TY - JOUR
T1 - Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture
T2 - Findings at MRCP versus ERCP
AU - Park, Mi Suk
AU - Kim, Tae Kyoung
AU - Kim, Kyoung Won
AU - Park, Sung Won
AU - Lee, Jeong Kyung
AU - Kim, Jung Sun
AU - Lee, Jean Hwa
AU - Kim, Kyoung Ah
AU - Kim, Ah Young
AU - Kim, Pyo Nyun
AU - Lee, Moon Gyu
AU - Ha, Hyun Kwon
PY - 2004/10
Y1 - 2004/10
N2 - PURPOSE: To retrospectively evaluate criteria for differentiating extrahepatic bile duct cholangiocarcinoma from benign cause of stricture at magnetic resonance cholangiopancreatography (MRCP) and to compare diagnostic accuracy with this modality versus endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: MRCP and ERCP images in 50 patients (27 with cholangiocarcinoma [18 men, nine women; mean age, 58 years] and 23 with benign cause of stricture [13 men, 10 women; mean age, 60 years]) were retrospectively reviewed to assess the appearance of bile duct strictures. Final diagnosis was based on surgical or biopsy findings. Strictures were described according to their imaging appearance (irregular or smooth margins, asymmetric or symmetric narrowing, abrupt narrowing or gradual tapering, and presence or absence of double-duct sign). Sensitivity, specificity, and accuracy of MRCP and ERCP were calculated by using ratings of confidence in image-based diagnosis. Lengths of stricture were electronically measured and compared by using the Student t test. RESULTS: Among cholangiographic criteria for malignant biliary stricture, irregular margins and asymmetric narrowing were more common in cholangiocarcinomas (24 [89%] of 27 patients) than in benign strictures (six [26%] and eight [35%] of 23 patients, respectively). Sensitivity, specificity, and accuracy of the two methods for differentiation of malignant from benign causes of biliary stricture were 81% (22 of 27), 70% (16 of 23), and 76% (38 of 50), respectively, for MRCP and 74% (20 of 27), 70% (16 of 23), and 72% (36 of 50), respectively, for ERCP. Mean length (± standard deviation) of cholangiocarcinomas was 30.0 mm ± 8.5, and that of benign strictures was 13.6 mm ± 9.1 (P < .001). CONCLUSION: Accuracy of MRCP is comparable with that of ERCP. Regardless of modality, a lengthy segment of extrahepatic bile duct stricture with irregular margin and asymmetric narrowing suggests cholangiocarcinoma, and a short segment with regular margin and symmetric narrowing suggests benign cause.
AB - PURPOSE: To retrospectively evaluate criteria for differentiating extrahepatic bile duct cholangiocarcinoma from benign cause of stricture at magnetic resonance cholangiopancreatography (MRCP) and to compare diagnostic accuracy with this modality versus endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: MRCP and ERCP images in 50 patients (27 with cholangiocarcinoma [18 men, nine women; mean age, 58 years] and 23 with benign cause of stricture [13 men, 10 women; mean age, 60 years]) were retrospectively reviewed to assess the appearance of bile duct strictures. Final diagnosis was based on surgical or biopsy findings. Strictures were described according to their imaging appearance (irregular or smooth margins, asymmetric or symmetric narrowing, abrupt narrowing or gradual tapering, and presence or absence of double-duct sign). Sensitivity, specificity, and accuracy of MRCP and ERCP were calculated by using ratings of confidence in image-based diagnosis. Lengths of stricture were electronically measured and compared by using the Student t test. RESULTS: Among cholangiographic criteria for malignant biliary stricture, irregular margins and asymmetric narrowing were more common in cholangiocarcinomas (24 [89%] of 27 patients) than in benign strictures (six [26%] and eight [35%] of 23 patients, respectively). Sensitivity, specificity, and accuracy of the two methods for differentiation of malignant from benign causes of biliary stricture were 81% (22 of 27), 70% (16 of 23), and 76% (38 of 50), respectively, for MRCP and 74% (20 of 27), 70% (16 of 23), and 72% (36 of 50), respectively, for ERCP. Mean length (± standard deviation) of cholangiocarcinomas was 30.0 mm ± 8.5, and that of benign strictures was 13.6 mm ± 9.1 (P < .001). CONCLUSION: Accuracy of MRCP is comparable with that of ERCP. Regardless of modality, a lengthy segment of extrahepatic bile duct stricture with irregular margin and asymmetric narrowing suggests cholangiocarcinoma, and a short segment with regular margin and symmetric narrowing suggests benign cause.
KW - Bile duct radiography
KW - Bile ducts, neoplasms
KW - Bile ducts, stenosis or obstruction
KW - Magnetic resonance (MR), cholangiopancreatography
UR - http://www.scopus.com/inward/record.url?scp=4644294235&partnerID=8YFLogxK
U2 - 10.1148/radiol.2331031446
DO - 10.1148/radiol.2331031446
M3 - Review article
C2 - 15333766
AN - SCOPUS:4644294235
SN - 0033-8419
VL - 233
SP - 234
EP - 240
JO - Radiology
JF - Radiology
IS - 1
ER -