Hilar and Suprapancreatic Cholangiocarcinoma: Value of 3D Angiography and Multiphase Fusion Images Using MDCT
Masafumi Uchida1,
Masatoshi Ishibashi1,
Naofumi Tomita1,
Masaharu Shinagawa1,
Naofumi Hayabuchi1 and
Kouji Okuda2
1 Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi,
Kurume City, Fukuoka 830-0011, Japan.
2 Department of Surgery, Division of Hepatic Surgery, Kurume University School
of Medicine, Kurume City, Fukuoka 830-0011, Japan.
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Fig. 1A. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Portal phase CT image shows hypervascular mass
(arrow) within dilated area of common bile duct.
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Fig. 1B. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Cholangiogram obtained during endoscopic
retrograde cholangiography shows irregular filling defect in common bile
duct.
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Fig. 1C. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Curved planar reformation image through common
bile duct clearly shows hypervascular tumor (arrow) in common bile
duct. Tumor was dilating bile duct in this case but was not invasive of portal
vein. This image depicts bile duct tumor and its relationship with surrounding
structures better than corresponding endoscopic retrograde cholangiography
image (B).
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Fig. 1D. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Three-dimensional image of hepatic artery on
arterial phase CT shows posterior segmental artery (arrow) in liver,
which appears to arise from gastroduodenal artery (arrowhead).
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Fig. 1E. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Digital subtraction angiographic image shows
posterior segmental artery (arrow) arising from gastroduodenal artery
(arrowhead). This was confirmed by our CT angiography findings.
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Fig. 1F. —73-year-old woman with mass in common bile duct. On the basis
of all the images, it was decided that surgery should be performed. Resection
of extrahepatic bile duct was performed, and surgical removal of tumor was
confirmed to be sufficient. Multiphase fusion image composed of vessels,
liver, and other organs depicts relationship between portal vein (dark
blue) and artery in hilus of liver. This image was useful for vascular
treatment during surgery. Pink = artery, light blue = vein.
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Fig. 2A. —63-year-old woman with mass in hepatic hilum. In this case,
right hemihepatectomy was performed. Portal phase CT image shows ill-defined
hypoattenuating mass adjacent to hepatic hilum (arrow).
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Fig. 2B. —63-year-old woman with mass in hepatic hilum. In this case,
right hemihepatectomy was performed. Volume-rendering CT arteriography image
clearly shows that right hepatic artery arises from aorta (arrow) and
lateral segmental artery arises from left gastric artery.
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Fig. 2C. —63-year-old woman with mass in hepatic hilum. In this case,
right hemihepatectomy was performed. Multiphase fusion image composed of
vessels and liver shows structure surrounding portal vein (black
arrow and dark blue) into liver, right hepatic artery (white
arrow), and left hepatic artery (black arrowhead). Furthermore,
it helped surgeons to understand flow into liver through lateral segmental
artery (white arrowhead). Pink = artery, light blue = vein.
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Fig. 2D. —63-year-old woman with mass in hepatic hilum. In this case,
right hemihepatectomy was performed. Multiphase fusion image depicts
localization of major accessory hepatic vein (arrow). Obtained before
surgery, this image aided in treatment of hepatic vein during right
hepatectomy. Pink = artery, light blue = vein.
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Fig. 3A. —68-year-old woman with mass in common bile duct. Surgery was
judged to be possible and resection of extrahepatic bile duct was performed on
the basis of the imaging findings. Percutaneous transhepatic bile drainage was
performed via IV injection and percutaneous transhepatic bile drainage tube of
contrast medium to treat obstructive jaundice. Portal phase CT image shows
well-enhanced mass in common bile duct (arrow).
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Fig. 3B. —68-year-old woman with mass in common bile duct. Surgery was
judged to be possible and resection of extrahepatic bile duct was performed on
the basis of the imaging findings. Percutaneous transhepatic bile drainage was
performed via IV injection and percutaneous transhepatic bile drainage tube of
contrast medium to treat obstructive jaundice. Curved planar reformation image
through common bile duct clearly shows well-enhanced, thickened bile duct wall
and hypervascular mass in common bile duct (arrow). Tumor is separate
from portal vein and was not invasive of portal vein.
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Fig. 3C. —68-year-old woman with mass in common bile duct. Surgery was
judged to be possible and resection of extrahepatic bile duct was performed on
the basis of the imaging findings. Percutaneous transhepatic bile drainage was
performed via IV injection and percutaneous transhepatic bile drainage tube of
contrast medium to treat obstructive jaundice. Three-dimensional CT
cholangiography image of bile duct system depicts bile duct systems clearly
and shows complete occlusion of common bile duct (arrow).
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Fig. 3D. —68-year-old woman with mass in common bile duct. Surgery was
judged to be possible and resection of extrahepatic bile duct was performed on
the basis of the imaging findings. Percutaneous transhepatic bile drainage was
performed via IV injection and percutaneous transhepatic bile drainage tube of
contrast medium to treat obstructive jaundice. Multiphase fusion image
composed of vessels shows relationship between portal vein (dark
blue) and artery (pink) and could be understood before surgery.
Image depicts noninvasive finding (arrowhead) in portal vein around
tumor. Light blue = vein.
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Fig. 4A. —69-year-old man with mass in hepatic hilum. This case was
considered to be inoperable because of liver and portal vein invasion. Portal
phase CT image shows ill-defined, hypoattenuating mass in hepatic hilum
(white arrows) and area adjacent to liver associated with ill-defined
hypoattenuating mass (black arrows). Indeed, this resulted in direct
invasion of liver.
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Fig. 4B. —69-year-old man with mass in hepatic hilum. This case was
considered to be inoperable because of liver and portal vein invasion. This
case underwent percutaneous transhepatic bile drainage due to obstructive
jaundice via IV injection and percutaneous transhepatic bile drainage tube of
contrast medium. This 3D image of bile duct system, created by cholangiogram
CT, shows complete occlusion of common hepatic bile duct (arrow) and
marked narrowing of right hepatic duct (arrowhead).
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Fig. 4C. —69-year-old man with mass in hepatic hilum. This case was
considered to be inoperable because of liver and portal vein invasion.
Multiphase fusion images composed of vessels, bile duct, and liver aid in
understanding surrounding structure of bile duct, hepatic artery, and portal
vein (dark blue). This image does not suggest invasive finding in
hepatic artery but depicts narrowing (arrows) of portal vein that is
suspected to occur with invasion. Pink = artery.
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Copyright © 2005 by the American Roentgen Ray Society.
