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Preoperative Evaluation of Bile Duct Cancer: MRI Combined with MR Cholangiopancreatography Versus MDCT with Direct Cholangiography

Hee Sun Park1,2, Jeong Min Lee1,2, Jin-Young Choi1,3, Min Woo Lee4, Hyuk Jung Kim5, Joon Koo Han1,2 and Byung Ihn Choi1,2

1 Department of Radiology, Seoul National University Hospital and College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea.
2 Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
3 Present address: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
4 Department of Radiology, Konkuk University College of Medicine, Seoul, Korea.
5 Department of Radiology, Seoul Medical Center, Seoul, Korea.


Figure 1
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  		Fig. 1A —Sensitivity and specificity of both image sets for each analysis item. Bar graph shows results for biliary involvement: second biliary confluence and intrapancreatic common bile duct.

 

Figure 2
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  		Fig. 1B —Sensitivity and specificity of both image sets for each analysis item. Bar graph shows results for vascular involvement: hepatic artery and portal vein.

 

Figure 3
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  		Fig. 1C —Sensitivity and specificity of both image sets for each analysis item. Bar graph shows results for tumor resectability.

 

Figure 4
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  		Fig. 2A —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Portal phase gadolinium-enhanced MR image shows right secondary confluence appears patent (arrow, A) and left secondary confluence separated (arrows, B).

 

Figure 5
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  		Fig. 2B —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Portal phase gadolinium-enhanced MR image shows right secondary confluence appears patent (arrow, A) and left secondary confluence separated (arrows, B).

 

Figure 6
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  		Fig. 2C —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Maximum-intensity-projection reconstruction of 3D MRCP image shows hilar tumor involvement without right secondary confluence involvement (arrow) but does not show left secondary confluence (arrowhead).

 

Figure 7
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  		Fig. 2D —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Portal venous phase contrast-enhanced CT scan shows narrowing and wall enhancement of hilar duct (arrow, D), suggesting hilar cholangiocarcinoma. Right anterior and posterior ducts are confluent (arrowhead, D), whereas left secondary confluence is separated (arrowhead, E).

 

Figure 8
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  		Fig. 2E —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Portal venous phase contrast-enhanced CT scan shows narrowing and wall enhancement of hilar duct (arrow, D), suggesting hilar cholangiocarcinoma. Right anterior and posterior ducts are confluent (arrowhead, D), whereas left secondary confluence is separated (arrowhead, E).

 

Figure 9
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  		Fig. 2F —66-year-old man with Bismuth type IIIb hilar cholangiocarcinoma. Direct cholangiogram through percutaneous cholangiographic catheter shows right secondary confluence is preserved (arrow). Left intrahepatic duct is not evident because of tumor involvement.

 

Figure 10
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  		Fig. 3A —49-year-old woman with distal common bile duct cancer. T2-weighted HASTE MR image (A) and portal phase of gadolinium-enhanced MR image (B) show luminal narrowing with irregularity (arrowhead, A) and wall thickening with enhancement (arrowhead, B) of intrapancreatic common bile duct.

 

Figure 11
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  		Fig. 3B —49-year-old woman with distal common bile duct cancer. T2-weighted HASTE MR image (A) and portal phase of gadolinium-enhanced MR image (B) show luminal narrowing with irregularity (arrowhead, A) and wall thickening with enhancement (arrowhead, B) of intrapancreatic common bile duct.

 

Figure 12
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  		Fig. 3C —49-year-old woman with distal common bile duct cancer. MR cholangiopancreatographic image shows abrupt cutoff with segmental narrowing of distal common bile duct (arrow) and upstream bile duct dilatation.

 

Figure 13
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  		Fig. 3D —49-year-old woman with distal common bile duct cancer. Portal phase enhanced CT scan shows narrowed and enhanced wall of intrapancreatic common bile duct (arrowhead).

 

Figure 14
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  		Fig. 3E —49-year-old woman with distal common bile duct cancer. ERCP image shows abrupt caliber change of distal common bile duct (arrow) with upstream duct dilatation.

 

Figure 15
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  		Fig. 4A —56-year-old man with Bismuth type IIIa hilar cholangiocarcinoma with right hepatic artery invasion. Arterial phase gadolinium-enhanced MR image shows equivocal tumor invasion of right hepatic artery (arrowheads). Neither reviewer interpreted this finding as tumor involvement.

 

Figure 16
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  		Fig. 4B —56-year-old man with Bismuth type IIIa hilar cholangiocarcinoma with right hepatic artery invasion. Arterial phase enhanced CT scan shows soft-tissue encasing right hepatic artery (arrowhead), which both reviewers interpreted as indicating tumor involvement.

 

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