Hilar cholangiocarcinoma: radiological assessment of resectability

Abstract

A pre-operative study of 31 patients with proximal cholangiocarcinoma was carried out with ultrasonography (US), duplex sonography (DS), computed tomography (CT), percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiography (ERC) and angiography. US, DS and PTC are the most effective techniques for pre-operative staging assessment of proximal cholangiocarcinoma. A tumour was visualised by US in 89% of cases, and the extent of extraductal tumour invasion was correctly established in 64%. Lobar segmental tumour extension was correctly documented in 80% of cases; however, the exact definition of tumour extension required the use of PTC. Vascular patency was correctly visualised by DS in 85% of cases. Altogether, tumour invasion was correctly documented in 68% in cases. In the event of radiologically localised tumour extension, radiological interpretation was correct in 64% of cases. The extent of tumour infiltration was radiologically underestimated in 36% of cases, especially in documenting lymph node metastases, infiltration of the hepato-duodenal ligament and segmental liver invasion.