Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

Abstract

Cholangiography is important for evaluating the resectability of hilar cholangiocarcinoma. This study evaluated Dyna-CT combined with direct cholangiography in the assessment of tumor extent and resectability of hilar cholangiocarcinoma. Sixteen patients with pathologically proven hilar cholangiocarcinoma who underwent preoperative biliary drainage and the Dyna-CT with direct cholangiography (percutaneous transhepatic cholangiography [PTC]) were included in this retrospective study. The image quality was compared with MRI cholangiography. An experienced radiologist and surgeon reviewed the image to evaluate the tumor extent for the involvement of extra- and intrahepatic ducts. The reader performance was evaluated by calculating sensitivity, specificity, and overall accuracy. Correlations were made with the resected specimens or surgical findings. All of the patients required biliary drainage, and the PTC procedure was performed successfully. No major complications were encountered. The Dyna-CT image processing can produce a precise three-dimensional overview of the biliary tree. The image quality score of the Dyna-CT was similar to the MRI cholangiography. The Dyna-CT had some advantage for more small branches. In addition, the shape-fitting of intrahepatic bile ducts was excellent. For image analysis, the overall accuracy for predicting the involvement of the bilateral secondary biliary confluences was 96.9%. Surgery showed good consistency with the Dyna-CT cholangiography. The Dyna-CT-based three-dimensional cholangiography is a new imaging method that can provide surgeons with three-dimensional and intuitive images of the biliary tree and provide useful information for evaluating the anatomical structure of the bile duct prior to surgery.