Department of Biliary-pancreatic Surgery, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China.
Therapeutics Research Centre, School of Medicine, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Brisbane, QLD 4102, Australia.
Abdom Radiol (NY). 2017 Mar;42(3):851-860. doi: 10.1007/s00261-016-0943-0.
The purpose of this study is to investigate the value of multidetector computed tomography (MDCT) assessment of resectability in hilar cholangiocarcinoma, and to identify the factors associated with unresectability and accurate evaluation of resectability.
From January 2007 to June 2015, a total of 77 consecutive patients were included. All patients had preoperative MDCT (with MPR and MinIP) and surgical treatment, and were pathologically proven with hilar cholangiocarcinoma. The MDCT images were reviewed retrospectively by two senior radiologists and one hepatobiliary surgeon. The surgical findings and pathologic results were considered to be the gold standard. The Chi square test was used to identify factors associated with unresectability and accurate evaluation of resectability.
The sensitivity, specificity, and overall accuracy of MDCT assessment were 83.3 %, 75.9 %, and 80.5 %, respectively. The main causes of inaccuracy were incorrect evaluation of N2 lymph node metastasis (4/15) and distant metastasis (4/15). Bismuth type IV tumor, main or bilateral hepatic artery involvement, and main or bilateral portal vein involvement were highly associated with unresectability (P < 0.001). Patients without biliary drainage had higher accuracy of MDCT evaluation of resectability compared to those with biliary drainage (P < 0.001).
MDCT is reliable for preoperative assessment of resectability in hilar cholangiocarcinoma. Bismuth type IV tumor and main or bilateral vascular involvement highly suggest the unresectability of hilar cholangiocarcinoma. Patients without biliary drainage have a more accurate MDCT evaluation of resectability. We suggest MDCT should be performed before biliary drainage to achieve an accurate evaluation of resectability in hilar cholangiocarcinoma.
本研究旨在探讨多层螺旋 CT（MDCT）评估肝门部胆管癌可切除性的价值，并确定与不可切除性和准确评估可切除性相关的因素。
2007 年 1 月至 2015 年 6 月，共纳入 77 例连续患者。所有患者均行术前 MDCT（MPR 和 MinIP）和外科治疗，并经病理证实为肝门部胆管癌。由 2 名资深放射科医生和 1 名肝胆外科医生对 MDCT 图像进行回顾性审查。手术结果和病理结果被认为是金标准。采用卡方检验确定与不可切除性和准确评估可切除性相关的因素。
MDCT 评估的敏感性、特异性和总体准确性分别为 83.3%、75.9%和 80.5%。不准确的主要原因是 N2 淋巴结转移（4/15）和远处转移（4/15）的评估错误。Bismuth Ⅳ型肿瘤、主要或双侧肝动脉受累以及主要或双侧门静脉受累与不可切除性高度相关（P<0.001）。无胆道引流的患者比有胆道引流的患者 MDCT 评估可切除性的准确性更高（P<0.001）。
MDCT 术前评估肝门部胆管癌的可切除性是可靠的。Bismuth Ⅳ型肿瘤和主要或双侧血管受累高度提示肝门部胆管癌不可切除。无胆道引流的患者 MDCT 评估可切除性更准确。我们建议在胆道引流前进行 MDCT，以实现肝门部胆管癌可切除性的准确评估。
