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MDCT assessment of resectability in hilar cholangiocarcinoma

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Abstract

Purpose

The purpose of this study is to investigate the value of multidetector computed tomography (MDCT) assessment of resectability in hilar cholangiocarcinoma, and to identify the factors associated with unresectability and accurate evaluation of resectability.

Methods

From January 2007 to June 2015, a total of 77 consecutive patients were included. All patients had preoperative MDCT (with MPR and MinIP) and surgical treatment, and were pathologically proven with hilar cholangiocarcinoma. The MDCT images were reviewed retrospectively by two senior radiologists and one hepatobiliary surgeon. The surgical findings and pathologic results were considered to be the gold standard. The Chi square test was used to identify factors associated with unresectability and accurate evaluation of resectability.

Results

The sensitivity, specificity, and overall accuracy of MDCT assessment were 83.3 %, 75.9 %, and 80.5 %, respectively. The main causes of inaccuracy were incorrect evaluation of N2 lymph node metastasis (4/15) and distant metastasis (4/15). Bismuth type IV tumor, main or bilateral hepatic artery involvement, and main or bilateral portal vein involvement were highly associated with unresectability (P < 0.001). Patients without biliary drainage had higher accuracy of MDCT evaluation of resectability compared to those with biliary drainage (P < 0.001).

Conclusion

MDCT is reliable for preoperative assessment of resectability in hilar cholangiocarcinoma. Bismuth type IV tumor and main or bilateral vascular involvement highly suggest the unresectability of hilar cholangiocarcinoma. Patients without biliary drainage have a more accurate MDCT evaluation of resectability. We suggest MDCT should be performed before biliary drainage to achieve an accurate evaluation of resectability in hilar cholangiocarcinoma.

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Acknowledgments

Dr. Haolu Wang acknowledges Shanghai Young Teachers’ Development Program (ZZjdyx12070). The authors thank Dr. Guozhen Zhang, the former radiologist-in-chief in the Department of Radiology at Huadong Hospital, Shanghai, China, for his long-term support and consideration.

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Authors and Affiliations

  1. Department of Biliary-pancreatic Surgery, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China

    Qihong Ni, Haolu Wang, Yunhe Zhang, Tao Chen & Jian Wang

  2. Therapeutics Research Centre, School of Medicine, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Brisbane, QLD 4102, Australia

    Haolu Wang & Xiaowen Liang

  3. Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China

    Lijun Qian & Jiachang Chi

Authors
  1. Qihong Ni
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  2. Haolu Wang
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  3. Yunhe Zhang
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  4. Lijun Qian
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  5. Jiachang Chi
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  6. Xiaowen Liang
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  7. Tao Chen
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  8. Jian Wang
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Correspondence to Jian Wang.

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Funding

This work was supported by grants from National Key Technology R&D Program (2012BAI06B01), Shanghai Science and Technology Commission (10411955400 and 12XD1403400) and Shanghai Bureau of the Health (XBR2011035).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived by the ethics committee of the institutional review board.

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Ni, Q., Wang, H., Zhang, Y. et al. MDCT assessment of resectability in hilar cholangiocarcinoma. Abdom Radiol 42, 851–860 (2017). https://doi.org/10.1007/s00261-016-0943-0

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  • DOI: https://doi.org/10.1007/s00261-016-0943-0

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