title: Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC).
  
  
  METHODS
  This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT - attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT - attenuation value at unenhanced CT)] × 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed.
  
  
  RESULTS
  The median washout ratio was 29.4 %. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027).
  
  
  CONCLUSIONS
  The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC.
  
  
  CONCLUSIONS
  • Dynamic contrast study can evaluate the aggressiveness of extrahepatic cholangiocarcinoma. • A lower washout ratio was an independent prognostic factor for overall survival. • CT can predict survival and inform decisions on surgical options or chemotherapy.
authors.affiliation: Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. asayama@radiol.med.kyushu-u.ac.jp.
authors.forename: Yoshiki
authors.identifier: http://orcid.org/0000-0001-6495-4821
authors.initials: Y
authors.lastname: Asayama
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Kousei
authors.initials: K
authors.lastname: Ishigami
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Takayama
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Okamoto
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Fujita
authors.affiliation: Departments of Surgery and Oncology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.affiliation: Departments of Surgery and Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.affiliation: Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.|Departments of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.affiliation: Departments of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods / Q000401:mortality; D064847:Multimodal Imaging / Q000379:methods / Q000401:mortality; D011169:Portal Vein / Q000000981:diagnostic imaging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods / Q000401:mortality
chemical_list: D003287:Contrast Media
keywords: Contrast enhancement pattern; Extrahepatic cholangiocarcinoma; Multidetector computed tomography; Pathology; Prognosis