Skip to main content

Advertisement

Log in

Cholangiocarcinoma: Diagnosis and Pre-operative Evaluation

  • Liver and Gastrointestinal Imaging (J Olpin, Section Editor)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cholangiocarcinoma is a primary malignancy of the biliary tree that comprises various anatomic and histologic subtypes. The purpose of this manuscript is to review the various imaging manifestations of cholangiocarcinoma in order to aid clinical radiologists in the diagnosis and classification of the complex malignancy, and to aid clinical colleagues in facilitating proper clinical management.

Recent Findings

Various imaging modalities may aid in the proper diagnosis and staging of cholangiocarcinoma. Recent studies have advocated the use of hepatobiliary phase magnetic resonance imaging following gadoxetic acid administration in order to improve lesion conspicuity and detection of satellite nodules and intrahepatic metastases.

Summary

Accurate recognition and classification of cholangiocarcinoma is essential for proper patient management. A thorough understanding of the different anatomic classifications, morphological patterns, and the mode of metastatic spread of cholangiocarcinoma is essential for radiologists involved in the interpretation of abdominal imaging studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Sainani NI, Catalano OA, Holalkere NS, Zhu AX, Hahn PF, Sahani DV. Cholangiocarcinoma: current and novel imaging techniques. Radiographics. 2008;28(5):1263–87.

    Article  PubMed  Google Scholar 

  2. Han JK, Choi BI, Kim AY, An SK, Lee JW, Kim TK, et al. Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. Radiographics. 2002;22(1):173–87.

    Article  PubMed  Google Scholar 

  3. Tompkins RK, Saunders K, Roslyn JJ, Longmire WP Jr. Changing patterns in diagnosis and management of bile duct cancer. Ann Surg. 1990;211(5):614 discussion 20-1.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Lee WJ, Lim HK, Jang KM, Kim SH, Lee SJ, Lim JH, et al. Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics. 2001;21 Spec No:S97-S116.

  5. Cancer AJCo. AJCC Cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  6. Lim JH, Kim YI, Park CK. Intraductal mucosal-spreading mucin-producing peripheral cholangiocarcinoma of the liver. Abdom Imaging. 2000;25(1):89–92.

    Article  CAS  PubMed  Google Scholar 

  7. Blechacz B, Komuta M, Roskams T, Gores GJ. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol. 2011;8(9):512–22.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol. 2003;181(3):819–27.

    Article  PubMed  Google Scholar 

  9. Lim JH, Yi CA, Lim HK, Lee WJ, Lee SJ, Kim SH. Radiological spectrum of intraductal papillary tumors of the bile ducts. Korean J Radiol. 2002;3(1):57–63.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kim TK, Choi BI, Han JK, Jang HJ, Cho SG, Han MC. Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings. Radiology. 1997;204(2):539–43.

    Article  CAS  PubMed  Google Scholar 

  11. Lim JH, Ko YT, Lee DH, Kim SY. Clonorchiasis: sonographic findings in 59 proved cases. AJR Am J Roentgenol. 1989;152(4):761–4.

    Article  CAS  PubMed  Google Scholar 

  12. Yoon KH, Ha HK, Kim CG, Roh BS, Yun KJ, Chae KM, et al. Malignant papillary neoplasms of the intrahepatic bile ducts: CT and histopathologic features. AJR Am J Roentgenol. 2000;175(4):1135–9.

    Article  CAS  PubMed  Google Scholar 

  13. Ros PR, Buck JL, Goodman ZD, Ros AM, Olmsted WW. Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation. Radiology. 1988;167(3):689–93.

    Article  CAS  PubMed  Google Scholar 

  14. • Chung YE, Kim MJ, Park YN, Choi JY, Pyo JY, Kim YC, et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics. 2009;29(3):683–700. The study accurately describes the various growth patterns of intraductal cholangiocarcinoma which was not described before facilitating the evaluation of these type of tumors.

  15. Soyer P, Bluemke DA, Reichle R, Calhoun PS, Bliss DF, Scherrer A, et al. Imaging of intrahepatic cholangiocarcinoma: 1. Peripheral cholangiocarcinoma. AJR Am J Roentgenol. 1995;165(6):1427–31.

    Article  CAS  PubMed  Google Scholar 

  16. Maetani Y, Itoh K, Watanabe C, Shibata T, Ametani F, Yamabe H, et al. MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roentgenol. 2001;176(6):1499–507.

    Article  CAS  PubMed  Google Scholar 

  17. Wernecke K, Henke L, Vassallo P, von Bassewitz DB, Diederich S, Peters PE, et al. Pathologic explanation for hypoechoic halo seen on sonograms of malignant liver tumors: an in vitro correlative study. AJR Am J Roentgenol. 1992;159(5):1011–6.

    Article  CAS  PubMed  Google Scholar 

  18. Itai Y, Ohtomo K, Kokubo T, Yamauchi T, Minami M, Yashiro N, et al. CT of hepatic masses: significance of prolonged and delayed enhancement. AJR Am J Roentgenol. 1986;146(4):729–33.

    Article  CAS  PubMed  Google Scholar 

  19. Lacomis JM, Baron RL, Oliver JH 3rd, Nalesnik MA, Federle MP. Cholangiocarcinoma: delayed CT contrast enhancement patterns. Radiology. 1997;203(1):98–104.

    Article  CAS  PubMed  Google Scholar 

  20. Vilgrain V, Van Beers BE, Flejou JF, Belghiti J, Delos M, Gautier AL, et al. Intrahepatic cholangiocarcinoma: MRI and pathologic correlation in 14 patients. J Comput Assist Tomogr. 1997;21(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  21. Stoupis C, Taylor HM, Paley MR, Buetow PC, Marre S, Baer HU, et al. The Rocky liver: radiologic-pathologic correlation of calcified hepatic masses. Radiographics. 1998;18(3):675–85 quiz 726.

