Biliary ductal evaluation of hilar cholangiocarcinoma: three-dimensional direct multi-detector row CT cholangiographic findings versus surgical and pathologic results--feasibility study.

The study was conducted, with institutional review board approval and informed patient consent, to assess the feasibility and diagnostic effectiveness of three-dimensional direct multi-detector row computed tomographic (CT) cholangiography for determining the extent of bile duct invasion by hilar cholangiocarcinoma. Eleven patients underwent contrast material-enhanced direct multi-detector row CT cholangiography of the primary and secondary biliary confluence levels and then surgical resection. In most patients, CT cholangiography was tolerable and yielded excellent or good opacification of the biliary tree. CT cholangiography enabled a correct diagnosis of the extent of ductal involvement at all 11 primary confluence levels and at 18 of the 19 secondary confluence levels. Three secondary confluences, which could not be analyzed owing to nonopacification or poor opacification, proved to be involved by hilar cholangiocarcinoma. The authors conclude that three-dimensional direct multi-detector row CT cholangiography is accurate and feasible for defining the extent of ductal invasion by hilar cholangiocarcinoma, especially in patients with preliminary biliary drainage.