MRCP Combined With CT Promotes the Differentiation of Benign and Malignant Distal Bile Duct Strictures

Abstract

ObjectiveTo determine whether contrast-enhanced computed tomography (CT) can promote the identification of malignant and benign distal biliary strictures (DBSs) compared to the use of magnetic resonance cholangiopancreatography (MRCP) alone and to identify imaging findings of malignant DBSs.Materials and MethodsA total of 168 consecutive patients with confirmed DBSs were reviewed. MRCP alone and MRCP combined with CT images were blindly analyzed by two radiologists (e.g., stricture pattern, margins), and malignant or benign DBSs were identified based on surgical findings, endoscopy findings, or follow-up. The diagnostic accuracy of the two reviewers using MRCP alone and MRCP combined with CT were evaluated. MRCP and CT features of malignant and benign DBSs were compared using multiple logistic regression analysis to identify independent malignant risk factors.ResultsMRCP combined with CT examination could improve the diagnostic accuracy, which increased from 70.2% to 81.5% in Doctor A and from 85.1% to 89.3% in Doctor B. The multiple logistic regression model revealed that stricture length [odds ratio (OR) 1.070, P=0.016], angle of the DBS (OR 1.061, P<0.001), double duct sign (OR 4.312, P=0.003) and low density in the arterial phase (OR 0.319, P=0.018) were associated with malignant DBS. A scoring model incorporating these four factors was established; at a threshold value of 1.75, and the sensitivity and specificity for the detection of malignant DBSs were 73.5 and 85.9%, respectively.ConclusionsCompared to the use of MRCP alone, MRCP combined with contrast-enhanced CT can improve the accuracy of DBS diagnosis. The scoring model accurately predicts malignant DBSs and helps make treatment decisions.

Practice guidelines for managing extrahepatic biliary tract cancers

“…As time progresses, the enhancement of fibrotic tissue becomes more pronounced [ 105 , 106 ]. In comparison with benign strictures, extrahepatic bile duct cancer exhibits a thicker bile duct wall, a longer extent of the involved duct, and an irregular lumen [ 107 - 110 ]. When these imaging characteristics were combined in retrospective studies, they identified malignant strictures with an accuracy of 100% and benign strictures with an accuracy of 87% [ 109 ].…”

“…In comparison with benign strictures, extrahepatic bile duct cancer exhibits a thicker bile duct wall, a longer extent of the involved duct, and an irregular lumen [ 107 - 110 ]. When these imaging characteristics were combined in retrospective studies, they identified malignant strictures with an accuracy of 100% and benign strictures with an accuracy of 87% [ 109 ]. However, various benign inflammatory conditions such as postinflammatory fibrotic strictures, primary sclerosing cholangitis, immunoglobulin G4-related sclerosing cholangitis, recurrent suppurative cholangitis, and ischemic cholangitis can also mimic similar imaging findings.…”

Magnetic Resonance Cholangiopancreatography: Diagnostic Role in Evaluating Pancreaticobiliary Abnormalities

“…We reviewed the published literature to assess the MRCP criteria of differentiating malignant from biliary strictures. As pe Nirhale et al, (1) , Shabanikia et al ., (19) , Wang et al ., (20) , Suthar . et al, (21) irregular, long, asymmetric, or abrupt narrowing of the biliary and/or pancreatic duct were considered as malignant features.…”

False-negative factors of percutaneous transluminal clamp biopsy for biliary stricture: 194 case analyses from a single center

“…There are many reasons for mechanical BS, such as malignant tumors, biliary stones, in ammation, and postoperative anastomotic stenosis. In the past few decades, great progress has been made in BS imaging, such as intraluminal ultrasound, MRCP and enhanced CT scanning [4][5] . These noninvasive imaging systems can quickly obtain the relevant BS anatomical information, but how to complete pathological biopsy of the narrow BS is the most critical information for the nal diagnosis.…”