    Article  CAS  PubMed  Google Scholar 

  22. Kang Y, Lee JM, Kim SH, Han JK, Choi BI. Intrahepatic mass-forming cholangiocarcinoma: enhancement patterns on gadoxetic acid-enhanced MR images. Radiology. 2012;264(3):751–60.

    Article  PubMed  Google Scholar 

  23. Okabayashi T, Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, et al. A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer. 2001;92(9):2374–83.

    Article  CAS  PubMed  Google Scholar 

  24. Mittelstaedt CA. Ultrasound of the bile ducts. Semin Roentgenol. 1997;32(3):161–71.

    Article  CAS  PubMed  Google Scholar 

  25. Robledo R, Muro A, Prieto ML. Extrahepatic bile duct carcinoma: US characteristics and accuracy in demonstration of tumors. Radiology. 1996;198(3):869–73.

    Article  CAS  PubMed  Google Scholar 

  26. Yamashita Y, Takahashi M, Kanazawa S, Charnsangavej C, Wallace S. Hilar cholangiocarcinoma. An evaluation of subtypes with CT and angiography. Acta Radiol. 1992;33(4):351–5.

    CAS  PubMed  Google Scholar 

  27. Choi BI, Lee JH, Han MC, Kim SH, Yi JG, Kim CW. Hilar cholangiocarcinoma: comparative study with sonography and CT. Radiology. 1989;172(3):689–92.

    Article  CAS  PubMed  Google Scholar 

  28. Soyer P, Bluemke DA, Reichle R, Calhoun PS, Bliss DF, Scherrer A, et al. Imaging of intrahepatic cholangiocarcinoma: 2. Hilar cholangiocarcinoma. AJR Am J Roentgenol. 1995;165(6):1433–6.

    Article  CAS  PubMed  Google Scholar 

  29. Weinbren K, Mutum SS. Pathological aspects of cholangiocarcinoma. J Pathol. 1983;139(2):217–38.

    Article  CAS  PubMed  Google Scholar 

  30. • Lee JW, Han JK, Kim TK, Kim YH, Choi BI, Han MC, et al. CT features of intraductal intrahepatic cholangiocarcinoma. AJR Am J Roentgenol. 2000;175(3):721–5. This study provides a clear cut off value for smaller lesions that can be easily missed on imaging as well as explaining the unorthothox pattern of enhancement seen in intraductal tumors.

  31. Kim YS, Myung SJ, Kim SY, Kim HJ, Kim JS, Park ET, et al. Biliary papillomatosis: clinical, cholangiographic and cholangioscopic findings. Endoscopy. 1998;30(9):763–7.

    Article  CAS  PubMed  Google Scholar 

  32. Loyer EM, Chin H, DuBrow RA, David CL, Eftekhari F, Charnsangavej C. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase helical CT–a comparative study. Radiology. 1999;212(3):866–75.

    Article  CAS  PubMed  Google Scholar 

  33. Han JK, Choi BI, Kim TK, Kim SW, Han MC, Yeon KM. Hilar cholangiocarcinoma: thin-section spiral CT findings with cholangiographic correlation. Radiographics. 1997;17(6):1475–85.

    Article  CAS  PubMed  Google Scholar 

  34. Valls C, Ruiz S, Martinez L, Leiva D. Radiological diagnosis and staging of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5(7):115–26.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chung YE, Kim MJ, Park YN, Lee YH, Choi JY. Staging of extrahepatic cholangiocarcinoma. Eur Radiol. 2008;18(10):2182–95.

    Article  PubMed  Google Scholar 

  36. •• van Gulik TM, Gouma DJ. Changing perspectives in the assessment of resectability of hilar cholangiocarcinoma. Ann Surg Oncol. 2007;14(7):1969–71. This study added a new prespective in reporting cholangiocarcinoma by mentioning the importance of biliary variations that has direct implicaiton on the surgical management.

  37. Lee HY, Kim SH, Lee JM, Kim SW, Jang JY, Han JK, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology. 2006;239(1):113–21.

    Article  PubMed  Google Scholar 

  38. Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg. 2009;250(2):210–8.

    Article  PubMed  Google Scholar 

  39. Baron RL, Stanley RJ, Lee JK, Koehler RE, Melson GL, Balfe DM, et al. A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography. Radiology. 1982;145(1):91–8.

    Article  CAS  PubMed  Google Scholar 

  40. Park MS, Kim TK, Kim KW, Park SW, Lee JK, Kim JS, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004;233(1):234–40.

    Article  PubMed  Google Scholar 

  41. Hann LE, Greatrex KV, Bach AM, Fong Y, Blumgart LH. Cholangiocarcinoma at the hepatic hilus: sonographic findings. AJR Am J Roentgenol. 1997;168(4):985–9.

    Article  CAS  PubMed  Google Scholar 

  42. Hayashi M, Matsui O, Ueda K, Kadoya M, Yoshikawa J, Gabata T, et al. Imaging findings of mucinous type of cholangiocellular carcinoma. J Comput Assist Tomogr. 1996;20(3):386–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Omneya Yakout Dogheim.

Ethics declarations

Conflict of Interest

Omneya Yakout Dogheim declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Liver and Gastrointestinal Imaging.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dogheim, O.Y., Rizvani, M. Cholangiocarcinoma: Diagnosis and Pre-operative Evaluation. Curr Radiol Rep 4, 40 (2016). https://doi.org/10.1007/s40134-016-0168-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40134-016-0168-6

Keywords

Navigation