Radiological diagnosis and intervention of cholangiocarcinomas (CC)

• Published in: RöFo : Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebende Verfahren Vol. 184; no. 10; p. 883
• Main Authors: Vogl, T J, Zangos, S, Eichler, K, Gruber-Rouh, T, Hammerstingl, R M, Trojan, J, Weisser, P
• Format: Journal Article
• Language: German
• Published: Germany 01.10.2012
• Subjects: Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - therapy; Bile Ducts, Intrahepatic - pathology; Biomarkers, Tumor - blood; CA-19-9 Antigen - blood; Carcinoembryonic Antigen - blood; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - pathology; Cholangiocarcinoma - therapy; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Combined Modality Therapy; Contrast Media - administration & dosage; Diagnostic Imaging; Humans; Image Enhancement; Magnetic Resonance Imaging; Prognosis; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 1438-9010
• DOI: 10.1055/s-0032-1312842

To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 - 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37-84% (depending on the location) for ultrasound, 79-94% for computed tomography (CT), and 95% for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI)--also known as chemoperfusion--, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.