Magnetic resonance cholangiopancreatography for assessing hilar cholangiocarcinoma

Abstract

Objectives: 1) To determine the performance of MRCP as a preoperative diagnostic procedure in patients with hilar cholangiocarcinoma (hilar CHCA) 2) To determine the performance of MRCP as a preoperative diagnostic procedure in patients with common duct cholangiocarcinoma (common duct CHCA) 3) To evaluate agreement between MRCP and operative findings in patients with hilar CHCA and common duct CHCA. Study design : Descriptive study, diagnostic test. Setting: Srinagarind hospital, Khon Kaen University. Research methodology: The study involved 54 Thai adult patients with pathologically proven cholangiocarcinoma who were assessed using the MRCP procedure, before undergoing a biliary tract operation. MRCP findings of CHCA patients were assessed and recorded by a trained radiologist. Operative findings were assessed and recorded by surgeons. The performance of MRCP as a preoperative diagnostic- procedure for hilar CHCA patients was evaluated by using operative findings as a gold standard. An agreement between the use of MRCP and operative findings for assessing biliary tract in hilar CHCA and CHCA at the common duct was also performed. Results: Fifty-four cases of patients with CHCA who were examined using MRCP and underwent biliary operation were recruited. The sample group included 39 males and 15 females. The mean (± S.D) age was 55.2 (+ 9.8 ) years. Seventy percent of patients had hilar involvement, and 48.1% had a common bile duct lesion. Some patients had cancer in more than one location. The characteristic diagnostic test of MRCP for hilar CHCA showed a sensitivity of 100%(95% lower Cl; 90.7%), a specificity of 87.5% (95% Cl; 61.6%, 98.4%), an accuracy of 96.3%(95% Cl; 87.3%, 99.5%) and likelihood ratio of 8 for the diagnosis of hilar CHCA, and a sensitivity of 88.5% (95% CI;69.8%, 97.6%), a specificity of 100% (95% lower Cl; 87.7%), an accuracy of 94.4%(84.6%, 98.8%) for the diagnosis of CHCA at the common bile duct. Therefore the MRCP had good diagnostic performance in the diagnosis of hilar CHCA and common duct CHCA.