Preoperative Assessment of Resectability of Hepatic Hilar Cholangiocarcinoma: Combined CT and Cholangiography with Revised Criteria

Abstract

Combined interpretation of CT and direct cholangiographic images by using our revised criteria resulted in overall accuracy of 74.5% for prediction of resectability for hilar cholangiocarcinoma.

Utility of convex EUS for preoperative vascular evaluation of malignant biliary tract neoplasm

“…N/A: We could not evaluate the distance between the RHA and the bile duct of the tumor site on the pathological specimen because the HA could be separated from the tumor during surgery. by cholangiocarcinoma has been reported as 87-100% (11)(12)(13)(14) for CT, whereas EUS offers 88-100% accuracy for predicting PV invasion and performs better than transabdominal US and angiography in this regard (15)(16)(17) (18) reported on combined vascular resection for hilar cholangiocarcinoma. They found that cancer invasion into the adventitia was present in 80% of the 44 resected portal veins and 40% of the 9 resected hepatic arteries, and concluded that caution should be exercised when planning combined hepatic artery resection, because cancer invasion into the adventitia of the HA occurs in only about half of the patients despite clinical findings of apparent invasion.…”

CT Evaluation of Disease Pattern in Hilar Cholangiocarcinoma

“…To determine the operability and in order to select the appropriate surgical procedure, an accurate preoperative evaluation of both longitudinal spread and vertical invasion is a prerequisite [15]. Complete resection with or without partial hepatectomy and regional lymphadenectomy is the treatment of choice in selected patients [8]. Therefore, imaging also plays an important role in determining whether a patient is a candidate for curative resection and in planning management [16].…”

“…Hilar cholangiocarcinoma was first described by Klatskin [4]. It is categorized using Bismuth classification in to: On the basis of classification scheme proposed by Japanese Liver Cancer Group, cholangiocarcinomas are classified into three types according to macroscopic appearance of the tumor: mass forming, intraductal growing, and periductal infiltrating; the last type is more prevalent in the hilar portion of the biliary tree [8,9]. This classification is considered to be the most reasonable because it describes the gross appearance, growing characteristics and biologic behavior.…”

Correct Diagnosis of Vascular Encasement and Longitudinal Extension of Hilar Cholangiocarcinoma by Four-Channel Multidetector-Row Computed Tomography

“…According to the imaging criteria of Lee et al (2006), the bile duct was considered to be involved if the ductal wall was irregularly thickened, (asymmetric upstream dilatation of the intrahepatic ducts), hyperattenuated relative to the liver, obliterated the lumen, or had an intraductal soft-tissue mass. Each bile duct segment was evaluated regardless of whether it was involved by the tumor, and the overall pattern of the longitudinal extension was classified according to Bismuth-Corlette (Fig.…”

“…Although there have been several studies on the preoperative assessment of resectability of hilar cholangiocarcinoma by multidetector-row computed tomography (MDCT) (Lee et al 2006;Chen et al 2006), these studies used relatively thick section images (2.5 mm) with no multiplanar reformation or overlap reconstruction for evaluating the biliary tree.…”