Abstract
ObjectiveTo determine whether contrast-enhanced computed tomography (CT) can promote the identification of malignant and benign distal biliary strictures (DBSs) compared to the use of magnetic resonance cholangiopancreatography (MRCP) alone and to identify imaging findings of malignant DBSs.Materials and MethodsA total of 168 consecutive patients with confirmed DBSs were reviewed. MRCP alone and MRCP combined with CT images were blindly analyzed by two radiologists (e.g., stricture pattern, margins), and malignant or benign DBSs were identified based on surgical findings, endoscopy findings, or follow-up. The diagnostic accuracy of the two reviewers using MRCP alone and MRCP combined with CT were evaluated. MRCP and CT features of malignant and benign DBSs were compared using multiple logistic regression analysis to identify independent malignant risk factors.ResultsMRCP combined with CT examination could improve the diagnostic accuracy, which increased from 70.2% to 81.5% in Doctor A and from 85.1% to 89.3% in Doctor B. The multiple logistic regression model revealed that stricture length [odds ratio (OR) 1.070, P=0.016], angle of the DBS (OR 1.061, P<0.001), double duct sign (OR 4.312, P=0.003) and low density in the arterial phase (OR 0.319, P=0.018) were associated with malignant DBS. A scoring model incorporating these four factors was established; at a threshold value of 1.75, and the sensitivity and specificity for the detection of malignant DBSs were 73.5 and 85.9%, respectively.ConclusionsCompared to the use of MRCP alone, MRCP combined with contrast-enhanced CT can improve the accuracy of DBS diagnosis. The scoring model accurately predicts malignant DBSs and helps make treatment decisions.
Highlights
It remains difficult to differentiate between benign and malignant biliary strictures (BSs) [1,2,3]
MRI/magnetic resonance cholangiopancreatography (MRCP) is superior to computed tomography (CT) in differentiating between malignant and benign BSs [1, 2, 16], the specificity of MRCP combined with CE-MRI still needs to be improved [15, 23], with a specificity of 70%–85% [15]
We found that the diagnostic accuracy of doctors using MRCP combined with CT for the differentiation of malignant from benign causes of distal biliary strictures (DBSs) was higher than the diagnostic accuracy of MRCP alone
Summary
It remains difficult to differentiate between benign and malignant biliary strictures (BSs) [1,2,3]. 15-24% of suspected malignant strictures are determined to be benign after surgical resection [1, 5]. The reason for this dilemma is that a focal malignant stricture without an identifiable mass. A benign stricture manifests as a focal area of wall thickening and mimics a malignant lesion [7, 8], and surgical resection may be performed. Unnecessary surgery may delay appropriate treatment and lead to deterioration of patient condition [9]. Early and accurate preoperative diagnosis of the cause of a BS is important to increase the likelihood of complete resection and to avoid unnecessary surgery
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