of secondary confluences, dynamic enhanced MRI in combination with MRCP would provide excellent performance (96,173). As for CT, CT with direct cholangiography or CT with multiplanar reconstruction and minimum intensity projection have reported comparable results to MRI with MRCP (87,174). In addition, a few studies have reported conflicting results regarding the additional role of DWI to conventional MRI (162,163).…”

“…This incomplete assessment of tumor extent, which may result in a margin-positive resection, is regarded to be a significant contributing factor to the high rate of recurrence after resection of IPNB (197). In this aspect, MRI with MRCP may have advantages in the evaluation of the tumor extent and multiplicity owing to its high soft-tissue contrast (174,193,198,199). In addition, DWI, which reflects tissue cellularity, would provide added value in the detection of intraductal tumors of IPNB and the determination of tumor invasiveness compared with conventional MRI (200).…”

ACR Appropriateness Criteria® Jaundice

“…The use of MRCP may decrease the number of ERCP examinations obtained prior to elective cholecystectomy (if no CBD stone is seen at the time of MRCP and there is no clinical suspicion for biliary obstruction, then surgeons may choose to proceed directly to cholecystectomy) [26,61]. MRCP is valuable in the clinical situation of failed ERCP [26,53], in patients who are too sick to undergo ERCP [97], and in patients with hilar biliary obstructions that are due to ductal tumor or periductal compression [51,52,63,[98][99][100][101]. MRCP offers additive value over US in pregnant patients with suspected pancreaticobiliary disease and is more sensitive than US for determining the cause of biliary obstruction when dilated bile ducts are seen on US [61].…”

Intraductal magnetic resonance imaging of cholangiocarcinoma - a practical possibility

“…MRI can delineate obstructed bile ducts owing to the long T2 time constant of bile, and contrast-enhancement can highlight mass-forming tumors due to their enhanced micro-vascularity ( 6 ). However, the small duct wall changes in early-stage disease are hard to detect ( 7 ), so precise staging and surgical planning are difficult.…”