Cholangiocarcinoma other imaging findings: Difference between revisions
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==Percutaneous Transhepatic Cholangiography== | ==Percutaneous Transhepatic Cholangiography== | ||
As an alternative to ERCP, [[percutaneous transhepatic cholangiography]] (PTC) may be utilized. | As an alternative to ERCP, [[percutaneous transhepatic cholangiography]] (PTC) may be utilized. | ||
==Direct Cholangiography== | ==Direct Cholangiography== | ||
Direct cholangiography is a blanket term for any imaging obtained with intra-biliary tree contrast, and includes: | Direct cholangiography is a blanket term for any imaging obtained with intra-biliary tree contrast, and includes: | ||
| Line 25: | Line 24: | ||
MRCP | MRCP | ||
All these modalities not only allow evaluation of the the biliary tree, but are invaluable in planning treatment as assessing for resectability. | All these modalities not only allow evaluation of the the biliary tree, but are invaluable in planning treatment as assessing for resectability. | ||
==MRCP== | ==MRCP== | ||
[[Magnetic resonance cholangiopancreatography]] (MRCP) is a [[non-invasive]] alternative to ERCP.<ref>{{cite journal |author=Schwartz L, Coakley F, Sun Y, Blumgart L, Fong Y, Panicek D |title=Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography |journal=AJR Am J Roentgenol |volume=170 |issue=6 |pages=1491–5 |year=1998 |id=PMID 9609160}}</ref><ref>{{cite journal |author=Zidi S, Prat F, Le Guen O, Rondeau Y, Pelletier G |title=Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures |journal=Gut |volume=46 |issue=1 |pages=103-6 |year=2000 |id=PMID 10601064}}</ref><ref>{{cite journal |author=Lee M, Park K, Shin Y, Yoon H, Sung K, Kim M, Lee S, Kang E |title=Preoperative evaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography |journal=World J Surg |volume=27 |issue=3 |pages=278-83 |year=2003 |id=PMID 12607051}}</ref> Some authors have suggested that MRCP should supplant ERCP in the diagnosis of biliary cancers, as it may more accurately define the tumor and avoids the risks of ERCP.<ref>{{cite journal |author=Yeh T, Jan Y, Tseng J, Chiu C, Chen T, Hwang T, Chen M |title=Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings |journal=Am J Gastroenterol |volume=95 |issue=2 |pages=432-40 |year=2000 |id=PMID 10685746}}</ref><ref>{{cite journal |author=Freeman M, Sielaff T |title=A modern approach to malignant hilar biliary obstruction |journal=Rev Gastroenterol Disord |volume=3 |issue=4 |pages=187–201 |year=2003 |id=PMID 14668691}}</ref><ref>{{cite journal |author=Szklaruk J, Tamm E, Charnsangavej C |title=Preoperative imaging of biliary tract cancers |journal=Surg Oncol Clin N Am |volume=11 |issue=4 |pages=865-76 |year=2002 |id=PMID 12607576}}</ref> | [[Magnetic resonance cholangiopancreatography]] (MRCP) is a [[non-invasive]] alternative to ERCP.<ref>{{cite journal |author=Schwartz L, Coakley F, Sun Y, Blumgart L, Fong Y, Panicek D |title=Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography |journal=AJR Am J Roentgenol |volume=170 |issue=6 |pages=1491–5 |year=1998 |id=PMID 9609160}}</ref><ref>{{cite journal |author=Zidi S, Prat F, Le Guen O, Rondeau Y, Pelletier G |title=Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures |journal=Gut |volume=46 |issue=1 |pages=103-6 |year=2000 |id=PMID 10601064}}</ref><ref>{{cite journal |author=Lee M, Park K, Shin Y, Yoon H, Sung K, Kim M, Lee S, Kang E |title=Preoperative evaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography |journal=World J Surg |volume=27 |issue=3 |pages=278-83 |year=2003 |id=PMID 12607051}}</ref> Some authors have suggested that MRCP should supplant ERCP in the diagnosis of biliary cancers, as it may more accurately define the tumor and avoids the risks of ERCP.