Biliary tract carcinoma complicating primary sclerosing cholangitis: evaluation with CT, cholangiography, US, and MR imaging.
OBJECTIVE
To assess the value of computed tomography (CT), cholangiography, ultrasonography (US), and magnetic resonance (MR) imaging in the demonstration of biliary tract carcinoma complicating primary sclerosing cholangitis (PSC).


METHODS
Thirty patients were studied who had PSC and biliary tract carcinoma. Twenty-six patients had cholangiocarcinoma, and four had gallbladder carcinoma. Sixty-four CT scans, 41 cholangiograms, 40 US studies, and seven MR studies were reviewed retrospectively for evidence of tumor and PSC. Imaging results were correlated with pathologic findings from whole liver specimens and biopsies. Presence of mass was rated as definite, probable, possible, or doubtful or absent.


RESULTS
On CT scans, cholangiocarcinomas produced hypoattenuating masses in 17 of 23 cases, delayed contrast enhancement in six of 12, progressive biliary dilatation in five of 15, and thickened bile duct wall in two of 23. On cholangiograms, dominant strictures were present in 18 of 21 cases of cholangiocarcinoma; 13 were malignant, and five were benign. Cholangiocarcinoma formed polypoid bile duct masses in two of 21 cases. Biliary dilatation was caused by cholangiocarcinoma in 10 of 12 cases and by benign stricture in two. Gallbladder carcinomas demonstrated masses on CT scans, cholangiograms, and US images, and wall thickening on CT and US images. Overall, definite or probable tumor was demonstrated in 25 of 30 patients (83%).


CONCLUSIONS
Most biliary tract carcinomas complicating PSC can be demonstrated on imaging studies.
Campbell
W L
WL
Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA.
Ferris
J V
JV
Holbert
B L
BL
Thaete
F L
FL
Baron
R L
RL
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D002758:Cholangiography; D015209:Cholangitis, Sclerosing / Q000150:complications*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography