Type:
Educational Exhibit
Keywords:
Biliary Tract / Gallbladder, Liver, CT, Ultrasound, Fluoroscopy, Ablation procedures, Chemoembolisation, Stents, Neoplasia, Cancer
Authors:
J. Yeh1, T. Yong1, S. Leong2, D. Burrows1, H. K. Kok1; 1VIC/AU, 2Singapore/SG
DOI:
10.26044/ranzcr2019/R-0045
Background
The incidence of hepatobiliary and pancreatic (HBP) malignancies (hepatocellular carcinoma, cholangiocarcinoma, pancreatic adenocarcinoma, neuroendocrine tumours and hepatic metastasis) is steadily increasing worldwide, in part due to the improvements in imaging techniques and availability, as well as an aging population(1). Primary HBP malignancies are often diagnosed at an advanced stage when curative surgical options are limited. However, recent years has seen a shift towards earlier diagnoses through timely investigation of incidental imaging findings in conjunction with minimally invasive therapies which can be curative or palliative in select patient groups(2). For patients with hepatic metastases, symptoms such as obstructive jaundice and cholangitis often profoundly impact quality of life which necessitates palliative intervention. Common presentations associated with HBP malignancies include abdominal pain, obstructive jaundice, pruritis and labile blood glucose levels(3). Catastrophic haemorrhage can occur from tumour rupture or secondary to liver failure whilst biliary obstruction may predispose to sepsis.
Concurrently, there has been rapid progress in the field of Interventional Oncology (IO) which now forms one of the four pillars of cancer care in addition to the fields of medical, surgical and radiation oncology(4). Both imaging and minimally invasive procedures have become integral components in not only the diagnosis, but also therapeutic and palliative approaches to management(5).
This article aims to provide a comprehensive review of the spectrum of common IO procedures across four major areas of practice – diagnosis, therapy, palliation and complication management (Table 1). Relevant pre and post-treatment imaging examples will highlight imaging pearls and pitfalls of these procedures to the clinician and Radiologist. We will also summarize the contemporary evidence-base supporting the use of current image-guided therapies.