Detection of cholangiocarcinoma with magnetic resonance spectroscopy of bile in patients with and without primary sclerosing cholangitis.
BACKGROUND
Early detection of cholangiocarcinoma (CC) is very difficult, especially in patients with primary sclerosing cholangitis (PSC) who are at increased risk of developing CC.


OBJECTIVE
To evaluate 1H magnetic resonance spectroscopy ((1)H-MRS) of bile as a diagnostic marker for CC in patients with and without PSC.


METHODS
The institutional review board approved the study, and all patients gave informed consent. Bile from 49 patients was sampled and investigated using 1H-MRS. MR spectra of bile samples from 45 patients (18 female; age range 22-87 years, mean age 57 years) were analyzed both conventionally and using computerized multivariate analysis. Sixteen of the patients had CC, 18 had PSC, and 11 had other benign findings.


RESULTS
The spectra of bile from CC patients differed from the benign group in the levels of phosphatidylcholine, bile acids, lipid, and cholesterol. It was possible to distinguish CC from benign conditions in all patients with malignancy. Two benign non-PSC patients were misclassified as malignant. The sensitivity, specificity, and accuracy were 88.9%, 87.1%, and 87.8%, respectively.


CONCLUSIONS
With 1H-MRS of bile, cholangiocarcinoma could be discriminated from benign biliary conditions with or without PSC.
Albiin
N
N
Division of Radiology, Department for Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden. nils.albiin@ki.se
Smith
I C P
IC
Arnelo
U
U
Lindberg
B
B
Bergquist
A
A
Dolenko
B
B
Bryksina
N
N
Bezabeh
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry*; D001647:Bile Acids and Salts / Q000032:analysis; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D014408:Biomarkers, Tumor / Q000032:analysis; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D015209:Cholangitis, Sclerosing / Q000150:complications*; D002784:Cholesterol / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010713:Phosphatidylcholines / Q000032:analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D001647:Bile Acids and Salts; D014408:Biomarkers, Tumor; D008055:Lipids; D010713:Phosphatidylcholines; D002784:Cholesterol