The Study Of Diagnosis And Preoperative Resectability Assessment For Hilar Cholangiocarcinoma: MSCT Versus MRI

With the development of multi-slice spiral CT (MSCT) and magnetic resonance imaging (MRI), the accuracy of diagnosis and resectability assessment of hilar cholangiocarcinoma has been greatly improved. The purposes of this study was to evaluate MSCT and MRI in the diagnosis, differential diagnosis, classification, and respectability assessment of hilar cholangiocarcinoma. The study included three Parts. Part I was to assess the evaluation of MSCT in the diagnosis and differential diagnosis of hilar cholangiocarcinoma. Part II was to study classification and resectability of hilar cholangiocarcinoma: MRI with MRCP. Part III To investigate the value of MSCT and MRI in evaluating the resectability of hilar cholangiocarcinoma, and to compare of the two methods.Part I Value of MSCT in the Diagnosis and Differential Diagnosis of Hilar CholangiocarcinomaObjective To study the value of MSCT in the diagnosis and differential diagnosis of hilar cholangiocarcinoma.Methods 36 patients with surgically and histopathologically proved hilar cholangiocarcinomas who underwent preoperative MSCT were included for study. Images of MSCT were reviewed to observe the lesions and other signs of hilar cholangiocarcinoma. The findings were compared with surgical and histopathological outcomes.Results The accuracy of MSCT reached 91.7%(33/36) in the diagnosis of hilar cholangiocarcinoma. The size, location and enhancement pattern of the tumors had certain characteristics that were helpful in the diagnosis and differential diagnosis of hilar cholangiocarcinoma. MSCT could also manifest lesions of lymph nodes and metastases of other organs. Besides, MSCT was able to show such signs as the dilation of intrahepatic ducts and the changes of the liver and the gallbladder, which provided a much more comprehensive evaluation of hilar cholangiocarcinoma.Conclusion MSCT serves an ideal and non-invasive tool in the diagnosis and differential diagnosis of hilar cholangiocarcinoma and provides references for clinical treatment planning.Part II The Study of Classification and Resectability for Hilar Cholangiocarcinoma: MRI with MRCPObjective To study the value of classification and resectability of hilar cholangiocarcinoma with MRI and MRCP.Methods 32 patients with surgery and histopathology proved hilar cholangiocarcinoma, who underwent preoperative MRI and MRCP examinations and were diagnosed as that correctly, were included in the study. The transverse images, coronal images of MRI and 2D, 3D MRCP images were reviewed to analyze Bismuth-Corlette classification and morphological classification of hilar cholangiocarcinoma. Then MRI and MRCP classifications were compared with the findings in surgery and histopathology. The evaluations for the resectability of hilar cholangiocarcinoma form MRI with MRCP and the findings in surgery and histopathology were analyzed with chi-square tests.Results In the 32 cases,the number of TypeⅠ,Ⅱ,Ⅲa,Ⅲb andⅣpatients , according to Bismuth-Corlette classification, were 4, 5, 4, 10 and 9 respectively. 16 patients underwent curative resections, among them, 4, 4, 1, 6 and 1 patient belonged to TypeⅠ,Ⅱ,Ⅲa,Ⅲb andⅣrespectively. The proportions of TypeⅠ,Ⅱ,ⅢandⅣof Bismuth-Corlette classification in curative and non-curative resection groups were 25%, 25%, 44%, 6% and 0%, 6%, 44%, 50%. The accuracy of MRI with MRCP in Bismuth-Corlette classification reached 87.5%(28/32). The proportions of periductal infiltrating, mass forming and intraductal growing type in curative and non-curative resection groups were 37%, 50%, 13% and 81%, 13%, 6%. The accuracy of MRI with MRCP in morphological classification was 100% (32/32) in this study group. There was no significant difference between MRI with MRCP and the findings in surgery and histopathology in evaluating the curative respectability of hilar cholangiocarcinoma (χ~2=0.50,P>0.05).Conclusion MRI with MRCP can make accurate assessments about Bismuth-Corlette classification and morphological classification, which is helpful in preoperative diagnosis of hilar cholangiocarcinoma.Part III The Evaluation of Resectability of Hilar Cholangiocarcinoma: MSCT versus MRIObjective To investigate the value of MSCT and MR imaging in evaluating the resectability of hilar cholangiocarcinoma, and to compare of the two methods. Methods 25 patients with surgery and histopathology proved hilar cholangiocarcinoma, who underwent preoperative MSCT and MRI examinations and were diagnosed as that correctly, were included in the study. The transverse images, reformatted MPR and CPR images of MSCT as well as the transverse images, coronal images and the MRCP images from MRI were reviewed for Bismuth-Corlette classification of hilar cholangiocarcinoma. MSCT and MRI classifications were compared with each other and the results were compared with the findings in surgery and histopathology. The Bismuth-Corlette classifications from MSCT and MRI and their evaluations for the resectability of different types were analyzed with chi-square tests.Results In the 25 cases,the number of TypeⅠ,Ⅱ,Ⅲa,Ⅲb andⅣpatients , according to Bismuth-Corlette classification, were 2, 4, 3, 9 and 7 respectively. 12 patients underwent curative resections,among them, 2, 3, 1, 5 and 1 patient belonged to TypeⅠ,Ⅱ,Ⅲa,Ⅲb andⅣrespectively. The accuracy of MSCT in Bismuth-Corlette classification was 84% (21/25), and MRI 88% (22/25), there was no significant difference between MSCT and MRI in evaluating Bismuth-Corlette classification of hilar cholangiocarcinoma(χ~2=0.00,P>0.05). The accuracy of MSCT and MRI in evaluating the curative respectability of hilar cholangiocarcinoma preoperatively were both 80%(20/25). There was no significant difference between them(χ~2=0.50,P>0.05).Conclusion MSCT and MRI both can make accurate diagnosis of Bismuth-Corlette classification and both are helpful in assessment of hilar cholangiocarcinoma preoperative respectability.