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Using CT and Cholangiography to Diagnose Biliary Tract Carcinoma Complicating Primary Sclerosing Cholangitis

¹ Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213-2582.
² Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582.
³ Present address: Real Hospital Português, Setor de Endoscopie (Endoscopie-Centro de Diagnóstico e Tratamento), Av. Portugal 163, Derby-Recife PE, 51010-010 Brazil.
⁴ Present address: Department of Radiology, University of Brescia, 1 via Valsabbina, Brescia 25100, Italy.
⁵ Present address: Department of Radiology, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Yamanashi, Japan 409-3815.
⁶ Present address: Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita Osaka, Japan 565-0871.
⁷ Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261.

OBJECTIVE. The objective of our study was to determine the value of CT and cholangiography for diagnosing biliary tract carcinoma complicating primary sclerosing cholangitis.

MATERIALS AND METHODS. One hundred thirteen abdominal CT examinations and cholangiograms in 45 patients with primary sclerosing cholangitis, including 18 patients with established biliary tract carcinoma, were analyzed for tumor. Four radiologists who were unaware of the presence or absence of carcinoma rated each study as to the probability of malignancy. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of CT and cholangiography, the value of imaging signs, and the degree of inter-observer variation in interpretation. Sensitivity and specificity values were calculated.

RESULTS. CT outperformed cholangiography in the detection of carcinoma. The average area under the receiver operating characteristic curve was 0.82 for CT and 0.57 for cholangiography (p = 0.003). Sensitivity and specificity for detecting carcinoma using CT were good, with average values of 82% and 80%, respectively. Average sensitivity and specificity for cholangiography were 54% and 53%, respectively. The most reliable sign of tumor on CT was a discrete mass. Progressive biliary dilatation on sequential studies was the most useful sign on cholangiography. Interobserver agreement assessed using the Cronbach was fair for cholangiography and good for CT.

CONCLUSION. CT provides good sensitivity and specificity and significantly outperforms cholangiography in detecting biliary tract carcinoma complicating primary sclerosing cholangitis. Despite limitations, CT and cholangiography provide useful information not otherwise available in the treatment of patients with primary sclerosing cholangitis.

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