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Benign and Malignant Bile Duct Strictures

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Diffusion Weighted Imaging of the Hepatobiliary System
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Abstract

Imaging plays a crucial role in the evaluation of patients with biliary strictures such as in detection, characterization and treatment planning. MRCP is well-established for the detection of intra- or/and extrahepatic bile duct strictures as well as for the site, length and degree of stricture. For the differentiation of benign from malignant causes of biliary strictures and for treatment planning, MRCP/gadolinium-based contrast-enhanced (CE) MRI has been traditionally widely used. Diffusion-weighted imaging (DWI) has recently been implemented in clinical protocols. Literature data on its role in the evaluation of patients with bile duct strictures are somehow contradictory. The available studies are retrospectively designed and, in their vast majority, indicate that the addition of DWI to MRCP/CE-MRI contributes in the differentiation of benign from malignant causes of bile duct strictures as well as in the preoperative assessment of tumour extend. Furthermore, DWI has been shown to perform better than MRCP (and/or T2-weighted sequences) for the diagnosis of bile duct stricture of malignant aetiology.

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References

  1. Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014;34(3):565–86. https://doi.org/10.1148/rg.343125211.

    Article  PubMed  Google Scholar 

  2. Bali MA, Pezzullo M, Pace E, Morone M. Benign biliary diseases. Eur J Radiol. 2017;93:217–28.

    Article  CAS  PubMed  Google Scholar 

  3. Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol. 2016;13(1):28–37.

    Article  CAS  PubMed  Google Scholar 

  4. Saarinen S, Olerup O, Broomé U. Increased frequency of autoimmune diseases in patients with primary sclerosing cholangitis. Am J Gastroenterol. 2000;95(11):3195–9.

    Article  CAS  PubMed  Google Scholar 

  5. Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis – a comprehensive review. J Hepatol. 2017;67(6):1298–323.

    Article  PubMed  Google Scholar 

  6. Aabakken L, Karlsen TH, Albert J, Arvanitakis M, Chazouilleres O, Dumonceau JM, Färkkilä M, Fickert P, Hirschfield GM, Laghi A, Marzioni M, Fernandez M, Pereira SP, Pohl J, Poley JW, Ponsioen CY, Schramm C, Swahn F, Tringali A, Hassan C. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy. 2017;49(6):588–608.

    Article  PubMed  Google Scholar 

  7. Walker SL, McCormick PA. Diagnosing cholangiocarcinoma in primary sclerosing cholangitis: an “evidence based radiology” review. Abdom Imaging. 2008;33(1):14–7.

    Article  PubMed  Google Scholar 

  8. Trikudanathan G, Navaneethan U, Njei B, Vargo JJ, Parsi MA. Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79(5):783–9.

    Article  PubMed  Google Scholar 

  9. Nanda A, Brown JM, Berger SH, Lewis MM, Barr Fritcher EG, Gores GJ, Keilin SA, Woods KE, Cai Q, Willingham FF. Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma. Ther Adv Gastroenterol. 2015;8(2):56–65.

    Article  Google Scholar 

  10. Hubers LM, Maillette de Buy Wenniger LJ, Doorenspleet ME, Klarenbeek PL, Verheij J, Rauws EA, van Gulik TM, Oude Elferink RP, van de Graaf SF, de Vries N, Beuers U. IgG4-associated cholangitis: a comprehensive review. Clin Rev Allergy Immunol. 2015;48(2-3):198–206.

    Article  CAS  PubMed  Google Scholar 

  11. Nakazawa T, Shimizu S, Naitoh I. IgG4-related sclerosing cholangitis. Semin Liver Dis. 2016;36(3):216–28.

    Article  CAS  PubMed  Google Scholar 

  12. Deoliveira ML, Schulick RD, Nimura Y, Rosen C, Gores G, Neuhaus P, Clavien PA. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology. 2011;53(4):1363–71.

    Article  PubMed  Google Scholar 

  13. Razumilava N, Gores GJ. Classification, diagnosis, and management of cholangiocarcinoma. Clin Gastroenterol Hepatol. 2013;11(1):13–21.e1; quiz e3–4. https://doi.org/10.1016/j.cgh.2012.09.009.

    Article  PubMed  Google Scholar 

  14. 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 

  15. Saxena A, Chua TC, Chu FC, Morris DL. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg. 2011;202(3):310–20.

    Article  PubMed  Google Scholar 

  16. Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol. 1997;15(3):947–54.

    Article  CAS  PubMed  Google Scholar 

  17. Igami T, Nagino M, Oda K, Nishio H, Ebata T, Yokoyama Y, Shimoyama Y. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg. 2009;249(2):296–302.

    Article  PubMed  Google Scholar 

  18. Chang S, Lim JH, Choi D, Kim SK, Lee WJ. Differentiation of ampullary tumor from benign papillary stricture by thin-section multidetector CT. Abdom Imaging. 2008;33(4):457–62.

    Article  PubMed  Google Scholar 

  19. Kim JH, Kim MJ, Chung JJ, Lee WJ, Yoo HS, Lee JT. Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics. 2002;22(6):1335–52.

