Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability.
BACKGROUND
To assess the accuracy of spiral computed tomography (CT) in predicting the resectability of Klatskin tumor as determined by vascular invasion.


METHODS
Twenty-one consecutive patients with Klatskin tumor who had undergone laparotomy were included in this study. The preoperative thin-section (5-mm-thick) spiral CT scans of these patients were assessed for the surgical resectability of tumor by evaluating the vascular invasion. The criterion for vascular invasion indicating unresectability was the tumoral invasion of the proper hepatic artery or main portal vein or simultaneous invasion of one side of the hepatic artery and the other side of the portal vein.


RESULTS
All nine patients with tumors thought to be unresectable on the basis of CT findings had tumors that were unresectable at surgery (positive predictive value, 100%). Of 12 patients with tumors thought to be resectable, six had resectable tumors (negative predictive value, 50%). Spiral CT failed to detect small hepatic metastasis (n = 1), lymph node metastasis (n = 1), extensive tumor (n = 2) and variation of bile duct (n = 2), which precluded surgical resection.


CONCLUSIONS
Spiral CT is a reliable method for detecting vascular invasion and unresectable tumors. However, it has limitations in detecting variations of the bile duct or the intraductal extent of tumor.
Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
J H
JH
Cha
J K
JK
Han
T K
TK
Kim
A Y
AY
Kim
S J
SJ
Park
B I
BI
Choi
K S
KS
Suh
S W
SW
Kim
M C
MC
Han
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000473:pathology; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D018285:Klatskin Tumor / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D014057:Tomography, X-Ray Computed