Preoperative evaluation of gallbladder carcinoma: Efficacy of combined use of MR imaging, MR cholangiography, and contrast‐enhanced dual‐phase three‐dimensional MR angiography

Abstract

Purpose:To determine the efficacy of the combined use of magnetic resonance (MR) imaging, MR cholangiography (MRC), and MR angiography (MRA) in the preoperative evaluation of gallbladder carcinoma. Materials and Methods:During a 20-month period, 41 patients with proven gallbladder carcinomas were referred for MR examination, including MR imaging, MRC, and gadolinium-enhanced dual-phase MRA to determine the operability of their gallbladder carcinoma. Eighteen patients who underwent surgery within six days of the MR examination were included in this study. All MR images were analyzed in order to assess bile duct invasion, vascular invasion, hepatic invasion or metastasis, lymph node metastasis, and invasion into adjacent organs.Results: Surgical and histopathologic findings revealed hepatic invasion in nine patients, bile duct invasion in nine, vascular invasion in three, and lymph node metastasis in 10. The sensitivity and specificity of MR examination were, respectively, 100% and 89% for bile duct invasion, 100% and 87% for vascular invasion, 67% and 89% for hepatic invasion, and 56% and 89% for lymph node metastasis. Conclusion:The "all-in-one" MR protocol, including MR imaging, MRC, and MRA, can be an effective diagnostic method in the preoperative work-up for gallbladder carcinoma.

Correlative Imaging in Gallbladder Carcinoma

“…1C and D) demonstrated a suspicious, contrast-enhanced mass adjacent to the wall of the gallbladder and possibly locally invading the liver. Non-contrast enhanced 18 F-FDG PET/CT ( Fig. 1E and F) confirmed a mass lesion with hypermetabolic characteristics at the fundus of the gallbladder and suggested local invasion of the liver parenchyma.…”

“…Abdominal history included diverticulosis, diverticulitis, cholangitis, pancreatitis, and a partial colectomy for an ileocaecal adenoma. Seven years earlier, there was an increased CA19.9 without signs of malignancy on 18 F-FDG PET/CT or US-endoscopy. The patient had no abdominal pain.…”

“…Physical examination revealed a painless abdomen with normal peristalsis. Contrast enhanced 18 F-FDG PET/CT (Fig. 3A, B, C and D) showed a mass lesion with hypermetabolic characteristics at the gallbladder with invasion of the liver.…”

“…CT and MRI are used for further characterization of the gallbladder lesions and metastatic survey. 18 F-FDG PET/CT is useful in diagnosing ambiguous primary lesions, uncovering distant disease and detecting residual disease after cholecystectomy. In this report, we present these imaging findings in 4 patients with gallbladder carcinoma.…”

Cholangiocarcinome vésiculaire de découverte fortuite sur pièce de cholécystectomie : faut-il réopérer ?

“…La tomographie à émission de positrons peut également permettre de rechercher des sites extra-vésiculaires [12]. En revanche, l'évaluation du statut ganglionnaire reste cependant difficile à apprécier en imagerie [13,14].…”