Pictorial Essay Imaging of Intrahepatic Cholangiocarcinoma: 2. Hilar ...

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Mar 17, 1995 - assessment of resectability of hilar cholangiocarcinoma is often extensive, requiring several types of imaging. This picto- rial essay reviews.
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Pictorial

Imaging of Intrahepatic Cholangiocarcinoma Philippe Elliot

Soyer1’2,

David

A. Bluemke1

,

Cholangiocarcinoma: Ralph

Reichle1

,

Paul

S. Calhoun1

,

Donald

Essay

2. Hilar F. Bliss1

,

Antoine

Schemer2,

K. Fishman1

Hilar cholangiocarcinoma (also called Klatskin’s tumor) is more common than peripheral cholangiocarcinoma. Sonography, CT, MR imaging, angiography, and cholangiography can

suggest tumor

the diagnosis,

but the major issue of imaging

whether the tumor is resectable. The anatomic location of hilar cholangiocarcinoma makes resection difficult, so that surgical exploration of patients with this condition should be undertaken only when preoperative evaluation has shown a potential for curative resection. Preoperative

of resectability

of hilar

sclerosing

ensis,

and exposure

cholangitis, infection to Thomotrast [1].

by Clonorchis

sin-

with this

is to determine

assessment

primary

cholangiocarcinoma

Imaging

Features

Sonography Sonogmaphy and normal-size ation suggests

is

often extensive, requiring several types of imaging. This pictorial essay reviews the imaging features of hilar cholangiocarcinoma. The role of imaging in the preoperative planning, with specific emphasis on staging extent of disease, including hepatic and vascular involvement, Is discussed and illustrated.

A definite duplex

shows dilatation of the intrahepatic bile duct extrahepatic bile ducts (Fig. 2). This associthe diagnosis of hilar cholangiocancinoma [4].

mass is namely seen on sonograms

and

color

Doppler

examinations

[4]. Conversely,

can

provide

useful

on the status of the portal vein.

information

CT Definition

CT shows

Hilan chobangiocancinoma the liver that arises from

is a primary the epithelium

adenocarcinoma of of the intrahepatic

bile ducts, near the bifurcation of the hepatic 1 ). Twenty-five percent of cholangiocarcinomas hilam cholangiocancinoma

[1-3].

carcinoma

is also

Because

cabled

CT features

central

cholangio-

is an

(5) minimal

undifferentiated on poorly differentiated adenocancinoma, this diagnosis is made when other metastatic conditions (cobomectab, pancreatic, on ovarian adenocarcinoma) at this location have been ruled out. The occurrence of hilar cholangiocarcinoma is associated with ulcerative colitis, intrahepatic chobelithiasis, biliany papilboma, Canoli’s disease,

Received

March

17, 1995; accepted

after

revision

in 40%

2Department 1995;165:1433-1436

of Radiology,

H#{244}pital Foch,

tumor

enhancement

(50%

BP 36, 92151

© American

CT during cinoma

Suresnes

Roentgen

of cases),

and (6)

on beading

arterial

portography

in the majority

of cases

depicts but

cedex,

Ray Society

France.

Address

correspondence

hilan cholangiocar-

usually

June 20, 1995.

40 rue Worth,

036i-803X195/i656-1433

[4].

of intmahepatic bile ducts [4-6]. Although small hilam cholangiocarcinomas (