MDCT assessment of resectability in hilar cholangiocarcinoma

Ni, Qihong, Wang, Haolu, Zhang, Yunhe, Qian, Lijun, Chi, Jiachang, Liang, Xiaowen, Chen, Tao and Wang, Jian (2016) MDCT assessment of resectability in hilar cholangiocarcinoma. Abdominal Radiology, 42 3: 1-10. doi:10.1007/s00261-016-0943-0


Author Ni, Qihong
Wang, Haolu
Zhang, Yunhe
Qian, Lijun
Chi, Jiachang
Liang, Xiaowen
Chen, Tao
Wang, Jian
Title MDCT assessment of resectability in hilar cholangiocarcinoma
Journal name Abdominal Radiology   Check publisher's open access policy
ISSN 2366-0058
2366-004X
Publication date 2016-10-21
Sub-type Article (original research)
DOI 10.1007/s00261-016-0943-0
Open Access Status Not yet assessed
Volume 42
Issue 3
Start page 1
End page 10
Total pages 10
Place of publication New York, NY, United States
Publisher Springer New York LLC
Language eng
Subject 3614 Radiological and Ultrasound Technology
2741 Radiology Nuclear Medicine and imaging
2715 Gastroenterology
2748 Urology
Abstract Purpose: The purpose of this study is to investigate the value of multidetector computed tomography (MDCT) assessment of resectability in hilar cholangiocarcinoma, and to identify the factors associated with unresectability and accurate evaluation of resectability. Methods: From January 2007 to June 2015, a total of 77 consecutive patients were included. All patients had preoperative MDCT (with MPR and MinIP) and surgical treatment, and were pathologically proven with hilar cholangiocarcinoma. The MDCT images were reviewed retrospectively by two senior radiologists and one hepatobiliary surgeon. The surgical findings and pathologic results were considered to be the gold standard. The Chi square test was used to identify factors associated with unresectability and accurate evaluation of resectability. Results: The sensitivity, specificity, and overall accuracy of MDCT assessment were 83.3 %, 75.9 %, and 80.5 %, respectively. The main causes of inaccuracy were incorrect evaluation of N2 lymph node metastasis (4/15) and distant metastasis (4/15). Bismuth type IV tumor, main or bilateral hepatic artery involvement, and main or bilateral portal vein involvement were highly associated with unresectability (P < 0.001). Patients without biliary drainage had higher accuracy of MDCT evaluation of resectability compared to those with biliary drainage (P < 0.001). Conclusion: MDCT is reliable for preoperative assessment of resectability in hilar cholangiocarcinoma. Bismuth type IV tumor and main or bilateral vascular involvement highly suggest the unresectability of hilar cholangiocarcinoma. Patients without biliary drainage have a more accurate MDCT evaluation of resectability. We suggest MDCT should be performed before biliary drainage to achieve an accurate evaluation of resectability in hilar cholangiocarcinoma.
Formatted abstract
Purpose: The purpose of this study is to investigate the value of multidetector computed tomography (MDCT) assessment of resectability in hilar cholangiocarcinoma, and to identify the factors associated with unresectability and accurate evaluation of resectability.

Methods: From January 2007 to June 2015, a total of 77 consecutive patients were included. All patients had preoperative MDCT (with MPR and MinIP) and surgical treatment, and were pathologically proven with hilar cholangiocarcinoma. The MDCT images were reviewed retrospectively by two senior radiologists and one hepatobiliary surgeon. The surgical findings and pathologic results were considered to be the gold standard. The Chi square test was used to identify factors associated with unresectability and accurate evaluation of resectability.

Results: The sensitivity, specificity, and overall accuracy of MDCT assessment were 83.3 %, 75.9 %, and 80.5 %, respectively. The main causes of inaccuracy were incorrect evaluation of N2 lymph node metastasis (4/15) and distant metastasis (4/15). Bismuth type IV tumor, main or bilateral hepatic artery involvement, and main or bilateral portal vein involvement were highly associated with unresectability (P < 0.001). Patients without biliary drainage had higher accuracy of MDCT evaluation of resectability compared to those with biliary drainage (P < 0.001).

Conclusion: MDCT is reliable for preoperative assessment of resectability in hilar cholangiocarcinoma. Bismuth type IV tumor and main or bilateral vascular involvement highly suggest the unresectability of hilar cholangiocarcinoma. Patients without biliary drainage have a more accurate MDCT evaluation of resectability. We suggest MDCT should be performed before biliary drainage to achieve an accurate evaluation of resectability in hilar cholangiocarcinoma.
Keyword Hilar cholangiocarcinoma
MDCT
Preoperative evaluation
Resectability
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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