Imaging of intrahepatic and hilar cholangiocarcinoma

Excerpt

Intrahepatic cholangiocarcinoma arises from the bile ducts peripheral to the secondary bifurcation of the left or right hepatic duct, whereas hilar cholangiocarcinoma arises from one of the hepatic ducts and may involve the bifurcation of the common bile duct [1,2,3,4,5,6]. For the diagnosis and evaluation of the extent of intrahepatic peripheral cholangiocarcinoma, contrast-enhanced spiral computed tomography (CT) and dynamic magnetic resonance imaging (MRI) could be used. Although CT provides better anatomic detail (e.g., by depicting vascular or extrahepatic invasion) and more accurate staging [7], MRI demonstrates more conspicuous contrast enhancement, which facilitates the detection and evaluation of hepatic parenchymal changes peripheral to the tumor. However, the two modalities are equally effective in the detection and correct diagnosis of the tumor. Traditionally, tumors accompanying biliary dilatation have been evaluated with direct cholangiography (percutaneous transhepatic or endoscopic retrograde cholangiography). However, recent technologic developments have led to rapid improvement in the quality of MR cholangiography. This imaging modality is diagnostic in more than 90% of patients with malignant hilar strictures. Further, MR cholangiography with axial T1- and T2-weighted imaging may allow identification, characterization, and staging of these lesions [8, 9]. In this article, we describe the imaging spectrum of intrahepatic and hilar cholangiocarcinomas. …