Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures

Abstract

Background-Magnetic resonance cholangiography (MRC) is currently under investigation for non-invasive biliary tract imaging.Aim-To compare MRC with endoscopic retrograde cholangiography (ERC) for pretreatment evaluation of malignant hilar obstruction. Methods-Twenty patients (11 men, nine women; median age 74 years) referred for endoscopic palliation of a hilar obstruction were included. The cause of the hilar obstruction was a cholangiocarcinoma in 15 patients and a hilar compression in five (one hepatocarcinoma, one metastatic breast cancer, one metastatic leiomyoblastoma, two metastatic colon cancers). MRC (T2 turbo spin echo sequences; Siemens Magnetomvision 1.5 T) was performed within 12 hours before ERC, which is considered to be the ideal imaging technique. Tumour location, extension, and type according to Bismuth's classification were determined by the radiologist and endoscopist. Results-MRC was of diagnostic quality in all but two patients (90%). At ERC, four patients (20%) had type I, seven (35%) had type II, seven (35%) had type III, and two (10%) had type IV strictures. MRC correctly classified 14/18 (78%) patients and underestimated tumour extension in four (22%). Successful endoscopic biliary drainage was achieved in 11/17 attempted stentings (65%), one of which was a combined procedure (endoscopic + percutaneous). One patient had a percutaneous external drain, one had a surgical bypass, and in a third a curative resection was attempted. EVective drainage was not achieved in six patients (30%). If management options had been based only on MRC, treatment choices would have been modified in a more appropriate way in 5/18 (28%) patients with satisfactory MRC. Conclusion-MRC should be considered for planning treatment of malignant hilar strictures. Accurate depiction of high grade strictures for which endoscopic drainage is not the option of choice can preclude unnecessary invasive imaging.

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

“…Indeed, several previous studies demonstrated that the accuracy of 2D-MRCP in assessing the level and feature of bile duct obstruction was comparable to that of ERCP/PTC (1,6,12,17,(22)(23)(24)(25)(26). However, at the same time, in several studies where surgical and pathological findings were used as a standard of reference, 2D-MRCP showed a relatively low accuracy regarding tumoral extent of the biliary tree (25)(26)(27). The determination of longitudinal tumor extension of bile duct cancer is one of the main challenges in MRC examinations due to the limited spatial resolution (in a range of 1.4 -2.5 mm resolution) of the MRC sequence, intrinsic complex anatomy of the bile duct near the perihilar region, and the superficial spreading of the bile duct tumors.…”

Issues in Surgery for Hilar Cholangiocarcinoma

“…2) is an extremely useful screening investigation to estimate the extent of spread in the biliary tree [7]. MRI with contrast combined with MRC can provide the same information with respect to vascularity as compared to CT scan.…”

“…MRI with contrast combined with MRC can provide the same information with respect to vascularity as compared to CT scan. Information on involvement is useful in planning preoperative biliary drainage and type of surgery, and in case of inoperable tumours, approach to palliative stenting [7].…”

A colangiopancreatografia por ressonância magnética deve substituir a colangiopancreatografia endoscópica retrógrada no algoritmo diagnóstico das doenças biliopancreáticas?

“…Há fortes indícios de que, nestes casos, a preferência seja drenar o segmento que foi contrastado durante o exame colangiográfico. Assim, através de CPRM, ZIDI et al (16) Vale ressaltar que a acurácia da ressonância para o estudo das via biliares não se repete para os ductos pancreáticos. Assim, novos métodos, tais como a pancreatorressonância dinâmica, feita com injeção de secretina, melhora a visibilização dos ductos pancreáticos (6) .…”