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Accuracy of Preoperative T-Staging of Gallbladder Carcinoma Using MDCT

¹ Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea.
² Present address: Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —51-year-old woman with stage pT1a lesion of gallbladder, which was diagnosed on CT as stage T1. Axial CT scan shows well-enhancing nodular lesion (arrow). There is no wall thickening around nodular lesion in gallbladder.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —51-year-old woman with stage pT1a lesion of gallbladder, which was diagnosed on CT as stage T1. Photomicrograph of histopathologic specimen reveals tumor to be confined to mucosal layer (pT1a). (H and E)

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —55-year-old woman with stage pT1b lesion of gallbladder, which was diagnosed on CT as stage T1. Axial CT scan shows nodular lesion with smooth thickening and enhancement of gallbladder wall (arrows).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —55-year-old woman with stage pT1b lesion of gallbladder, which was diagnosed on CT as stage T1. Photomicrograph of histopathologic specimen shows tumor to be confined to muscular layer (pT1b) (arrowheads). (H and E, x40)

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —72-year-old man with stage pT1 gallbladder cancer, which was overstaged as T2. Axial CT scan shows focal wall thickening and nodular lesion (black arrow) in body of gallbladder. Tumor was overstaged as T2 by observers because enhancement of thickened gallbladder wall was considered to represent tumor involvement of whole layer of gallbladder wall (white arrow).

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —72-year-old man with stage pT1 gallbladder cancer, which was overstaged as T2. Endoscopic sonogram definitely shows preserved hypoechoic muscle layer (arrowheads) that suggests T1 lesion.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —72-year-old man with stage pT1 gallbladder cancer, which was overstaged as T2. Photomicrograph of histopathologic specimen reveals tumoral extension (arrowheads) through Rokitansky-Aschoff sinuses (asterisk). Involvement of Rokitansky-Aschoff sinuses indicates T1 lesion. However, tumor involvement of Rokitansky-Aschoff sinuses, which is invaginated into muscular layer, may mimic T2 lesion. (H and E, x40)

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —57-year-old man with stage pT3 gallbladder cancer that was understaged as T2 on axial CT images. Axial CT scan shows nodular lesion (arrow) in body of gallbladder and subtle hyperattenuation of adjacent pericholecystic fat (arrowheads). Observers considered lesion to be cholecystitis accompanying cancer because of weak enhancement of pericholecystic fat.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —57-year-old man with stage pT3 gallbladder cancer that was understaged as T2 on axial CT images. Oblique coronal CT scan shows pericholecystic fat infiltration and pericholecystic vessel involvement (arrowheads).

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —57-year-old man with stage pT3 gallbladder cancer that was understaged as T2 on axial CT images. Cut surface of gross specimen of gallbladder reveals pericholecystic fat invasion (arrowheads).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —54-year-old woman with stage pT3 gallbladder cancer. These images show value of multiplanar reformation (MPR) images in evaluation of T-staging. Axial CT scan shows eccentric wall thickening (arrow) and papillary lesion (asterisk) in fundus of gallbladder. Fat plane between liver and gallbladder seems to be preserved on this axial plane (arrowheads). This lesion was interpreted as T2 on axial CT image.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —54-year-old woman with stage pT3 gallbladder cancer. These images show value of multiplanar reformation (MPR) images in evaluation of T-staging. However, oblique coronal MPR image shows focal liver invasion of gallbladder cancer into adjacent liver (arrowheads). Asterisk indicates papillary lesion.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —54-year-old woman with stage pT3 gallbladder cancer. These images show value of multiplanar reformation (MPR) images in evaluation of T-staging. Cut surface of gross specimen reveals pT3 lesion (arrowheads).

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