title: MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications.
abstract: OBJECTIVE
  The purpose of this study was to test the hypothesis that soft-tissue infiltration along the celiac plexus and delayed enhancement exceeding two-thirds of the tumor area on preoperative MDCT correlate with histologic evidence of perineural invasion in resected intrahepatic cholangiocarcinomas.
  
  
  METHODS
  Two experienced abdominal radiologists retrospectively reviewed preoperative multiphasic MDCT scans of 20 patients who underwent resection of intrahepatic cholangiocarcinoma, identifying soft-tissue infiltration along the celiac plexus, delayed enhancement exceeding two-thirds of the tumor area, and maximum tumor diameter. Consensus findings were compared with intratumoral perineural invasion in resected intrahepatic cholangiocarcinomas using the Fisher exact test.
  
  
  RESULTS
  Six patients had histologic intratumoral perineural invasion, five of whom had soft-tissue infiltration along the celiac plexus on preoperative MDCT, with corresponding 83.3% sensitivity and 92.9% specificity for perineural invasion and significant association between these MDCT and histologic findings (p = 0.002). No patients with histologic perineural invasion had enhancement exceeding two-thirds of the tumor area on MDCT; sensitivity was 0.0% for this finding. Tumor diameter on MDCT was not significantly associated with perineural invasion at histopathology (p = 0.530).
  
  
  CONCLUSIONS
  Soft-tissue infiltration along the celiac plexus on MDCT is an indicator of perineural invasion in patients with intrahepatic cholangiocarcinoma. The data did not confirm an association between delayed enhancement exceeding two-thirds of the tumor area and perineural invasion. Because perineural invasion from intrahepatic cholangiocarcinoma is associated with a very poor prognosis and is generally a contraindication to surgery, the MDCT diagnosis of celiac plexus perineural invasion in patients with intrahepatic cholangiocarcinoma may have important implications for prognosis and treatment planning.
authors.affiliation: 1 Harvard Medical School, Boston, MA.
authors.forename: Kesav
authors.initials: K
authors.lastname: Raghavan
authors.affiliation: 2 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105.
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.affiliation: 3 Department of Radiology, Duke University School of Medicine, Durham, NC.
authors.forename: Bhavik N
authors.initials: BN
authors.lastname: Patel
authors.affiliation: 2 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105.
authors.forename: Michael A
authors.initials: MA
authors.lastname: DiMaio
authors.affiliation: 2 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105.
authors.forename: Juergen K
authors.initials: JK
authors.lastname: Willmann
authors.affiliation: 2 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105.|4 Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Olcott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002447:Celiac Plexus / Q000000981:diagnostic imaging* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: MDCT; bile duct neoplasms; cholangiocarcinoma; liver neoplasms; neoplasm staging