<ref>{{cite journal |author=Yeh T, Jan Y, Tseng J, Chiu C, Chen T, Hwang T, Chen M |title=Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings |journal=Am J Gastroenterol |volume=95 |issue=2 |pages=432-40 |year=2000 |id=PMID 10685746}}</ref><ref>{{cite journal |author=Freeman M, Sielaff T |title=A modern approach to malignant hilar biliary obstruction |journal=Rev Gastroenterol Disord |volume=3 |issue=4 |pages=187–201 |year=2003 |id=PMID 14668691}}</ref><ref>{{cite journal |author=Szklaruk J, Tamm E, Charnsangavej C |title=Preoperative imaging of biliary tract cancers |journal=Surg Oncol Clin N Am |volume=11 |issue=4 |pages=865-76 |year=2002 |id=PMID 12607576}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
ERCP
While abdominal imaging can be useful in the diagnosis of cholangiocarcinoma, direct imaging of the bile duct is often necessary. Endoscopic retrograde cholangiopancreatography (ERCP), an endoscopic procedure performed by a gastroenterologist or specially trained surgeon, has been widely used for this purpose. Although ERCP is an invasive procedure with attendant risks, its advantages include:
- Determine if there is a bile duct tumor and obtain a biopsy to look for cancer cells.
- Observe if cancer has spread from the bile ducts.
- Help plan surgery.
- Place a small tube (stent) into the bile duct to relieve a blockage caused by a tumor.
Endoscopic Ultrasound
Endoscopic ultrasound can also be performed at the time of ERCP and may increase the accuracy of the biopsy and yield information on lymph node invasion and operability.[1]
Percutaneous Transhepatic Cholangiography
As an alternative to ERCP, percutaneous transhepatic cholangiography (PTC) may be utilized.
Direct Cholangiography
Direct cholangiography is a blanket term for any imaging obtained with intra-biliary tree contrast, and includes: PTC ERCP CT IVC MRCP All these modalities not only allow evaluation of the the biliary tree, but are invaluable in planning treatment as assessing for resectability.
MRCP
Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive alternative to ERCP.[2][3][4] Some authors have suggested that MRCP should supplant ERCP in the diagnosis of biliary cancers, as it may more accurately define the tumor and avoids the risks of ERCP.[5][6][7]
References
- ↑ Sugiyama M, Hagi H, Atomi Y, Saito M. "Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography". Abdom Imaging. 22 (4): 434–8. PMID 9157867.
- ↑ Schwartz L, Coakley F, Sun Y, Blumgart L, Fong Y, Panicek D (1998). "Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography". AJR Am J Roentgenol. 170 (6): 1491–5. PMID 9609160.
- ↑ Zidi S, Prat F, Le Guen O, Rondeau Y, Pelletier G (2000). "Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures". Gut. 46 (1): 103–6. PMID 10601064.
- ↑ Lee M, Park K, Shin Y, Yoon H, Sung K, Kim M, Lee S, Kang E (2003). "Preoperative evaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: comparison with intraarterial digital subtraction angiography". World J Surg. 27 (3): 278–83. PMID 12607051.
- ↑ Yeh T, Jan Y, Tseng J, Chiu C, Chen T, Hwang T, Chen M (2000). "Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings". Am J Gastroenterol. 95 (2): 432–40. PMID 10685746.
- ↑ Freeman M, Sielaff T (2003). "A modern approach to malignant hilar biliary obstruction". Rev Gastroenterol Disord. 3 (4): 187–201. PMID 14668691.
- ↑ Szklaruk J, Tamm E, Charnsangavej C (2002). "Preoperative imaging of biliary tract cancers". Surg Oncol Clin N Am. 11 (4): 865–76. PMID 12607576.