Preoperative Evaluation of Hilar Cholangiocarcinoma with Contrast-enhanced Three-dimensional Fast Imaging with Steady-state Precession Magnetic Resonance Angiography: Comparison with Intraarterial Digital Subtraction Angiography

Abstract

We sought to evaluate the image quality of double-dose, contrast-enhanced 3D fast imaging with steady-state precession (FISP) magnetic resonance (MR) angiography in patients with hilar cholangiocarcinoma, and to compare its efficacy with intraarterial digital subtraction angiography (DSA). Thirty-six patients were studied to determine the visibility of the hepatic artery and portal vein with contrast-enhanced MR angiography. Determination of hepatic arterial and/or portal invasion from cholangiocarcinoma was compared between MR angiography and DSA as well. 0.2 mmol/kg gadolinium chelates were administrated at a rate of 4ml/s. The hepatic artery was diagnostically visible in 28 patients (78%); the portal vein, in 34 patients (94%). The sensitivities, specificities, and accuracies in distinguishing arterial invasion, were 58%, 93%, and 89%, respectively, with MR angiography; 75%, 99%, and 96%, respectively, with DSA. In distinguishing portal venous invasion, these were 78%, 91%, and 89%, respectively, with MR angiography; 78%, 92%, and 90%, respectively, with DSA. There were no significant differences between imaging methods (p > .05); however, DSA was superior in specificity regarding hepatic arterial invasion (p = .0143). The data presented here indicate that noninvasive contrast-enhanced 3D FISP MR angiography has the potential to replace DSA in the preoperative evaluation of hilar cholangiocarcinoma.