Abstract
The role of MR imaging in hilar cholangiocarcinoma is to confirm/reach a diagnosis and to assess resectability. Hilar cholangiocarcinoma shows the same signal intensity pattern of peripheral tumors both on T1- and T2-weighted images. On magnetic resonance cholangiopancreatography (MRCP) images, hilar cholangiocarcinoma appears as a moderately irregular thickening of the bile duct wall (5 mm) with symmetric upstream dilation of the intrahepatic bile ducts. The aim of preoperative investigation in Klatskin tumors typically requires the evaluation of the level of biliary obstruction, the intrahepatic tumor spread, and the vascular involvement; it also needs to show any atrophy–hypertrophy complex. Because of its intrinsic high tissue contrast and multiplanar capability, MR imaging and MRCP are able to detect and preoperatively assess patients with cholangiocarcinoma, investigating all involved structures such as bile ducts, vessels and hepatic parenchyma. The main reason for surgical/imaging discrepancy is represented by the microscopic diffusion along the mucosa and in the perineural space.
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References
Klatskin G (1965) Adenocarcinoma of the hepatic ducts at its bifurcation with the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–245
Alexander F, Rossi RL, O’Bryan M, et al. (1994) Biliary carcinoma: a review of 109 cases. Am J Surg 147:503–509
Launois B, Wemyss-Holden S, Maddern GJ (2002) Current and future trends in management and treatment of Klatskin tumour. Int J Clin Oncol 7:91–102
Gibson RN, Yeung E, Thompson JN, et al. (1986) Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability. Radiology 160:43–47
Guthrie JA, Ward J, Robinson PJ (1996) Hilar cholangiocarcinoma: T2-weighted spin-echo and gadolinium enhanced FLASH MR imaging. Radiology 201:347–351
Fulcher AS, Turner MA (1997) HASTE MR cholangiography in the evaluation of hilar cholangiocarcinoma. AJR Am J Roentgenol 169:1501–1505
Reinhold C, Bret P, Atri M, et al. (1996) MR cholangiopancreatography:potential clinical application. Radiographics 16:309–320
Adam A, Benjamin IS (1992) Review. The staging of cholangiocarcinoma. Clin Radiol 46:299–303
Vogl TJ, Schwarz WO, Heller M, et al. (2006) Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol 16(10):2317–25
American Joint Committee on Cancer (2005) AJCC cancer staging. New York: Springer, pp 1–150
Slattery JM, Sahani DV (2006) What is the current state of the art imaging for detection and staging of cholangiocarcinoma? Oncologist 11:913–922
Nakanuma Y, Minato H, Kida T, et al. (1994) Pathology of cholangiocarcinoma. In Primary liver Cancer in Japan. Tokyo, Japan: Springer, pp 39–50
Bhuiya MR, Nimura Y, Kamiya J, et al. (1992) Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349
Lim JH, Park CK (2004) Pathology of cholangiocarcinoma. Abdom Imaging 29:540–547
Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 181:819–827
Malhi H, Gores GJ (2006) Review article: the modern diagnosis and therapy of cholangiocarcinoma. Aliment Pharmacol Ther 23:1287–1296
Choi BI, Lee JM, Han JK (2004) Imaging of intrahepatic and hilar cholangiocarcinoma 29:548–557
Looser C, Stain SC, Baer HU, Triller J, Blungart LH (1992) Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings. Br J Radiol 65:871–877
Tillich M, Mischinger HJ, Preisegger KH, Rabl H, Szolar DH (1998) Multiphasic Helical CT in Diagnosis and Staging of Hilar Cholangiocarcinoma. AJR Am J Roentgenol 171:651–658
Wilkinson M (1996) The art of diagnostic imaging: the biliary tree. J Hepatol 25:5–19
Bilbao MK, Dotter CT, Lee TG, et al. (1976) Complications of endoscopic retrograde cholangiopancreatography (ERCP): a study of 10.000 cases. Gastroenterology 70:314–320
Zech JC, Schoenberg SO, Reiser M, Helmeberger (2004) Cross-sectional imaging of biliary tumors:current clinical status and future developments. Eur Radiol 14:1174–1187
Manfredi R, Barbaro B, Masselli G, Vecchioli A, Marano P (2004) Magnetic Resonance imaging of cholangiocarcinoma. Seminar Liv Dis 24:155–164
Manfredi R, Masselli G, Maresca G, et al. (2003) MR imaging and MRCP of hilar cholangiocarcinoma. Abdom Imaging 28:319–325
Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178
Lopera JE, Soto JA, Munera F (2001) Malignant hilar and perihilar biliary obstruction: use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions. Radiology 220:90–96
Zidi SH, Prat F, Le Guen L, Rondeua Y, Pelletier G (2000) Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures. Gut 46:103–106
Manfredi R, Brizi MG, Masselli G, et al. (2001) Malignant Biliary hilar stenosis. MR cholangiopancreatography compared with endoscopic retrograde cholangiography. Radiol Med 102:48–54
Otto G, Romaneehsen B, Bittinger F, et al. (2004) Preoperative imaging of hilar cholangiocarcinoma:surgical evaluation of standard practices. Z Gastroenterol. 42(1):9–14
Lee HY, Kim SH, Lee JM, et al. (2006) Preoperative assessment of respectability of hepatic hilar cholangiocarcinoma:combined CT and cholangiography with revised criteria. Radiology 239:113–121
Masselli G, Casciani E, Polettini E, et al. (2006) MR imaging and MRCP in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings[Abstract]. Radiol Suppl RSNA 2006:273
Mcfarland EG, Kaufman JA, Saini S, et al. (1996) Preoperative staging of cancer of the pancreas: value of MR angiography versus conventional angiography in detecting portal venous invasion. AJR Am J Roentgenol 166:37–43
Lee GM, Park KB, Shin YM, et al. (2003) Preoperative evaluation of hilar cholangiocarcinoma with contrast enhanced 3D Fast Imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography. World J Surg 7:278–283
Lygidakis NJ, Van der Henden MN, Houthoff HJ (1988) Surgical approaches to the management of primary biliary cholangiocarcinoma of the porta hepatis. The decision making dilemma. Hepatogastroenterology 35:261–267
Baer HU, Stain SC, Dennison MD, et al. (1992) Improvement in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 217:20–27
Rosai J (1996) Ackerman’s Surgical Pathology, 8th edn. St. Louis: Mosby 914–915, 960
Lygidakis NJ, Sgourakis GJ, Dedemadi GV, Vlachos L, Safioleas M (2001) Long term results following resectional surgery for Klatskin tumors: a twenty-year personal experience. Hepatogastroenterology 48:95–101
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Masselli, G., Gualdi, G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging 33, 444–451 (2008). https://doi.org/10.1007/s00261-007-9281-6
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DOI: https://doi.org/10.1007/s00261-007-9281-6