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Hilar cholangiocarcinoma: radiological assessment of resectability

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  • Gastrointestinal radiology
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Abstract

A pre-operative study of 31 patients with proximal cholangiocarcinoma was carried out with ultrasonography (US), duplex sonography (DS), computed tomography (CT), percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiography (ERC) and angiography. US, DS and PTC are the most effective techniques for pre-operative staging assessment of proximal cholangiocarcinoma. A tumour was visualised by US in 89% of cases, and the extent of extraductal tumour invasion was correctly established in 64%. Lobar segmental tumour extension was correctly documented in 80% of cases; however, the exact definition of tumour extension required the use of PTC. Vascular patency was correctly visualised by DS in 85% of cases. Altogether, tumour invasion was correctly documented in 68% in cases. In the event of radiologically localised tumour extension, radiological interpretation was correct in 64% of cases. The extent of tumour infiltration was radiologically underestimated in 36% of cases, especially in documenting lymph node metastases, infiltration of the hepato-duodenal ligament and segmental liver invasion.

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References

  1. Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. Am J Med 38: 241–256

    Article  PubMed  Google Scholar 

  2. Altemeier WA, Gall EA, Zinninger MM, Hoxworth PJ (1957) Sclerosing carcinoma of the major intrahepatic ducts. Arch Surg 75: 450–460

    Google Scholar 

  3. Beazley RM, Blumgart LH (1985) Malignant stricture at the confluence of the biliary tree: diagnosis and management. Ann Surg 17: 125–150

    Google Scholar 

  4. Blumgart LH, Benjamin IS, Hadjis NS, Beazley R (1984) Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet IV: 66–70

    Google Scholar 

  5. Czerniak A, Blumgart LH (1988) Hilar cholangiocarcinoma. Aust N Z J Surg 59: 837–844

    Google Scholar 

  6. Benjamin IS, Blumgart LH (1988) Assessment of diagnostic techniques. In: Blumgart LH (ed) Surgery of the liver and biliary tract, Vol 1. Livingstone, London, p 337–347

    Google Scholar 

  7. Gibson RN, Yeung E, Thompson JN, et al (1986) Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability. Radiology 160: 43–47

    CAS  PubMed  Google Scholar 

  8. Nesbit GM, Johnson CD, James EM, McCarty RL, Nagorney DM, Bender CE (1988) Cholangiocarcinoma: diagnosis and evaluation of resectability by CT and sonography as procedures complementary to cholangiography. AJR 151: 933–938

    CAS  PubMed  Google Scholar 

  9. Voyles CR, Bowley NJ, Allison DJ, Benjamin IS, Blumgart LH (1983) Carcinoma of the proximal extrahepatic biliary tree: radiologic assessment and therapeutic alternatives. Ann Surg 197: 188–194

    Google Scholar 

  10. Looser CH, Stain STC, Baer HU, Triller J, Blumgart LH (1992) Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings. Br J Radiol 65: 871–877

    Google Scholar 

  11. Baer HU, Stain SC, Dennison AR, Egger B, Blumgart LH (1993) Improvements and survival by aggressive resection of hilar cholangiocarcinoma Ann Surg (in press)

  12. Yeung EYC, McCarthy P, Gompertz RH, Benjamin S, Gibson N, Dawson P (1988) The ultrasonographic appearances of hilar cholangiocarcinoma (Klatskin tumuors). Br J Radiol 61: 991–995

    Google Scholar 

  13. Choi BI, Lee JH, Han MC, Kim SH, Yi JG, Kim CW (1989) Hilar cholangiocarcinoma: comparative study with sonography and CT. Radiology 172: 689–692

    CAS  PubMed  Google Scholar 

  14. Carr DH, Hadjis NS, Banks LM, Hemingway AP, Blumgart LH (1985) Computed tomography of hilar cholangiocarcinoma: a new sign. AJR 145: 53–56

    Google Scholar 

  15. Karstrup S (1988) Ultrasound diagnosis of cholangiocarcinoma at the confluence of the hepatic ducts (Klatskin tumours). Br J Radiol 61: 987–990

    Google Scholar 

  16. Machan L, Müller NL, Cooperberg PL (1986) Sonographic diagnosis of Klatskin tumors. AJR 147: 509–512

    Google Scholar 

  17. Laing FC, Jeffrey RB Jr, Wing VW, Nyberg DA (1986) Biliary dilatation: defining the level and cause by real-time US. Radiology 160: 39–42

    Google Scholar 

  18. Takayasu K, Ikeya S, Mukai K, Muramatsu Y, Makuuchi M, Hasegawa H (1990) CT of hilar cholangiocarcinoma: late contrast enhancement in six patients. AJR 154: 1203–1206

    CAS  PubMed  Google Scholar 

  19. Schulte SJ, Baron RL, Teefey SA, Rohrmann CA Jr, Freeny PC, Shuman WP, Foster MA (1990) CT of the extrahepaic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts. AJR 154: 79–85

    CAS  PubMed  Google Scholar 

  20. Gulliver DJ, Baker ME, Cheng CA, Meyers WC, Pappas TN (1992) Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability. AJR 159: 503–507

    Google Scholar 

  21. Bargon GW, Goldman A (1992) Zur intravasalen Applikation von Kontrastmitteln in der computertomographischen Diagnostik. In: Peters PE, Zeitler E, Clauss W (eds) Qualitätssicherung bei der Anwendung von Kontrastmittel. Springer, Berlin Heidelberg New York, pp 62–70

    Google Scholar 

  22. Gibbons CP, Griffiths GJ, Cormack A (1983) The role of percutaneous transhepatic cholangiography and grey-scale ultrasound in the investigation and treatment of bile duct obstruction. Br J Surg 70: 494–496

    Google Scholar 

  23. Hadjis NS, Collier NA, Blumgart LH (1985) Malignant masquerade at the hilum of the liver. Br J Surg 72: 659–661

    Google Scholar 

  24. Williamson BWA, Blumgart LH, McKellar NJ (1980) Management of tumors of the liver: combined use of arteriography and venography in the assessment of resectability, especially in hilar tumors. Am J Surg 139: 210–215

    Google Scholar 

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Correspondence to: J. Triller

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Triller, J., Looser, C., Baer, H.U. et al. Hilar cholangiocarcinoma: radiological assessment of resectability. Eur. Radiol. 4, 9–17 (1994). https://doi.org/10.1007/BF00177380

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