CT findings of Cholangiocarcinoma in Debaratana Nakhonratchasima Hospital

Abstract

Background: Cholangiocarcinoma (CCA) remains a significant public health issue in Thailand, particularly in the Northeastern region, which is an area where liver fluke infections, a major risk factor for bile duct cancer, are found. Therefore, radiological imaging, such as computed tomography (CT), is crucial for characterizing lesions, differential diagnosis, pre-treatment evaluation, and assessing disease spread.

Objectives: To evaluate CT findings and pattern enhancement of cholangiocarcinoma and other associated findings at Debaratana Nakhonratchasima hospital.

Methods: A retrospective descriptive study collecting data from the patients diagnosed with cholangiocarcinoma, who had computed tomography (CT) scan at Debaratana Nakhonratchasima hospital, between August 2023 and August 2025. The data collection tool is a self-designed record form, with diagnostic CT image reviews conducted using the hospital's PACS system. The data were analyzed using descriptive statistics, including number and percentage.

Results: A total of 66 patients were identified, consisting of 43 males (65.2%) and 23 females (34.8%). The patients ranged in age from 38 to 93 years, with a mean age of 69.9 years. The most common type and location of bile duct cancer is intrahepatic mass-forming type (47%), followed by hilar and perihilar cholangiocarcinoma (27.3%), and distal extrahepatic type (7.5%). Overall, the enhancement patterns showed approximately 26.9% in the arterial phase, 66.7% in the portovenous phase, and 96.1% in the delayed phase. It was observed that the contrast media gradually accumulated within the mass over time, a characteristic known as progressive delayed contrast enhancement. Other radiological features include biliary dilatation (100%), lymph node metastasis (48.5%), hepatic artery involvement (39.4%), hepatic vein and portal vein involvement (66.7%), intrahepatic metastasis (25.7%), hepatic capsular retraction (32.4%), lobar atrophy (12.1%), and distant metastasis (19.6%), involving spread to the lungs, bones, peritoneum, and adrenal gland.

Conclusion: The most common type of cholangiocarcinoma in Debaratana Nakhonratchasima hospital is the intrahepatic mass-forming type. The finding of progressive enhancement, which becomes most prominent during the delayed phase, combined with biliary dilatation and the other aforementioned features, such as lymph node metastasis and vascular involvement, serves as the clue diagnostic indicators that assist in the diagnosis of the cholangiocarcinoma.