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Overview of Current Strategies for Diagnostic Imaging of Biliary Tract and Gallbladder Tumors

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Biliary Tract and Gallbladder Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Early diagnosis of biliary cancers would be important to improve their prognosis, and accurate staging would help to choose the best possible treatment. However, biliary cancers present specific diagnostic challenges. Imaging modalities, imaging-guided fine-needle aspiration, and endoscopic brush samples play a crucial role in the diagnostic work-up. However, there is no single modality capable of reliably detecting and accurately staging biliary cancers; hence, complementary modalities are usually needed. Transabdominal ultrasound (US) is often the first imaging modality applied to patients with jaundice or nonspecific gastrointestinal complaints. US visualizes bile duct obstruction accurately and is a suitable method for assessing even mild symptoms, and it is noninvasive, nonradiative, and commonly available. If a biliary malignancy is suspected, further investigations are usually performed after US. Magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) may yield additional information of the tumor and/or its extent. Fast-imaging techniques have made MRI potentially more valuable, and magnetic resonance cholangiography (MRC) is the least invasive mode of cholangiography, which is useful with MRI in the case of biliary obstruction. MDCT can produce multiplanar reconstructions of good quality but it has exposed patients to relatively high dose of radiation. In ambiguous cases, both MRI and MDCT may be needed. Direct cholangiography may provide the most accurate anatomic information of the bile ducts. It is also needed for therapeutic purposes in the case of bile duct obstruction. Further, positron emission tomography (PET), PET/CT, and endoscopic or intraductal US may help in the diagnostic work-up, when available.

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References

  1. Choi BI, Lee JM (2008) Neoplasms of the gallbladder and biliary tract. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology. Saunders Elsevier, Philadelphia, pp 1467–1487

    Chapter  Google Scholar 

  2. Oikarinen H (2006) Dignostic imaging of carcinomas of the gallbladder and the bile ducts. Acta Radiol 47:345–358. doi:10.1080/02841850600580317

    Google Scholar 

  3. In: Edge SB, Byrd DR, Compton CC (eds) (2010) AJCC cancer staging handbook, 7th edn. Springer, New York

    Google Scholar 

  4. Vogl TJ, Zangos S, Eichler K, Gruber-Rouh T, Hammerstingl RM, Trojan J et al (2012) Radiological diagnosis and intervention of cholangiocarcinomas (CC). Fortschr Röntgenstr 184:883–892

    Article  CAS  Google Scholar 

  5. Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) (2010) Tumours of the gallbladder and extrahepatic bile ducts. In: WHO classification of tumours of the digestive system. IARC, Lyon, pp 263–278

    Google Scholar 

  6. Choi H, Loyer EM, Charnsangavej C (2004) Neoplasms of the liver and the bile ducts. Semin Roentgenol 39:412–427

    Article  PubMed  Google Scholar 

  7. Miller G, Jarnagin WR (2008) Gallbladder carcinoma. Eur J Surg Oncol 34:306–312

    Article  PubMed  CAS  Google Scholar 

  8. Chamberlain RS, Blumgart LH (2000) Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol 7:55–66

    Article  PubMed  CAS  Google Scholar 

  9. Parodi A, Fisher D, Giovannini M, Baron T, Conio M (2012) Endoscopic management of hilar cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 9:105–112

    Article  PubMed  Google Scholar 

  10. Lee K-H, Lee DY, Kim KW (2004) Biliary intervention for cholangiocarcinoma. Abdom Imaging 29:581–589

    Article  PubMed  Google Scholar 

  11. Oikarinen H, Leinonen S, Karttunen A, Tikkakoski T, Hetemaa T, Mäkelä J et al (1999) Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction. J Vasc Interv Radiol 10:1387–1393

    Article  PubMed  CAS  Google Scholar 

  12. Bach AM, Loring LA, Hann LE, Illescas FF, Fong Y, Blumgart LH (1998) Gallbladder cancer: can ultrasonography evaluate extent of disease? J Ultrasound Med 17:303–309

    PubMed  CAS  Google Scholar 

  13. Yarmenitis SD (2002) Ultrasound of the gallbladder and the biliary tree. Eur Radiol 12:270–282

    Article  PubMed  CAS  Google Scholar 

  14. Oikarinen H, Päivänsalo M, Lähde S, Tikkakoski T, Suramo I (1993) Radiological findings in cases of gallbladder carcinoma. Eur J Radiol 17:179–183

    Article  PubMed  CAS  Google Scholar 

  15. Rooholamini SA, Tehrani NS, Razavi MK, Au AH, Hansen GC, Ostrzega N et al (1994) Imaging of gallbladder carcinoma. Radiographics 14:291–306

