What is the role of ultrasonography in the workup 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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Depending on the tumor type, the sensitivity of ultrasonography (US) in depicting cholangiocarcinomas is variable, but a more definitive role in demonstrating cholangiocarcinomas with US has been defined. Dilatation of the intrahepatic bile ducts is the most common abnormality in patients with ductal cholangiocarcinoma. [17, 18, 19]

With intrahepatic tumors, the mass can be a predominantly homogeneous or heterogeneous lesion, and it is usually hyperechoic in 75% of cases. The mass may be isoechoic (about 10% of cases) or hypoechoic (15% of cases) with irregular borders and satellite nodules. Peripheral tumors are usually hypoechogenic when they are smaller than 3 cm, but they are hyperechoic when larger. Peripheral cholangiocarcinoma may be either infiltrating or nodular. The infiltrating form may be manifested as a simple diffuse abnormality of the liver echotexture. With the nodular type, the mass predominates and appears as a solitary mass with a distinct predilection for the right lobe.

With extrahepatic tumors, nearly 100% of cases with polypoidal intraluminal tumors are depicted at US, whereas US demonstrates the primary sign of the mass in only 13% of cases involving sclerosing tumors and in only 29% of those involving exophytic masses. Klatskin tumors classically manifest as segmental dilatation and nonunion of the right and left ducts at the porta hepatis.

Newer developments include extension of US techniques with endoscopic routes. Intraportal endovascular US has been used to assess vascular invasion by bile duct tumors. The use of 3-dimensional intraductal US has been investigated for the staging of bile duct cancer. In a group of 8 patients in Japan, this technique enabled the accurate assessment of tumor invasion of the arteries in 88% of patients and of portal vein and pancreatic parenchymal invasion in 100%.

In capable hands, modern high-resolution color Doppler US is highly sensitive in depicting, characterizing, and determining the resectability of a cholangiocarcinoma.

In more than 90% of cases, US is sufficient for adequate imaging and staging. Diffuse tumors may be difficult to demonstrate with US. Benign tumors of the bile duct and cholangitis may simulate cholangiocarcinomas. Strictures caused by cholangitis may cause false-positive results. Sclerosing lesions may result in false-negative results.

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