| OBJECTIVE: The objective of this paper is to evaluate the diagnostic value of(MRI)Magnetic resonance imaging,(MRCP)Magnetic resonance cholangiopancreatography,Percutaneous Transhepatic Cholangial Drainage and Biopsy(PTCD,Biopsy)and Digital subtraction angiography(DSA)as a comparative study in diagnosing Hilar cholangiocarcinoma,to assess the sensitivity of each modality separately and in combination.BACKGROUND: Hilar cholangiocarcinoma(hCC)is a tumor of malignant nature that can be localized in the left and right hepatic ducts,the common hepatic duct and its confluence,its special anatomical location,adjacent relationship and its peculiar characteristics of infiltration to the adjacent tissues and metastasis result in making it difficult to diagnose and hence usually is late in presentation and the mortality rate associated with it as well broad improvement in the therapeutic interventions that can limit the disease if found early presents a biggest challenge in getting the final diagnosis,such is the importance of correlating the imaging modalities in early assessing and management.Method: This observational retrospective study describes the prospective series of outcomes in diagnosis of hilar cholangiocarcinoma by MRI/MRCP,PTCD,DSA,who underwent the above diagnostic procedures for obstructive jaundice in the First Affiliated Hospital of Zhengzhou university during January 1,2018 to December 31,2018.Result: 57 patients with suspected Hilar cholangiocarcinoma of the biliary tract who underwent MRI and heavily T2-weighted and MRCP of 57 cases 31 cases were taken of which male patients(21),female patients(10)with mean age(63.16 ± 8.46 years)were taken in to account of which Clinical and histopathological correlation confirmed Klatskin tumors 23 cases has shown high signal in the t2 weighted image and MRCP shown the stricture or stenotic part at the hilum,.MRI showed hyperintense signal in the infiltrated bile ducts in T2-weighted sequences.The malignant lesion seen as a hypointense area in T1-weighted gradient-echo sequences with slight contrast enhancement along the involved bile duct walls.MRC revealed the location and extension of the tumor in 23 of 31 cases correctly giving a sensitivity of 85%,specificity of 87%,positive predictive value of 85%,diagnostic accuracy of 85%.Forty patients underwent DSA/PTC among which 27 cases with male(18)and female(9)with mean age of(63.16 ± 8.46 years)were taken in whom 22 patients shown that the contrast cannot be passed through the confluence of bile ducts,stricture/stenosis at the area around hilum at porta hepatis and then forceps biopsy was acquired through the PTC and confirmed on histopathology to be klatskin tumors in 22 patients accurately of 27,giving a sensitivity of 85%,specificity of 93%,positive predictive value of 96% and yielding the diagnostic accuracy of 88%(more than MRCP).A serum marker of ca-19-9,was screened in all the patients and it shows the sensitivity of 91% and specificity of 87%.16 cases with male(10),female(6)were selected in whom MRI/MRCP,DSA/PTC,PTCD(biopsy)were done,among the 16 cases,10 cases were selected,and all the investigations gave the preliminary diagnosis of hilar cholangiocarcinoma,of whom 8 cases were confirmed to be Hilar cholangiocarcinoma on histopathological correlation,giving an overall sensitivity of 92%,positive predictive value of 91% and diagnostic accuracy of 93% was found.And p value of <0.05 was found giving the statistical significance.CONCLUSION: MRI/MRCP and DSA/PTCD are reliable techniques in evaluation of biliary complications,but DSA/PTC can give the details of very small lesions.PTC/DSA is more accurate in diagnosing of bile duct pathologies similar to MRCP,diagnostic accuracy is more compared to MRCP and allows tissue diagnosis through forceps biopsy and cytology studies.Thus,providing an upper edge.MRI/MRCP combined with DSA/PTC and BIOPSY and serum markers of CA19-9 and CA125 the overall accuracy of diagnosing the hilar cholangiocarcinoma increases. |
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