Preoperative assessment and staging of hilar cholangiocarcinoma with 16-multidetector computed tomography cholangiography and angiography.

BACKGROUND/AIMS: To evaluate prospectively the preoperative use of 16-multidetector computed tomography (MDCT) with cholangiography and angiography in determining the resectability of hilar cholangiocarcinoma. METHODOLOGY: From January 2002 to January 2008, 75 consecutive patients with hilar cholangiocarcinoma underwent preoperative MDCT with cholangiography and angiography. 3D images of the portal vein, hepatic artery, and bile ducts were created and viewed simultaneously. The accuracy of MDCT with cholangiography and angiography was determined by comparison with intraoperative and pathologic findings. RESULTS: All patients tolerated the CT imaging well and without serious complication. The sensitivity, specificity, and accuracy rates were 92.9%, 100%, and 96% for portal vein invasion and 83.3%, 100%, and 93.3% for hepatic arterial invasion. The accuracy rate of longitudinal tumor extension, using the modified Bismuth-Corlette classification, was 96%. The sensitivity, specificity, and accuracy of prediction of resectability were 95.7%, 82.1%, and 90.7%, respectively. CONCLUSIONS: Preoperative MDCT with cholangiography and angiography gave a good assessment of the degree of biliary and vascular involvement of hilar cholangiocarcinoma. It also accurately predicted resectability.