Radiographic Findings of Cholangiocarcinoma in Roi-Et Hospital

Abstract

Cholangiocarcinoma is cancer that had high incidence in Thailand, especially in northeast region. Since surgery is the only way to achieve cure in patients with cholangiocarcinoma, imaging are prerequisites for the determination of resectability and accurate preoperative staging. The aims of this study was to determine the radiographic findings, type, extension and metastasis of cholangiocarcinoma detected by computed tomography and magnetic resonance imaging in Roi-Et hospital. Material and Method: A retrospective review of patients with cholangiocarcinoma, who had computed tomography or magnetic resonance imaging performed in Roi-Et hospital,
between March 2019 to March 2021, included 200 patients (108 men, 92 women, 31-86 years old, mean age 61.6) by using Picture Archiving and Communication System (PACS) to access imaging features, type, extension and calculated to percentage

The most common type of cholangiocarcinoma in Roi-Et hospital was intrahepatic cholangiocarcinoma 98 cases (48%), hilar cholangiocarcinoma 65 cases (32.5%), Extrahepatic cholangiocarcinoma 28 cases (14%). Intrahepatic cholangiocarcinoma appear hypodense on non contrast CT (79.8%), peripheral enhancement follow by progressive and concentric filling in the tumor after contrast material injection (72.3%). On MRI intrahepatic
cholangiocarcinoma appeared hypointense on T1weighted images and hyperintense on T2 weighted images (85.0%
and 92.5%, respectively) with pattern of enhancement same as CT (76.2%). Most of hilar cholangiocarcinoma
was periductal type (95%), which show biliary stricture, thickened enhanced wall and upstream biliary dilatation
on CT and MRI. Only 5% of hilar cholangiocarcinoma were intraductal type. The imaging feathers of extrahepatic cholangiocarcinoma were focal biliary stricture with thickened wall (92.8%), hyperenhancement (85.7%) ill-defined margin (64.3%), asymmetrical narrowing (71.4%) and abrupt narrowing (100%), mean length 18 mm., mean width 4 mm. Other findings included vascular invasion (47%), biliary dilatation (90%), capsular retraction (21.5%), lobar atrophy (12%), intrahepatic metastasis (32.5%), lymph node metastasis (40%), adjacent organ invasion (6.5%) and distant metastasis (31.5%). 61% of patients with cholangiocarcinoma, who had preoperative imaging was categorized as unresectable cases. Computed tomography and magnetic resonance imaging has high accuracy to determined type, extension of cholangiocarcinoma and useful for planning of treatment and operation. Most of cholangiocarcinoma has typical imaging appearance. However in some cases cholangiocarcinoma may manifest with various imaging patterns that look like other condition. Awareness of the characteristics of cholangiocarcinoma is important for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.