    Article  PubMed  Google Scholar 

  20. Kim S, Lee NK, Lee JW, Kim CW, Lee SH, Kim GH, Kang DH. CT evaluation of the bulging papilla with endoscopic correlation. Radiographics. 2007;27(4):1023–38.

    Article  PubMed  Google Scholar 

  21. Irie H, Honda H, Shinozaki K, Yoshimitsu K, Aibe H, Nishie A, Nakayama T, Masuda K. MR imaging of ampullary carcinomas. J Comput Assist Tomogr. 2002;26(5):711–7.

    Article  PubMed  Google Scholar 

  22. Kim TU, Kim S, Lee JW, Woo SK, Lee TH, Choo KS, Kim CW, Kim GH, Kang DH. Ampulla of Vater: comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy. Eur J Radiol. 2008;66(1):48–64.

    Article  PubMed  Google Scholar 

  23. Andersson M, Kostic S, Johansson M, Lundell L, Asztély M, Hellström M. MRI combined with MR cholangiopancreatography versus helical CT in the evaluation of patients with suspected periampullary tumors: a prospective comparative study. Acta Radiol. 2005;46(1):16–27.

    Article  CAS  PubMed  Google Scholar 

  24. 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 

  25. Kim JY, Lee JM, Han JK, Kim SH, Lee JY, Choi JY, Kim SJ, Kim HJ, Kim KH, Choi BI. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures. J Magn Reson Imaging. 2007;26(2):304–12.

    Article  PubMed  Google Scholar 

  26. Kim MJ, Mitchell DG, Ito K, Outwater EK. Biliary dilatation: differentiation of benign from malignant causes—value of adding conventional MR imaging to MR cholangiopancreatography. Radiology. 2000;214(1):173–81.

    Article  CAS  PubMed  Google Scholar 

  27. Park MS, Kim TK, Kim KW, Park SW, Lee JK, Kim JS, Lee JH, Kim KA, Kim AY, Kim PN, Lee MG, Ha HK. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004;233(1):234–40.

    Article  PubMed  Google Scholar 

  28. Clayton RA, Clarke DL, Currie EJ, Madhavan KK, Parks RW, Garden OJ. Incidence of benign pathology in patients undergoing hepatic resection for suspected malignancy. Surgeon. 2003;1(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  29. Gerhards MF, Vos P, van Gulik TM, Rauws EA, Bosma A, Gouma DJ. Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg. 2001;88(1):48–51.

    Article  CAS  PubMed  Google Scholar 

  30. Cui XY, Chen HW. Role of diffusion-weighted magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma. World J Gastroenterol. 2010;16(25):3196–201.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tsai TH, Hsu JS, Lai ML, Liu GC, Shih MC, Chen CY. Added value of diffusion-weighted imaging to MR cholangiopancreatography for the diagnosis of bile duct dilatations. Abdom Radiol (NY). 2016;41(3):485–92.

    Article  Google Scholar 

  32. Park HJ, Kim SH, Jang KM, Choi SY, Lee SJ, Choi D. The role of diffusion-weighted MR imaging for differentiating benign from malignant bile duct strictures. Eur Radiol. 2014;24(4):947–58.

    Article  PubMed  Google Scholar 

  33. Choi KS, Lee JM, Joo I, Han JK, Choi BI. Evaluation of perihilar biliary strictures: does DWI provide additional value to conventional MRI? AJR Am J Roentgenol. 2015;205(4):789–96.

    Article  PubMed  Google Scholar 

  34. Lee NK, Kim S, Seo HI, Kim DU, Woo HY, Kim TU. Diffusion-weighted MR imaging for the differentiation of malignant from benign strictures in the periampullary region. Eur Radiol. 2013;23(5):1288–96.

    Article  PubMed  Google Scholar 

  35. Yoo RE, Lee JM, Yoon JH, Kim JH, Han JK, Choi BI. Differential diagnosis of benign and malignant distal biliary strictures: value of adding diffusion-weighted imaging to conventional magnetic resonance cholangiopancreatography. J Magn Reson Imaging. 2014;39(6):1509–17.

    Article  PubMed  Google Scholar 

  36. Sim KC, Park BJ, Han NY, Sung DJ, Kim MJ, Han YE. Efficacy of ZOOMit coronal diffusion-weighted imaging and MR texture analysis for differentiating between benign and malignant distal bile duct strictures. Abdom Radiol. 2020;45(14) https://doi.org/10.1007/s00261-020-02625-0.

  37. Park MJ, Kim YK, Lim S, Rhim H, Lee WJ. Hilar cholangiocarcinoma: value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation. Radiology. 2014;270(3):768–76.

    Article  PubMed  Google Scholar 

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Kartalis, N., Valls, C. (2021). Benign and Malignant Bile Duct Strictures. In: Matos, C., Papanikolaou, N. (eds) Diffusion Weighted Imaging of the Hepatobiliary System. Springer, Cham. https://doi.org/10.1007/978-3-319-62977-3_5

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  • DOI: https://doi.org/10.1007/978-3-319-62977-3_5

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  • Online ISBN: 978-3-319-62977-3

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