Preoperative Radiologic Evaluation of Cholangiocarcinoma

So Yeon Kim

doi:10.4166/kjg.2017.69.3.159

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Kim: Preoperative Radiologic Evaluation of Cholangiocarcinoma

Review Article

Korean J Gastroenterol 2017;69(3):159-163.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.3.159

Preoperative Radiologic Evaluation of Cholangiocarcinoma

So Yeon Kim

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: So Yeon Kim, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-4400, Fax: +82-2-476-4719, E-mail: sykimrad@amc.seoul.kr

Received 21 February 2017 Revised 13 March 2017 Accepted 13 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In patients with cholangiocarcinoma, surgical resection with curative intent is the only way to achieve cure. Since surgical resection of cholangiocarcinomas is technically demanding, determination of resectability and accurate preoperative staging are crucial. For these purposes, high quality imaging including multidetector computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreaticography, is mandatory. This article will present recent advances in imaging techniques for chol-angiocarginomas, potential pitfalls in imaging evaluation, and a checklist for preoperative radiologic assessment of resectability in these patients with an emphasis on perihilar cholangiocarinoma.

Keywords: Cholangiocarcinoma, Multidetector-row computed tomography, Magnetic resonance imaging, Imaging, diagnostic, Neoplasm staging

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Fig. 1.

MDCT images for staging CCA. (A) Coronal reformatted image demonstrates the longitudinal tumor extent (arrows) in a patient with pCCA. (B) Volume rendering image shows the relationship between the tumor (arrows) and hepatic vessels (arrowhead, hepatic artery; P, portal vein). (C, D) CT arteriography and CT venography images reconstructed with maximum intensity projection clearly depict vascular anatomy in the patient. MDCT, multidetector computed tomography; CCA, cholangiocarcinoma; pCCA, perihilar cholangiocarcinoma; CT, computed tomography.

Fig. 2.

Effects of biliary stent in a patient with CCA. (A) Coronal reformatted contrastenhanced CT image demonstrates the distal CCA (arrows). (B) The longitudinal tumor extent is difficult to determine in CT after biliary stent insertion. (C) On contrast enhanced coronal MR images, there is a diffuse bile duct wall thickening at the entire bile duct (arrows) due to postinverventional inflammatory changes which may cause overstaging of disease extent. CCA, cholangiocarcinoma; CT, computed tomography; MR, magnetic resonance.

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