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Differentiation of Extrahepatic Bile Duct Cholangiocarcinoma from Benign Stricture: Findings at MRCP versus ERCP

 Mi-Suk Park  ;  Tae Kyoung Kim  ;  Hyun Kwon Ha  ;  Moon-Gyu Lee  ;  Pyo Nyun Kim  ;  Ah Young Kim  ;  Kyoung Ah Kim  ;  Jean Hwa Lee  ;  Jung-Sun Kim  ;  Jeong Kyung Lee  ;  Sung Won Park  ;  Kyoung Won Kim 
 RADIOLOGY, Vol.233(1) : 234-240, 2004 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Alkaline Phosphatase/blood ; Bile Duct Diseases/diagnosis* ; Bile Duct Diseases/diagnostic imaging ; Bile Duct Neoplasms/diagnosis* ; Bile Duct Neoplasms/diagnostic imaging ; Bile Ducts, Extrahepatic/diagnostic imaging ; Bile Ducts, Extrahepatic/pathology* ; Bilirubin/blood ; CA-19-9 Antigen/blood ; Cholangiocarcinoma/diagnosis* ; Cholangiocarcinoma/diagnostic imaging ; Cholangiopancreatography, Endoscopic Retrograde* ; Constriction, Pathologic/diagnosis ; Constriction, Pathologic/diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity
Bile duct radiography, 768.1222 Bile ducts, neoplasms, 768.3212 Bile ducts, stenosis or obstruction, 768.288, 768.294, 768.297 Magnetic resonance (MR) ; cholangiopancreatography ; 768.12149
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
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