Imaging and staging of perihilar cholangiocarcinoma

Congress:

ECR 2019

Poster Number:

C-2884

Type:

Educational Exhibit

Keywords:

Neoplasia, Image verification, Image registration, Staging, Diagnostic procedure, MR-Cholangiography, MR, CT, Liver, Gastrointestinal tract, Abdomen

Authors:

S. B. Tsvetkova-Trichkova, K. Doykova, E. Vasilska, A. Georgiev, D. C. Psomas, A. Vasilska, R. Pachova; Plovdiv/BG

DOI:

10.26044/ecr2019/C-2884

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2884

Fig. 1: Drawings illustrate the Bismuth-Corlette classification of perihilar...

Fig. 2: Abdominal US demonstrating biliary dilatation. No tumor mass is visible.

Fig. 3: MDCT of a 76-year-old female showing a tumor mass 15 mm in the lumen of the...

Fig. 4

Fig. 5: Fig.4 and Fig.5 - A 49 year old female. Bismuth-Corlette type 4 tumor....

Fig. 6

Fig. 7: Fig.6 and Fig.7 - MR and MRCP of 51-year-old female showing dilated biliary...

Fig. 8

Fig. 9

Fig. 10: Fig.8, Fig.9 and Fig.10: MDCT, MR and MRCP in 72 years-old female. Type 1...

Fig. 11: 56 year old female. Type IV perihilar cholangiocarcinoma.Ascites. Solitary...

Learning objectives

Review the state-of-the-art imaging workup of patients with perihilar cholangiocarcinoma Discuss differential diagnosis, pretherapeutic staging and assessment of resectability Propose optimized imaging protocols and reading template

Background

Cholangiocarcinoma is the most common primary tumor of the biliary system, arising from the bile ducts epithelium. It has been divided into intrahepatic, perihilar and distant types, with perihilar or Klatskin tumors being most common - 40-60% of all cases /1/. The main histopathologic type is adenocarcinoma (95% of cases) /2/. Its peak prevalence is during the 7th decade of life, male patients with a slight predilection /2/. Main risk factors include primary sclerosing cholangitis (PSC), hepatolithiasis, choledocal cyst, bile stasis. Some genetic factors are...

Findings and procedure details

Imaging workup Abdominal ultrasonography It can be used as initial modality. Biliary dilatation is easily detected, while intraductal lesions, small tumor masses and wall thickeninig is more difficult to detect and usually are discovered in more advanced cases. Propper assessment of tumor spread and respectability is also relatively unreliable. The accuracy of US depends also on the equipment quality and operator’s experience (fig.2) /7,8/. Multidetector CT The technique is widely available, noninvasive, quick and relatively easy to perform. It can depict the level and cause...

Conclusion

Imaging methods play an important role for the diagnosis, differential diagnosis, staging, treatment planning and followup of perihilar cholangiocarcinoma.

Personal information

1. S.B.Tsvetkova - Trichkova -Assoc. Prof. Medical University Plovdiv e-mail: [email protected] 2. K. Doykova - Medical University Plovdiv, University hospital" Kaspela"-Plovdiv 3. E. Vasilska - Medical Diagnostic Laboratory"Mediscan" Plovdiv 4. A. Georgiev - Medical University Plovdiv, MBAL"Unihospital" -Panagyurishte 5. D.C. Psomas -Medical University Plovdiv, University hospital" Eurohospital"- Plovdiv 6. A. Vasilska - Medical University Plovdiv 7. R. Pachova - Medical Diagnostic Laboratory"Mediscan" Plovdiv

References

1. Mangal S. Mahajan, Srikanth Moorthy, Sreekumar P., Karumathil, R. Rajeshkannan, Ramchandran Pothera. Hilar cholangiocarcinoma: Cross sectional evaluation of disease spectrum. Indian journal of radiology and imaging,2015,25;2;184-192. 2. Bloom CM, Langer B, Wilson SR. Role of US in the detection, characterization and staging of cholangiocarcinoma. RadioGraphics 1999;19:1199-1218. 3. Levi S, Urbano-Ispizua A, Gill R, et.al. Multiple K-ras codon 12 mutations in cholangiocarcinomas demonstrated with a sensitive polymerase chain reaction technique. Cancer Res 1991;51:3497-3502. 4. Liver Cancer Study group of Japan. The general rules for the...