Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma: correlation between MDCT and microscopic findings.
BACKGROUND
A few authors have reported the value of multidetector row CT (MDCT) for evaluating the longitudinal extent of cholangiocarcinoma. They have not focused on CT attenuation of a tumor and actual tumor extent along the bile ducts. We designed the present study to analyze attenuation.


METHODS
Between January 2003 and July 2005, 113 consecutive patients with cholangiocarcinoma underwent a surgical resection following MDCT. Of these MDCT studies, 73 (perihilar cholangiocarcinoma, n = 62; middle and distal cholangiocarcinoma, n = 11) were suitable for analysis, and the patients were enrolled in the study. Patients were divided according to tumor hypoattenuation and hyperattenuation on MDCT. Histologic differentiation, desmoplastic reaction, and vascular density were microscopically compared with the tumor attenuation to differentiate the characteristics of the attenuation. The extent of cancer along the bile duct diagnosed by MDCT was compared with the actual extent determined by the microscopic findings.


RESULTS
Hyperattenuated tumor was observed in 40 patients. There was no difference in histologic differentiation, desmoplastic reaction, or vascular density between the hyperattenuated and hypoattenuated cholangiocarcinomas. Neither the proximal nor the distal borders between the normal and thickened bile duct wall could be determined in the 33 patients with hypoattenuated tumor; in contrast, an accurate assessment of extent of tumor was obtained in 76% of the proximal borders and 82% of the distal borders in the 40 patients with hyperattenuated tumor.


CONCLUSIONS
Although the cause of the difference between the hyperattenuated and hypoattenuated cholangiocarcinoma still is unclear, MDCT can be an alternative to direct cholangiography in selected patients with hyperattenuated cholangiocarcinoma.
Senda
Yoshiki
Y
Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nishio
Hideki
H
Oda
Koji
K
Yokoyama
Yukihiro
Y
Ebata
Tomoki
T
Igami
Tsuyoshi
T
Sugiura
Teiichi
T
Shimoyama
Yoshie
Y
Nimura
Yuji
Y
Nagino
Masato
M
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*