CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts.

Schulte, Scott J.; Baron, Richard L.; Teefey, S A; Rohrmann, Charles A.; Freeny, Patrick C.; Shuman, W P; Foster, Michael A.

doi:10.2214/ajr.154.1.2104731

Cited by 105 publications

(39 citation statements)

References 15 publications

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“…They reported that infiltrating tumours, which are the most common, are more difficult to detect by CT than exophytic or polypoid tumours [4]. Furthermore, it is difficult to interpret smooth wall thickening of the bile duct on CT, because several diseases, including bile duct cancer and cholangitis, have been reported to be associated with enhanced thickening of the bile duct [19]. In our series, CT failed to identify six of 17 infiltrating tumours.…”

Section: Discussioncontrasting

confidence: 52%

“…Many investigators have shown that 18 F-FDG PET is more accurate than CT for evaluation of mediastinal lymph node metastases of nonsmall cell lung cancers [21]. The ranges of sensitivity, specificity and accuracy are 66%-100%, 81%-100% and 80%-100%, respectively [19]. In the case of bile duct cancer, Kluge et al [18] reported low sensitivity (13%) of 18 F-FDG PET for regional lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

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Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

et al. 2002

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In extrahepatic bile duct cancer, preoperative evaluation is important because only surgical excision of all detectable tumours is associated with improvement in 5-year survival. However, morphological imaging techniques, including computed tomography (CT), are still insufficient for accurate staging. The purpose of this study was to assess the additional value, in relation to CT, of 2-[(18)F]fluoro-2-deoxy- D-glucose positron emission tomography ((18)F-FDG PET) for the evaluation of extrahepatic bile duct cancer. Thirty patients with extrahepatic bile duct cancer underwent both (18)F-FDG PET and CT for initial staging. The results of the two modalities for evaluation of primary tumours and regional lymph nodes were compared with the final diagnoses based on pathological or clinical findings. The primary tumours were interpreted as malignant on the basis of CT in 24 (80%) of the patients, while (18)F-FDG PET revealed increased (18)F-FDG uptake in 18 (60%) of them. On the other hand, (18)F-FDG PET showed focal accumulation of (18)F-FDG in the bile duct in three of the six patients with equivocal findings on CT. The sensitivity, specificity and accuracy of CT for regional lymph node metastases were 54%, 59% and 57%, while those of (18)F-FDG PET were 38%, 100% and 73%, respectively. The specificity of (18)F-FDG PET for regional lymph node metastases was significantly higher than that of CT ( P<0.01). Of 14 patients with N1 or N2 disease diagnosed by CT, only seven (50%) had a final diagnosis of regional lymph node metastasis. In these 14 patients, (18)F-FDG PET accurately evaluated the N component of the disease in 12 patients (86%). In conclusion, in the initial staging of patients with extrahepatic bile duct cancer, (18)F-FDG PET offers additional value in relation to CT in evaluating both the primary tumour and regional lymph nodes.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

et al. 2002

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“…The MDCT findings were classified malignant when there was apparent thickening and contrast enhancement of the wall and/or intraluminal mass of the bile duct or the gallbladder [3][4][5][6][7][8][9]. They were assessed for detectability of the primary tumour, regional lymph node involvement (N factor) and distant metastasis (M factor).…”

Section: Image Analysismentioning

confidence: 99%

“…This allows the objective organ to be imaged during the bolus phase of contrast enhancement with thin-collimation, resulting in improved multiplanar reconstructions. However, the interpretation of CT images is still sometimes difficult when differentiating carcinoma from benign cholecystitis or cholangitis, and even such sophisticated imaging techniques are still not sufficient for accurate staging [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology

et al. 2008

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The aim of this study was to evaluate the value of positron emission tomography with (18)F-labeled fluorodeoxyglucose (FDG-PET) as a preoperative diagnostic investigation in patients with biliary carcinoma. Seventy-two patients with potentially resectable biliary carcinoma underwent preoperative multidetector-row computed tomography (MDCT) and FDG-PET. Both diagnoses were compared with subsequent histopathology and follow-up results. In 64 lesions with biliary carcinoma, 57 (89%) revealed an intense focal accumulation on FDG-PET and were interpreted as malignant. On the other hand, eight benign lesions did not show any specific accumulation. Detection rate of FDG-PET in the nodular type of the tumour (96% or 27/28) was superior to that of the infiltrating type (74% or 17/23) (p = 0.037). For the evaluation of lymph node metastasis, the overall accuracy was 69% (35/51) in both FDG-PET and MDCT: FDG-PET had a lower sensitivity (33% vs. 57%) and a higher specificity (97% vs. 79%) than MDCT, although the values were not significantly different. FDG-PET revealed all six lesions of distant metastases in six patients including two lesions missed by MDCT. FDG-PET has high detectability of biliary malignancies. Like MDCT, FDG-PET offers only modest accuracy for regional lymph node staging, but it may reveal distant metastases missed by MDCT.

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“…Recent reports have shown that CT can detect changes in the bile duct wall after intravenous administration of contrast material [40]. In a prospective study at the University of Padua [39], CT scan findings were compared to magnetic resonance cholangiopancreatography (MRCP) and the sensitivity of CT cholangiography was 94 versus 63% for MRCP.…”

Section: Noninvasive Imaging Modalitiesmentioning

confidence: 99%

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Abu-Wasel

Keough

Renfrew³

et al. 2013

Pathobiology

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The diagnosis and the treatment of dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the scientific literature on the subject is quite limited. Only level II and level III evidence is available to guide physicians managing patients with DS and PSC. For the diagnosis, intraductal endoscopic ultrasound is the most sensitive (64%) and specific (95%) test. However, the majority of cases require a combination of several different diagnostic tests, as there is no single investigation that can rule out malignancy in this group of patients. For the treatment, serial endoscopic or percutaneous dilatations provide 1- and 3-year biliary duct patency in 80 and 60% of patients, respectively. Dilatation and stenting are the most common interventions, although the optimal duration of treatment has still not been clearly defined. Bile duct resection and/or bilioenteric bypass are currently indicated only for patients with preserved liver function. For all other patients, benign DS can be treated with endoscopic dilatation with short-term stenting. This approach is effective and safe and does not increase the risk of malignant transformation or complications for liver transplant candidates. During the last decade, the use of self-expandable metallic stents for benign diseases has become an innovative option. The aim of this article is to review the diagnostic and therapeutic strategies for patients affected by PSC and DS with specific emphasis on the outcomes of patients treated with temporary stents.

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CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts.

Cited by 105 publications

References 15 publications

Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

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