| MR cholangiopancreatography(MRCP) was undertaken for preoperative examination in 26 cases of hilar cholangiocarcinoma (HC) in this study. We analyzed the imaging findings of MRCP, and compared it with the results of pathology and the pattern of surgery. Our objectives were: 1. to summarize the imaging features of MRCP, and to evaluate its advantage and disadvantage in the diagnosis of HC; 2. toevaluate the accuracy of the classifications with MRCP and its role in the prediction of tumor resectability of HC. 3. to measure the length of proximal bile duct above the lesion, and observe the confluence of the hepatic hilar bile ducts. Finally we discussed its value in the judgment of the possiblility of the biliary-enteric anastomoses and the choice of the surgery management. This article is divided into two parts: 1.MRCP features of hilar cholangiocarcinoma.The imaging features of HC in 26 cases with surgical and pathologic confirmation were reported. Our discussion centered on the imaging features of MRCP, and the relation between the MRCP imaging features and the gross pathological appearances. In general the findings on MRCP could be classified as three types: obstruction, stenosis and filling defects. The gross pathological appearances of HC could be classified as four types. The imaging findings of MRCP were different among the four types: Polypoid type lesion appeared as filling defect on MRCP; tubercular type lesion occulted theduct on MRCP; most infiltrating type lesions showed a stenotic duct and only a few with the blocked duct; sclerosal type lesion either blocked or narrowed the duct. MRCP could confirm the level of bile duct obstruction with an accuracy of 96% in this article. The accordance of MRCP in assessing tumor involvement was 81%. But MRCP itself is unable to made a histological diagnosis. MRCP could determine the level of the obstruction and the involved extent of the proximal bile duct. MRCP could clearly show the degree of dilatation. These provided the guarantee to classification of HC with MRCP. 2. The role of MRCP in preoperative classification of hilar cholangiocarcinomas.Based on the Bismuth-Corlette classification of I~IV, we divided the 26 cases of hilar cholangiocarcinoma into four types: I, II, IIIa, IIIb, IV with MRCP and correlated with the results of surgery. Then we analyzed the excision rate of all types, and the reliability of MRCP in preoperative classification of hilar cholangiocarcinomas. We measured the length from the bile duct above the lesion to its main branchon MRCP and observed the confluence of the hepatic hilar bile ducts, finally compared it with the pattern of the biliary-enteric anastomoses and the management to the bile ducts in surgery. The accurate rate of the preoperative classification with MRCP was 96%. The excision rate was 82% in types I+II, 75% in type-IIIb, 67% in type IIL and zero in type IV. The excision rate of types I+II was insignificantly different from that of types IIIb and IIIa(P>0. 05). According to the results of our study, MRCP is an important method for evaluation of the possibility of tumor resectability. Trident choledochojejunostomy could be performed in the cases, in those the length from the bile duct above the lesion to its main bra'nch was at least 0. 5cm. The length from the bile duct above the lesion to its main branch was 0. 5~lcm in all cases of types I and II. Trident choledochojejunostomy was performed successfully. The excision rate of types I+II was high. Extensive hepatic resection was performed in all cases of type III. Besides the length of the bile duct, tumor resectability was also depended on the extent of involved liver. The extentof involved bile duct was so extensive that the bile ducts couldn't be anastomized with jejunum in all cases of type IV. Resection was impossible in such cases. MRCP was undertaken to depict the anatomy and variations of hepatic hilar bile ducts, which were identical to the findings in surgery. MRCP could clearly depict the anatomy and variations of hepatic hilar bi... |
