Skip to main content

Advertisement

SpringerLink
Log in

Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC).

Methods

This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT − attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT − attenuation value at unenhanced CT)] × 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed.

Results

The median washout ratio was 29.4 %. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027).

Conclusions

The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC.

Key points

• Dynamic contrast study can evaluate the aggressiveness of extrahepatic cholangiocarcinoma.

• A lower washout ratio was an independent prognostic factor for overall survival.

• CT can predict survival and inform decisions on surgical options or chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

DPA:

attenuation on delayed phase contrast-enhanced scans

EHC:

extrahepatic cholangiocarcinoma

ICC:

intrahepatic cholangiocarcinoma

PA:

precontrast attenuation

PVPA:

attenuation on portal venous scans

WR:

washout ratio

References

  1. Khan SA, Taylor-Robinson SD, Toledano MB, Beck A, Elliott P, Thomas HC (2002) Changing international trends in mortality rates for liver, biliary and pancreatic tumours. J Hepatol 37:806–813

    Article  PubMed  Google Scholar 

  2. Sobin LH, Gospodarowicz M, Wittekind C (2009) TNM classification of malignant tumors, 7th edn. Wiley, Chichester

    Google Scholar 

  3. Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K (2005) Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103:1210–1216

    Article  PubMed  Google Scholar 

  4. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T (2007) Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg 31:337–342.

  5. Murakami Y, Uemura K, Sudo T et al (2013) Perineural invasion in extrahepatic cholangiocarcinoma: prognostic impact and treatment strategies. J Gastrointest Surg 17:1429–1439

    Article  PubMed  Google Scholar 

  6. Cho MS, Kim SH, Park SW et al (2012) Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience. J Gastrointest Surg 16:1672–1679

    Article  PubMed  Google Scholar 

  7. Cai WK, Lin JJ, He GH, Wang H, Lu JH, Yang GS (2014) Preoperative serum CA19-9 levels is an independent prognostic factor in patients with resected hilar cholangiocarcinoma. Int J Clin Exp Pathol 7:7890–7898

    PubMed  PubMed Central  Google Scholar 

  8. Zhou Y, Liu S, Wu L, Wan T (2015) Survival after surgical resection of distal cholangiocarcinoma: a systematic review and meta-analysis of prognostic factors. Asian J Surg. doi:10.1016/j.asjsur.2015.07.002

    Google Scholar 

  9. Kim SA, Lee JM, Lee KB et al (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern–correlation with clinicopathologic findings. Radiology 260:148–157

    Article  PubMed  Google Scholar 

  10. Asayama Y, Yoshimitsu K, Irie H et al (2006) Delayed-phase dynamic CT enhancement as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma. Radiology 238:150–155

    Article  PubMed  Google Scholar 

  11. Nakanuma Y, Sato Y (2014) Hilar cholangiocarcinoma is pathologically similar to pancreatic duct adenocarcinoma: suggestions of similar background and development. J Hepatobiliary Pancreat Sci 21:441–447

    Article  PubMed  Google Scholar 

  12. Ercolani G, Dazzi A, Giovinazzo F et al (2015) Intrahepatic, peri-hilar and distal cholangiocarcinoma: three different locations of the same tumor or three different tumors? Eur J Surg Oncol 41:1162–1169

    Article  CAS  PubMed  Google Scholar 

  13. Kim JE, Lee JM, Kim SH et al (2010) Differentiation of intraductal growing-type cholangiocarcinomas from nodular-type cholangiocarcinomas at biliary MR imaging with MR cholangiography. Radiology 257:364–372

    Article  PubMed  Google Scholar 

  14. Miyazaki M, Ohtsuka M, Miyakawa S et al (2015) Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J Hepatobiliary Pancreat Sci 22:181–196

    Article  PubMed  Google Scholar 

  15. Kajiyama K, Maeda T, Takenaka K, Sugimachi K, Tsuneyoshi M (1999) The significance of stromal desmoplasia in intrahepatic cholangiocarcinoma: a special reference of 'scirrhous-type' and 'nonscirrhous-type' growth. Am J Surg Pathol 23:892–902

    Article  CAS  PubMed  Google Scholar 

  16. Aishima S, Oda Y (2015) Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci 22:94–100

    Article  PubMed  Google Scholar 

  17. Jarnagin WR, Bowne W, Klimstra DS et al (2005) Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg 241:703–712.

  18. Choi YH, Lee JM, Lee JY et al (2008) Biliary malignancy: value of arterial, pancreatic, and hepatic phase imaging with multidetector-row computed tomography. J Comput Assist Tomogr 32:362–368

    Article  PubMed  Google Scholar 

  19. Lacomis JM, Baron RL, Oliver JH 3rd, Nalesnik MA, Federle MP (1997) Cholangiocarcinoma: delayed CT contrast enhancement patterns. Radiology 203:98–104

    Article  CAS  PubMed  Google Scholar 

  20. Itai Y, Ohtomo K, Kokubo T et al (1986) CT of hepatic masses: significance of prolonged and delayed enhancement. AJR Am J Roentgenol 146:729–733

    Article  CAS  PubMed  Google Scholar 

  21. Kim NR, Lee JM, Kim SH et al (2008) Enhancement characteristics of cholangiocarcinomas on mutiphasic helical CT: emphasis on morphologic subtypes. Clin Imaging 32:114–120

    Article  CAS  PubMed  Google Scholar 

  22. Nishie A, Asayama Y, Ishigami K et al (2014) Pathological manifestation of difference in washout pattern of adrenal hyperplasia on dynamic CT. J Med Imaging Radiat Oncol 58:559–564

    Article  PubMed  Google Scholar 

  23. Boland GW (2011) Adrenal imaging: why, when, what, and how? Part 2. What technique? AJR Am J Roentgenol 196:W1–W5

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Professor Hiroshi Honda. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 16 K10282. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Study subjects or cohorts have not been previously reported.

Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yoshiki Asayama

  2. Departments of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita & Hiroshi Honda

  3. Departments of Surgery and Oncology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Takao Ohtsuka

  4. Departments of Surgery and Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Tomoharu Yoshizumi

  5. Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan

    Shinichi Aishima

  6. Departments of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shinichi Aishima & Yoshinao Oda

Authors
  1. Yoshiki Asayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiro Nishie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kousei Ishigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasuhiro Ushijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukihisa Takayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daisuke Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nobuhiro Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takao Ohtsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoharu Yoshizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shinichi Aishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshinao Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroshi Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiki Asayama.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asayama, Y., Nishie, A., Ishigami, K. et al. Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma. Eur Radiol 27, 2563–2569 (2017). https://doi.org/10.1007/s00330-016-4621-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4621-y

Keywords

Search

Navigation