Preoperative Evaluation of Malignant Perihilar Biliary Obstruction: Negative-Contrast CT Cholangiopancreatography and CT Angiography Versus MRCP and MR Angiography

Wu, Xiaoping; Ni, Jianming; Zhang, Zhuiyang; Lu, Fengqi; Li, Bin; Jin, Huihan; Dai, Tu

doi:10.2214/ajr.14.13983

Cited by 16 publications

(13 citation statements)

References 30 publications

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“…The sensitivity and specificity of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography in detecting hepatic invasion, lymph node metastasis, and bile duct invasion are reported to be 87.5% and 86%, 60% and 90%, and 80 and 100%, respectively [23]. The correct diagnostic rate for classification of malignant hilar obstruction, which corresponds to the "invasion of the left margin or entire areas of the hepatoduodenal ligament" in our study, has been reported to be 90.5% for CT and 81.0-85.7% for MRI, and may sometimes underestimate the degree of biliary stricture [24]. Moreover, the preoperative diagnosis of lymph node metastasis in patients with GBC was also reported with a sensitivity ranging from 0.25-0.93 for CT and 0.59-0.93 for MRI, and specificity of 1.00 for CT and 0.78-1.00 for MRI [25].…”

Section: Discussionmentioning

confidence: 42%

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Higuchi

Yazawa

Uemura

et al. 2020

Cancers

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In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien–Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors (p < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.

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Section: Discussionmentioning

confidence: 42%

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Higuchi

Yazawa

Uemura

et al. 2020

Cancers

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“…The authors acknowledged that imaging techniques are often combined as each technique may provide higher accuracy for a specific item (e. g., vascular invasion for CT, lymph node metastasis for PET/CT). The two studies (not included in the meta-analysis) that compared MRI and CT in identical patients with hilar cholangiocarcinoma (total, 36 patients) found that both techniques had similar accuracies for the evaluation of bile duct involvement [150,151]. Patients with biliary stents were excluded from these studies as from others because the staging accuracy of both modalities diminishes after biliary stent placement as a result of ductal decompression and imaging artifacts [152].…”

Section: Role Of Eus-bdmentioning

confidence: 99%

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

et al. 2018

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ESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence.

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“…Differentiation of ICC and HCC in the setting of liver cirrhosis is of great importance, because the treatment and prognosis of these entities can be quite different [ 6 , 7 ]. Ultrasonography (US) is helpful to investigate the cause of the bile duct obstruction and to locate the lesions [ 8 , 9 ], computed tomography (CT) is usually used to evaluate the full extension of tumor and determine surgical resectability [ 10 , 11 ], routine unenhanced T1- and T2-weighted imaging enable the ability to evaluate the surrounding tissues, magnetic resonance cholangiopancreatography (MRCP) is useful for assessing the biliary system [ 12 – 14 ]. However, accurate preoperative diagnosis of ICC in patients with cirrhosis has been quite difficult by using these usual imaging because of similar imaging features compared with HCC especially in the cirrhotic liver [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: Differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging

Gao

Zheng³

et al. 2017

Oncotarget

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Accurate preoperative differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in the setting of cirrhotic liver is of great clinical significance because the treatment and prognosis of these entities differ markedly. Through a retrospectively research, we sought to determine the diagnostic performances of intravoxel incoherent motion (IVIM) and diffusion weighted imaging (DWI) parameters in the differentiating of ICC and HCC. According to the results, we found that apparent diffusion coefficient (ADC) derived from mono-exponential model and true ADC (ADCslow) derived from bi-exponential model can be used to distinguish the ICC and HCC, and ADCslowentailed the higher diagnostic performance than ADC. However, pseudo-ADC (ADCfast) and perfusion fraction (f) can not be used to differentiate ICC and HCC. These results suggested that IVIM and DWI parameters can be useful in differentiating ICC and HCC and might be helpful in selecting the treatment plan and predicting prognosis.

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Preoperative Evaluation of Malignant Perihilar Biliary Obstruction: Negative-Contrast CT Cholangiopancreatography and CT Angiography Versus MRCP and MR Angiography

Abstract: Compared with the MRI set, the CT set provides equivalent performance in assessing the classification of malignant perihilar biliary obstruction, portal vein involvement, nodal metastasis, and organ spread, but has higher accuracy in assessing arterial invasion.

Cited by 16 publications

References 30 publications

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: Differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging

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