Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions

Hänninen, Enrique Lopez; Pech, Maciej; Jonas, Sven; Ricke, Jens; Thelen, Armin; Langrehr, Jan M.; Hintze, R. E.; Röttgen, R; Denecke, Timm; Winter, Leopold; Neuhaus, P.; Félix, R.

doi:10.1080/02841850510021625

Cited by 73 publications

(43 citation statements)

References 26 publications

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“…In another smaller study, MRCP predicted the extent of biliary ductal involvement in 96% of cases with malignant hilar obstructions [115] . Regarding surrounding structures, MRI has been shown to have 66% accuracy for detection of lymph node metastases [119] , 78% sensitivity and 91% specificity for portal vein invasion, 58%-73% sensitivity [120] and 93% specificity for arterial invasion [121] . In a comparative study the relationship of ICC to the vessels and surrounding organs was more easily evaluated on CT compared to MRI [89] .…”

Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

View full text Add to dashboard Cite

show abstract

“…20) [19]. The sensitivity and specificity for nodal involvement are not so high on current cross-sectional imaging, and false-negative cases are frequently encountered on CT, MRI, or FDG-PET [34][35][36]. Therefore, lymph node status cannot be reliably determined on the current imaging system, and the presence of equivocal lymph nodes cannot be used as a criterion for unresectability.…”

Section: Evaluation Of Resectabilitymentioning

confidence: 93%

Staging of extrahepatic cholangiocarcinoma

et al. 2008

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Preoperative staging of extrahepatic cholangiocarcinoma is important in determining the best treatment plan. Several classification systems have been suggested to determine the operability and extent of surgery. Longitudinal tumor extent is especially important in extrahepatic cholangiocarcinoma because operative methods differ depending on the tumor extent. The Bismuth-Corlette classification system provides useful information when planning for surgery. However, this classification system is not adequate for selecting surgical candidates. Anatomic variation of the bile duct and gross morphology of the tumor must be considered simultaneously. Lateral spread of the tumor can be evaluated based on the TNM staging provided by American Joint Committee on Cancer (AJCC). However, there is a potential for ambiguity in the distinction of T1 and T2 cancer from one another. In addition, T stage does not necessarily mean invasiveness. Blumgart T staging is helpful for the assessment of resectability with the consideration of nodal status and distant metastasis as suggested by the AJCC cancer staging system. Computed tomography (CT) and magnetic resonance imaging (MRI) are the primary tools used in the assessment of longitudinal and lateral spread of a tumor when determining respectability. Diagnostic laparoscopy and positron emission tomography (PET) may play additional roles in this regard.

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“…The MRI study of pancreatic adenocarcinoma is based on T1-and T2-weighted sequences, dynamic postcontrast images, and magnetic resonance cholangiopancreatography (MRCP) sequences [ 76 ].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Ductal Adenocarcinoma

D’Onofrio¹,

Capelli²,

Robertis³

et al. 2014

Imaging and Pathology of Pancreatic Neoplasms

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PathologyDuctal adenocarcinoma is a malignant epithelial neoplasm with glandular (ductal) differentiation, without a predominant component of any other types of carcinoma [ 7 ].Sixty to seventy percent of ductal adenocarcinomas is located in the pancreatic head, 30 % in the body and tail, and 5 % involve the whole organ. Multifocal disease has been reported as well as synchronous or metachronous carcinomas.Carcinomas of the pancreatic head tend to cause symptoms such as painless jaundice, acute pancreatitis, and epigastric pain that radiates to the back.Carcinomas of the body-tail of the pancreas often present with unexplained weight loss, back pain, or distant metastases.Sudden onset of diabetes mellitus may be the fi rst sign of pancreatic cancer. 2Carcinomas of the pancreatic head are usually diagnosed earlier and are more often resectable than carcinomas that involve the body-tail.Surgically resected carcinomas of the pancreatic head are generally signifi cantly smaller than the tumors of the body and tail (2-3 cm versus 5-7 cm, respectively). MacroscopyOn the cut surface, the tumor usually appears as a solid fi rm mass with infi ltrative, indefi nable margins, whitish color, and hard consistency.The tumor is often surrounded by a phlogistic fi brous "cuff," derived from a focal peritumoral pancreatitis, making it sometimes hard to identify the actual dimensions of the tumor, both at imaging and macroscopically.Extensive areas of hemorrhage and necrosis with cystic cavitation are uncommon, but microscopic foci are not so uncommon.Carcinomas of the pancreatic head, with the exception of those arising in the uncinate process, almost always infi ltrate both the common bile duct and Wirsung's duct, leading to a variable degree of stenosis and upstream dilation (radiological "double-duct sign"). This causes jaundice and upstream obstructive pancreatitis, which could lead to chronic pancreatitis, characterized by the presence of fi brotic or fi bro-adipous components, associated with a variable degree of acinar cells atrophy, with duct dilatation and retention cysts formation.The involvement of duodenum and/or Vater's ampulla, frequently found in the carcinomas of the pancreatic head, causes retraction of the intestinal wall, and eventually mucosal ulceration.Invasion and thrombosis of large peripancreatic vessels, such as the splenic vein, are frequently observed in bodytail carcinomas.The pathological evaluation of the retroperitoneal resection margin provides the most important information about local recurrence and patient survival. This margin is defi ned as the peripancreatic adipose tissue behind the head of the pancreas, which is located ventral and lateral, in respect to the superior mesenteric artery [ 8 -11 ].When the tumor involves the celiac trunk or the superior mesenteric artery, it is considered unresectable; so, this involvement is rarely present in surgical pathology specimens. A focal and partial, noncircumferential, adhesion of the posterior pancreatic surface to the mesenteric vein may justify ...

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Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions

Cited by 73 publications

References 26 publications

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Staging of extrahepatic cholangiocarcinoma

Ductal Adenocarcinoma

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