What are the imaging criteria for assessing unresectability of cholangiocarcinoma?

Updated: Apr 13, 2018
  • Author: Mahesh Kumar Neelala Anand, MBBS, DNB, FRCR; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

Imaging is an important link in the decision-making process at multidisciplinary meetings while determining resectability. Surgical colleagues depend vastly on imaging in case selection.

The major determinants of resectability are the following:

  • The extent of tumor within the biliary tree

  • The amount of hepatic parenchyma involved

  • Vascular invasion

  • Hepatic lobar atrophy

  • Metastatic disease

Determination of resectability is most challenging in patients with Klatskin tumors. About half of patients with Klatskin tumors that are determined to be resectable preoperatively have unresectable disease intraoperatively.

See the image below.

Three-dimensional treatment planning uses CT scan Three-dimensional treatment planning uses CT scan slices to reconstruct the patient as a volume. Shown here is the display for planning external-beam radiotherapy to the cholangiocarcinoma (green structure). A biliary catheter (red tube) runs through the tumor volume and was used to deliver brachytherapy, which was given in addition to external-beam radiotherapy. Such technology has assisted greatly in the delivery of high doses to the tumor, while sparing vital normal structures, such as the kidney and spinal cord

The radiologic criteria defining unresectability in patients with hilar tumors is shown below [9] :


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