Value of computed tomography in the diagnosis and resect-ability evaluation of hilar cholangiocarcinoma / 中华消化外科杂志

ABSTRACT

Computed tomography (CT) has become a very important method for preoperative examination for hilar cholangiocarcinoma.In this article,the multidetector helical CT findings of 20 patients with hilar cholangiocarcinoma who were confirmed by surgical pathological examination or biopsy in the Ruijin Hospital of Shanghai Jiaotong University from September 2010 to September 2012 were retrospectively analyzed to investigate the value of muhidetector helical CT in the diagnosis and resectability evaluation of hilar cholangiocarcinoma.All the 20 patients received dynamic contrast enhanced CT scanning after abdominal plain scanning,including arterial phase and portal venous phase scanning.Six patients received additional delayed phase scanning for 3-4 minutes.Muhi-phase reconstruction (MPR) and CT angiography were performed after the scanning.The location and sizes of lesious,the range of invasion of adjacent vessels,swelling of lymph nodes of hilar and retroperitoneum,and hepatic metastasis were recorded.The results showed that only 8 lesions were found on CT plain scanning,and they were presented as hypodense nodules.All lesions were showed on contrast enhanced images.Five cases with infiltrating type were showed as focal wall thickness of hilar bile duct,ringlike enhancement appeared on arterial phase scanning,and the enhancement was more apparent in portal venous and delayed phasc scanning.Eight cases with intraductal growing type demonstrated as intraductal nodules,obvious enhancement was detected on delayed phase scanning,and the dilation of intrahepatic bile duct was also found.Seven cases of tumoral type showed as mass located in hilar region and involved adjacent vessels and partial hepatic parenchyma.Diffused or local dilation of bile duct could be seen on CT images.Combination of 2and 3-dimensional reconstruction images can show more clearly of hilar cholangiocarcinoma lesions,invasion of hepatic arery or portal vein,segmental atrophy and metastasis of lymph nodes and liver.One-stop CT examination combined with axial multiphase dynamic contrast enhanced scanning with MPR and CT angiography of multidetector helical CT can clearly show the lesions of hilar cholangiocarcinoma,improve the preoperative tumor staging and help to design the surgical treatment.