    Article  PubMed  CAS  Google Scholar 

  16. Levy AD, Murkata LA, Rohrmann CA (2001) Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics 21:295–314

    Article  PubMed  CAS  Google Scholar 

  17. Chijiiwa K, Sumiyoshi K, Nakayama F (1991) Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 15:322–327

    Article  PubMed  CAS  Google Scholar 

  18. Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323

    Article  PubMed  Google Scholar 

  19. Matsumoto J (1998) Endoscopic ultrasonography diagnosis of gallbladder lesions. Endoscopy 30(Suppl 1):A124–A127

    PubMed  Google Scholar 

  20. Meara RS, Jhala D, Eloubeidi MA, Eltoum I, Chhieng DC, Crowe DR et al (2006) Endoscopic ultrasound-guided FNA biosy of bile duct and gallbladder: analysis of 53 cases. Cytopathology 17:42–49

    Article  PubMed  CAS  Google Scholar 

  21. Inui K, Yoshino J, Miyoshi H (2011) Diagnosis of gallbladder tumors. Intern Med 50:1133–1136

    Article  PubMed  Google Scholar 

  22. Mishra G, Conway JD (2009) Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 11:150–154

    Article  PubMed  Google Scholar 

  23. Baron LR, Tublin ME, Peterson MS (2002) Imaging the spectrum of biliary tract disease. Radiol Clin North Am 40:1325–1354

    Article  PubMed  Google Scholar 

  24. Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. Am J Roentgenol 181:819–827

    Article  Google Scholar 

  25. Mittelstaedt CA (1997) Ultrasound of the bile ducts. Semin Roentgenol 32:161–171

    Article  PubMed  CAS  Google Scholar 

  26. Päivänsalo M, Oikarinen H, Tikkakoski T, Puumala K, Suramo I (1993) Radiological findings in bile duct carcinoma. Fortschr Röntgenstr 159:4–9

    Article  Google Scholar 

  27. Hann LE, Greatrex KV, Bach AM, Fong Y, Blumgart LH (1997) Cholangiocarcinoma at the hepatic hilus: sonographic findings. Am J Roentgenol 168:985–989

    Article  CAS  Google Scholar 

  28. Choi J-Y, Kim M-J, Lee JM, Kim KW, Lee JY, Han JK et al (2008) Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. Am J Roentgenol 191:1448–1457

    Article  Google Scholar 

  29. Takanami K, Yamada T, Tsuda M, Takase K, Ishida K, Nakamura Y et al (2011) Intraductal papillary mucinous neoplasm of the bile ducts: multimodality assessment with pathologic correlation. Abdom Imaging 36:447–456

    Article  PubMed  Google Scholar 

  30. Dietrich CF (2004) Characterisation of focal liver lesions with contrast enhanced ultrasonography. Eur J Radiol 51:S9–S17

    Article  PubMed  Google Scholar 

  31. Khalili K, Metser U, Wilson SR (2003) Hilar biliary obstruction: preliminary results with Levovist-enhanced sonography. Am J Roentgenol 180:687–693

    Article  Google Scholar 

  32. Inui K, Miyoshi H (2005) Cholangiocarcinoma and intraductal sonography. Gastrointest Endosc Clin North Am 15:143–155

    Article  Google Scholar 

  33. Levy MJ, Heimbach JK, Gores GJ (2012) Endoscopic ultrasound staging of cholangiocarcinoma. Curr Opin Gastroenterol 28:244–252

    Article  PubMed  Google Scholar 

  34. Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Koshita S et al (2009) Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases. Best Pract Res Clin Gastroenterol 23:729–742

    Article  PubMed  Google Scholar 

  35. Buck JL, Elsayed AM (1993) From the archives of the AFIP. Ampullary tumors: radiologic-pathologic correlation. Radiographics 13:193–212

    Article  PubMed  CAS  Google Scholar 

  36. Zech CJ, Schoenberg SO, Reiser M, Helmberger T (2004) Cross- sectional imaging of biliary tumors: current clinical status and future developments. Eur Radiol 14:1174–1187

    Article  PubMed  Google Scholar 

  37. Ohtani T, Shirai Y, Tsukada K, Muto T, Hatakeyama K (1996) Spread of gallbladder carcinoma: CT evaluation with pathologic correlation. Abdom Imaging 21:195–201

    Article  PubMed  CAS  Google Scholar 

  38. Yoshimitsu K, Honda H, Shinozaki K, Aibe H, Kuroiwa T, Irie H et al (2002) Helical CT of the local spread of carcinoma of the gallbladder: evaluation according to the TNM system in patients who underwent surgical resection. Am J Roentgenol 179:423–428

