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CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

Hee Sun Park1, Jeong Min Lee1, Se Hyung Kim1, Jun Yong Jeong1, Young Jun Kim1, Kyoung Ho Lee1, Seung Hong Choi1, Joon Koo Han1 and Byung Ihn Choi1

1 All authors: Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, Korea.


Figure 1
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  		Fig. 1A —Scatterplots of relative ductal enhancement. Scatterplots show relative ductal enhancement in portal venous phase (PVP) (A) and ductal wall thickness (B) in cholangiocarcinoma and periductal fibrosis groups. Optimal cutoff values were 10 H and 2.8 mm, respectively. Sensitivity and specificity were 71.4% and 81.2%, respectively, at 10 H and 71.4% and 75.0% at 2.8 mm.

 

Figure 2
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  		Fig. 1B —Scatterplots of relative ductal enhancement. Scatterplots show relative ductal enhancement in portal venous phase (PVP) (A) and ductal wall thickness (B) in cholangiocarcinoma and periductal fibrosis groups. Optimal cutoff values were 10 H and 2.8 mm, respectively. Sensitivity and specificity were 71.4% and 81.2%, respectively, at 10 H and 71.4% and 75.0% at 2.8 mm.

 

Figure 3
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  		Fig. 2A —Receiver operating characteristic (ROC) curves for relative ductal enhancement. ROC curves show relative ductal enhancement in portal venous phase (A) and ductal wall thickness (B). Areas under ROC curves are 0.806 and 0.775, respectively.

 

Figure 4
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  		Fig. 2B —Receiver operating characteristic (ROC) curves for relative ductal enhancement. ROC curves show relative ductal enhancement in portal venous phase (A) and ductal wall thickness (B). Areas under ROC curves are 0.806 and 0.775, respectively.

 

Figure 5
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  		Fig. 3A —75-year-old woman with hepatolithiasis and cholangiocarcinoma, which were confirmed by biopsy. On unenhanced CT scan, there is an intrahepatic duct stone in the right lobe posterior segment of the liver (arrow). Both intrahepatic ducts (arrowheads) are dilated. Also note right pleural effusion.

 

Figure 6
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  		Fig. 3B —75-year-old woman with hepatolithiasis and cholangiocarcinoma, which were confirmed by biopsy. Portal venous phase image shows periductal low-attenuated mass (larger arrowheads). Right intrahepatic duct (smaller arrowheads) is enhanced and the right portal vein (arrow) is obliterated.

 

Figure 7
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  		Fig. 4A —53-year-old woman with hepatolithiasis and cholangiocarcinoma, which were confirmed by biopsy. She had undergone left lobectomy due to intrahepatic duct stones. Portal venous phase (PVP) scan shows focal intrahepatic duct dilatation (arrow) and periductal low-attenuated soft-tissue lesions along dilated duct (arrowheads).

 

Figure 8
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  		Fig. 4B —53-year-old woman with hepatolithiasis and cholangiocarcinoma, which were confirmed by biopsy. She had undergone left lobectomy due to intrahepatic duct stones. On scan obtained more caudad to A on hepatic arterial phase, ductal wall (arrowheads) is thickened and enhanced well.

 

Figure 9
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  		Fig. 4C —53-year-old woman with hepatolithiasis and cholangiocarcinoma, which were confirmed by biopsy. She had undergone left lobectomy due to intrahepatic duct stones. On PVP scan obtained at the same level as B, thickened ductal wall (arrowheads) is more strongly enhanced.

 

Figure 10
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  		Fig. 5A —59-year-old man with hepatolithiasis and cholangiocarcinoma, which were confirmed by common hepatic duct biopsy. On unenhanced scan, left intrahepatic duct stone with dilated duct (arrow) is seen. Also note atrophied left lobe lateral segment of the liver.

 

Figure 11
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  		Fig. 5B —59-year-old man with hepatolithiasis and cholangiocarcinoma, which were confirmed by common hepatic duct biopsy. Hepatic arterial phase scan shows dilated and thickened common hepatic duct with wall enhancement (arrowheads) and heterogeneous high-attenuated foci in the liver (arrow) suggesting transient hepatic attenuation difference.

 

Figure 12
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  		Fig. 5C —59-year-old man with hepatolithiasis and cholangiocarcinoma, which were confirmed by common hepatic duct biopsy. On portal venous phase (PVP) scan, thickened wall of common hepatic duct (arrowheads) is more prominently enhanced than the wall of normal duct (arrow).

 

Figure 13
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  		Fig. 5D —59-year-old man with hepatolithiasis and cholangiocarcinoma, which were confirmed by common hepatic duct biopsy. On PVP scan, aortocaval and paraaortic lymph nodes (arrowheads) are enlarged more than 1 cm, suggesting lymph node metastasis.

 

Figure 14
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  		Fig. 6A —76-year-old man with hepatolithiasis and periductal fibrosis, which were confirmed by the left lobectomy. Hepatic arterial phase scan shows dilated left intrahepatic duct filled with low-attenuated material (arrows) that was identified as intraductal stones. Around the dilated duct is geographic high attenuation (arrowheads), suggesting transient hepatic attenuation difference, in atrophied left hepatic lobe.

 

Figure 15
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  		Fig. 6B —76-year-old man with hepatolithiasis and periductal fibrosis, which were confirmed by the left lobectomy. On portal venous phase scans, there is dilated duct with intrahepatic duct stone (arrows, B) but no significant ductal wall thickening or enhancement (arrow, C) and intact portal vein (arrowheads, C).

 

Figure 16
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  		Fig. 6C —76-year-old man with hepatolithiasis and periductal fibrosis, which were confirmed by the left lobectomy. On portal venous phase scans, there is dilated duct with intrahepatic duct stone (arrows, B) but no significant ductal wall thickening or enhancement (arrow, C) and intact portal vein (arrowheads, C).

 

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