Type:
Educational Exhibit
Keywords:
Abdomen, CT, Cholangiography, Neoplasia
Authors:
N. jurjevic1, L. Kavur2, L. Ištvanović2, F. Matijević2, V. Vidjak2; 1Rijeka/HR, 2Zagreb/HR
DOI:
10.26044/ecr2019/C-2594
Conclusion
The clinical presentation of cholangiocarcinoma (CCC) is non-specific and insufficient to establish a diagnosis.
Direct visualization of the bile duct with directed biopsy is ideal.28
The initial study is usually a contrast-enhanced magnetic resonance imaging (MRI) scan/magnetic resonance cholangiopancreatography (MRCP) or a multiphasic contrast-enhanced multidetector-row computed tomography (MDCT).
The staging evaluation starts with MDCT scanning of the abdomen and pelvis,
with or without MRCP,
precontrast and triphasic phase,
including late arterial phase,
hepatic venous phase,
and equilibrium phase scanning.
The typical morphological appearance is that of a hypodense hepatic mass in the unenhanced phase with irregular margins,
peripheral rim enhancement in the arterial phase,
and progressive hyperattenuation on venous and delayed phases.
If there is no evidence of distant metastatic disease,
extraregional lymph node involvement,
or invasion of critical adjacent structures,
we obtain a PET scan to look for occult metastases.
If the PET scan is normal and the patient is a good surgical candidate,
we proceed with laparoscopy.29