    Article  Google Scholar 

  39. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA (2008) Gallbladder carcinoma update: multimodality imaging evaluation, staging, and treatment options. Am J Roentgenol 191:1440–1447

    Article  Google Scholar 

  40. Kim SJ, Lee JM, Lee JY, Choi JY, Kim SH, Han JK et al (2008) Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. Am J Roentgenol 190:74–80

    Article  Google Scholar 

  41. Feydy A, Vilgrain V, Denys A, Sibert A, Belghiti J, Vullierme M-P et al (1999) Helical CT assessment in hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Am J Roentgenol 172:73–77

    Article  CAS  Google Scholar 

  42. Choi BI, Lee JM, Han JK (2004) Imaging of intrahepatic and hilar cholangiocarcinoma. Abdom Imaging 29:548–557

    PubMed  CAS  Google Scholar 

  43. Han JK, Lee JM (2004) Intrahepatic intraductal cholangiocarcinoma. Abdom Imaging 29:558–564

    Article  PubMed  CAS  Google Scholar 

  44. Lim JH, Lee WJ, Takehara Y, Lim HK (2004) Imaging of extrahepatic cholangiocarcinoma. Abdom Imaging 29:565–571

    PubMed  CAS  Google Scholar 

  45. Tillich M, Mischinger H-J, Preisegger K-H, Rabl H, Szolar DH (1998) Multiphasic helical CT in diagnosis and staging of hilar cholangiocarcinoma. Am J Roentgenol 171:651–658

    Article  CAS  Google Scholar 

  46. Chung YE, Kim M-J, Park YN, Choi J-Y, Pyo JY, Kim YC et al (2009) Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29:683–700

    Article  PubMed  Google Scholar 

  47. Kalra N, Suri S, Gupta R, Natarajan SK, Khandelwal N, Wig JD et al (2006) MDCT in the staging of gallbladder carcinoma. Am J Roentgenol 186:758–762

    Article  Google Scholar 

  48. Kumaran V, Gulati S, Paul B, Pande K, Sahni P, Chattopadhyay K (2002) The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder. Eur Radiol 12:1993–1999

    Article  PubMed  Google Scholar 

  49. Kim HJ, Lee DH, Lim JW, Ko YT (2009) Multidetector computed tomography in the preoperative workup of hilar cholangiocarcinoma. Acta Radiol 50:845–853

    Article  PubMed  Google Scholar 

  50. Park M-S, Lee DK, Kim M-J, Lee WJ, Yoon D-S, Lee SJ et al (2006) Preoperative staging accuracy of multidetector row computed tomography for extrahepatic bile duct carcinoma. J Comp Ass Tomogr 30:362–367

    Article  Google Scholar 

  51. Chen HW, Pan AZ, Zhen ZJ, Su SY, Wang JH, Yu SCH et al (2006) Preoperative evaluation of resectability of Klatskin tumor with 16-MDCT angiography and cholangiography. Am J Roentgenol 186:1580–1586

    Article  CAS  Google Scholar 

  52. Lee HY, Kim SH, Lee JM, Kim S-W, Jang J-Y, Han JK et al (2006) Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology 239:113–121

    Article  PubMed  Google Scholar 

  53. Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ (1999) A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol 54:513–520

    Article  PubMed  CAS  Google Scholar 

  54. Holzknecht N, Gauger J, Sackmann M, Thoeni RF, Schurig J, Holl J et al (1998) Breath-hold MR cholangiography with snapshot techniques: prospective comparison with endoscopic retrograde cholangiography. Radiology 206:657–664

    PubMed  CAS  Google Scholar 

  55. Vogl TJ, Schwarz WO, Heller M, Herzog C, Zangos S, Hintze RE et al (2006) Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol 16:2317–2325

    Article  PubMed  Google Scholar 

  56. Sagoh T, Itoh K, Togashi K, Shibata T, Minami S, Noma S et al (1990) Gallbladder carcinoma: evaluation with MR imaging. Radiology 174:131–136

    PubMed  CAS  Google Scholar 

  57. Tseng JH, Wan YL, Hung CF, Ng KK, Pan KT, Chou AS et al (2002) Diagnosis and staging of gallbladder carcinoma. Evaluation with dynamic MR imaging. Clin Imaging 26:177–182

    Article  PubMed  Google Scholar 

  58. Yoshimitsu K, Honda H, Kaneko K, Kuroiwa T, Irie H, Ueki T et al (1997) Dynamic MRI of the gallbladder lesions: differentiation of benign from malignant. J Magn Reson Im 7:696–701

    Article  CAS  Google Scholar 

  59. Hänninen EL, Pech M, Jonas S, Ricke J, Thelen A, Langrehr J et al (2005) Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions. Acta Radiol 46:462–470

