High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma
High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma
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DOI：
10.1016/j.amjsurg.2006.10.024
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发表时间：
2007-06-01
影响因子：
3
通讯作者：
Curley, Steven A.
中科院分区：
文献类型：
--
作者：
Aloia, Thomas A.;Charnsangavej, Chusilp;Curley, Steven A.
简介：尽管使用了放射学、内窥镜和腹腔镜分期技术，但肝门部胆管癌患者的非治疗性剖腹手术率仍然很高。本研究评估了术前高分辨率计算机断层扫描 (HRCT) 以确定在此情况下可切除性的准确性。 患者和方法：肝胆放射科医师对 2000 年至 2005 年因诊断肝门部胆管癌而接受剖腹手术的 32 名连续患者的术前螺旋 HRCT（2 个造影期，快速静脉推注造影剂，2.5 毫米切片厚度）进行了审查。 HRCT 的准确性是通过将影像学解释与术中和病理结果进行比较来确定的。卡方检验用于确定最能预测不可切除性的影像学结果。结果：32 名研究患者中有 14 名 (44%) 不可切除（沿胆管延伸，4 例；腹膜转移，4 例；血管包绕，3 例；非连续肝转移，2 例；N2 淋巴结肿大，1 例）。 HRCT 正确预测了 18 名接受治疗性剖腹手术的患者中的 17 名的可切除性（敏感性 = 94%）。 HRCT 正确预测了其余 14 例中的 11 例无法切除（特异性 = 79%）。在 HRCT 预测可切除但患者无法切除的 3 例中，亚厘米级腹膜病变、亚厘米级肝转移和远端胆管受累是主要因素。 HRCT的阴性和阳性预测值分别为92%和85%。最能预测不可切除性的个体放射学检查结果是腹膜扩散 (P = .0 15) 和肝动脉 (P = .006) 或门静脉 (P = .002) 受累。结论：术前 HRCT 可以准确预测肝门部胆管癌患者的可切除性。我们小组现在使用特定放射学特征的识别，特别是主要血管受累和腹膜异常来避免不必要的剖腹手术。 (C) 2007 Excerpta Medica Inc. 保留所有权利。
Introduction: Despite the use of radiologic, endoscopic, and laparoscopic staging techniques, the rate of nontherapeutic laparotomies in patients with hilar cholangiocarcinoma remains high. This study evaluated the accuracy of preoperative high-resolution computed tomograpy (HRCT) to determine resectability in this setting.Patients and Methods: Preoperative helical HRCT (2 contrast phases, rapid intravenous contrast bolus, 2.5-mm section thickness) for 32 consecutive patients who underwent laparotomy for the diagnosis of hilar cholangiocarcinoma from 2000 to 2005 were reviewed by a hepatobiliary radiologist. The accuracy of HRCT was determined by comparison of the imaging interpretation to intraoperative and pathologic findings. The chi-square test was used to identify imaging findings that best predicted unresectability.Results: Fourteen of the 32 (44%) study patients were unresectable (extension along bile duct, 4; peritoneal metastases, 4; vascular encasement, 3; noncontiguous liver metastases, 2; N2 lymphadenopathy, 1). HRCT correctly predicted resectability in 17 of 18 patients who underwent therapeutic laparotomy (sensitivity = 94%). HRCT correctly predicted the inability to resect in 11 of the remaining 14 cases (specificity = 79%). In the 3 cases in which HRCT predicted resectability and the patient was unresectable, subcentimeter peritoneal disease, a subcentimeter liver metastasis, and distal bile duct involvement were responsible factors. The negative and positive predictive values of HRCT were 92% and 85%, respectively. Individual radiographic findings that best predicted unresectability were peritoneal spread (P =.0 15) and hepatic artery (P =.006) or portal vein (P =.002) involvement.Conclusions: Preoperative HRCT accurately predicts resectability in patients with hilar cholangiocarcinoma. Identification of specific radiographic features, in particular major vascular involvement and peritoneal abnormalities, is now used by our group to avoid unnecessary laparotomy. (C) 2007 Excerpta Medica Inc. All rights reserved.