    Article  PubMed  Google Scholar 

  60. Park M-S, Kim TK, Kim KW, Park SW, Lee JK, Kim J-S et al (2004) Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 233:234–240

    Article  PubMed  Google Scholar 

  61. Takehara Y (2004) Preoperative assessment of extrahepatic cholangiocarcinoma with imaging. Abdom Imaging 29:572–580

    Article  PubMed  CAS  Google Scholar 

  62. Kim JY, Lee JM, Han JK, Kim SH, Lee JY, Choi JY et al (2007) 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 26:304–312

    Article  PubMed  Google Scholar 

  63. Li N, Liu C, Bi W, Lin X, Jiao H, Zhao P (2012) MRCP and 3D LAVA imaging of extrahepatic cholangiocarcinoma at 3 T MRI. Clin Radiol 67:579–586

    Article  PubMed  CAS  Google Scholar 

  64. Semelka RC, Kelekis NL, John G, Ascher SM, Burdeny D, Siegelman ES (1997) Ampullary carcinoma: demonstration by current MR techniques. J Magn Reson Imaging 7:153–156

    Article  PubMed  CAS  Google Scholar 

  65. Kaza RK, Gulati M, Wig JD, Chawla YK (2006) Evaluation of gallbladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography. Australas Radiol 50:212–217

    Article  PubMed  CAS  Google Scholar 

  66. Rodriguez-Fernandez A, Gomez-Rio M, Medina-Benitez A, Villar-Del Moral J, Ramos-Font C, Ramia-Angel JM et al (2006) Application of modern imaging methods in diagnosis of gallbladder cancer. J Surg Oncol 93:650–664

    Article  PubMed  Google Scholar 

  67. Schwartz LH, Black J, Fong Y, Jarnagin W, Blumgart L, Gruen D et al (2002) Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography. J Comp Ass Tomogr 26:405–410

    Article  Google Scholar 

  68. Park HS, Lee JM, Choi J-Y, Lee MW, Kim HJ, Han JK et al (2008) Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. Am J Roentgenol 190:396–405

    Article  Google Scholar 

  69. Misra S, Chaturvedi A, Misra NC, Sharma ID (2003) Carcinoma of the gallbladder. Lancet Oncol 4:167–176

    Article  PubMed  Google Scholar 

  70. Brugge WR (2005) Endoscopic techniques to diagnose and manage biliary tumors. J Clin Oncol 23:4561–4565

    Article  PubMed  Google Scholar 

  71. Geier A, Nguyen HN, Gartung C, Matern S (2000) MRCP and ERCP to detect small ampullary carcinoma. Lancet 356:1607–1608

    Article  PubMed  CAS  Google Scholar 

  72. Petrowsky H, Wildbrett P, Husarik DB, Hany TF, Tam S, Jochum W et al (2006) Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol 45:43–50

    Article  PubMed  Google Scholar 

  73. Rosenbaum SJ, Stergar H, Antoch G, Veit P, Bockisch A, Kuhl H (2006) Staging and follow-up of gastrointestinal tumors with PET/CT. Abdom Imaging 31:25–35

    Article  PubMed  CAS  Google Scholar 

  74. Chung YE, Kim M-J, Park YN, Lee Y-H, Choi J-Y (2008) Staging of extrahepatic cholangiocarcinoma. Eur Radiol 18:2182–2195

    Article  PubMed  Google Scholar 

  75. Sacks A, Peller PJ, Surasi DS, Chatburn L, Mercier G, Subramaniam RM (2011) Value of PET/CT in the management of primary hepatobiliary tumors, part 2. Am J Roentgenol 197:W260–W265

    Article  Google Scholar 

  76. Lee SW, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI et al (2010) Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol 45:560–566

    Article  PubMed  Google Scholar 

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Acknowledgments

The author expresses sincere gratitude to Dr. Eija Pääkkö, MD, PhD, for useful comments of the manuscript.

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  1. Department of Diagnostic Radiology, Oulu University Hospital (OYS), POB 50, FI-90029, Oulu, Finland

    Heljä Oikarinen

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  1. Heljä Oikarinen
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Correspondence to Heljä Oikarinen .

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Editors and Affiliations

  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA

    Joseph M. Herman

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Timothy M. Pawlik

  3. Department of Radiation Oncology, Oregon Health and Science University, Portland, Oregon, USA

    Charles R. Thomas, Jr.

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Oikarinen, H. (2014). Overview of Current Strategies for Diagnostic Imaging of Biliary Tract and Gallbladder Tumors. In: Herman, J., Pawlik, T., Thomas, Jr., C. (eds) Biliary Tract and Gallbladder Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40558-7_8

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  • DOI: https://doi.org/10.1007/978-3-642-40558-7_8

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