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A case-based approach to MR imaging patterns of cholangiocarcinoma and post-intervention features
Peter Aaron Harri1, Juan Camacho2, Lauren Alexander1, and Pardeep Mittal1

1Radiology and Imagining Sciences, Emory University School of Medicine, Atlanta, GA, United States, 2Radiology, Medical Univeristy of South Carolina

Synopsis

Cholangiocarcinoma may demonstrate typical imaging manifestations and common patterns of organ involvement, guiding diagnosis, and facilitating imaging follow up after therapy. Adequate knowledge of tumoral biology in cholangiocarcinoma and current image-guided therapeutic approaches, along with imaging appearance of cholangiocarcinoma before and after image-guided interventions is crucial for adequate diagnosis and surveillance .MR imaging plays a key role for patient management, assessing therapy response and patient surveillance.

Learning Goals

1. Review basic principles of cholangiocarcinoma and common dissemination pathways, including differential diagnosis.

2. Discuss tumoral biology in cholangiocarcinoma and current image-guided therapeutic approaches.

3.Discuss a practical approach to determine key diagnostic imaging findings and post-treatment changes following image-guided interventions for cholangiocarcinoma on MR imaging.

Background Information and Content

Basic presentation of cholangiocarcinoma and differential diagnosis for their mimics in a pattern-based approach.

MR evaluation: Review of MR imaging findings and algorithms for an adequate imaging approach to cholangiocarcinoma.

Role of imaging in diagnosis and treatment of cholangiocarcinoma, applying key concepts though a case presentation format.

Important concepts are illustrated with schematic diagrams. Emphasis is placed on practical approaches, image pattern recognition and image guided therapies evaluation.

Conclusions

Cholangiocarcinoma may demonstrate typical imaging manifestations and common patterns of organ involvement, guiding diagnosis, and facilitating imaging follow up after therapy.

MR imaging plays a key role for patient management, assessing therapy response and patient surveillance.

Adequate knowledge of imaging appearance of cholangiocarcinoma before and after image-guided interventions is crucial for adequate diagnosis and surveillance.

Acknowledgements

No acknowledgement found.

References

- Ibrahim SM, Mulcahy MF, Lewandowski RJ, Sato KT, Ryu RK, Masterson EJ, Newman SB, Benson A, Omary RA, Salem R. Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study. Cancer. 2008;113:2119-28.

- Saxena A, Bester L, Chua TC, Chu FC, Morris DL. Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option. Ann Surg Oncol. 2010;17:484-91.

- Camacho J, Kokabi N, Xing M, Schuster D, Kim H. PERCIST criteria predict survival at 3-months following intra-arterial resin-based Yttrium-90 radioembolization therapy for unresectable Intrahepatic Cholangiocarcinoma. Presented at CIRSE 2013.

- Camacho J, Kokabi N, Xing M, Prajapati H, El Reyes B, D, Kim H. mRECIST Criteria Responses at an early time point by contrast enhanced imaging Predicts Survival in Patients with unresectable Intrahepatic Cholangiocarcinoma (ICC) refractory to standard chemotherapy following Intra-arterial Yttrium-90 (Y-90) Resin-based Radioembolization Presented at WCIO 2013.

Figures

CHOLANGIOCARCINOMA SUBTYPES

CRITERIA FOR ASSESSING TREATMENT RESPONSE FOR ICC AFTER Y-90

mRECIST and PERCIST CRITERIA FOR ASSESSING TREATMENT RESPONSE AFTER Y-90 FOR ICC

mRECIST CRITERIA AS IMAGING BIOMARKER TO PREDICT SURVIVAL AFTER Y90 IN ICC

PERCIST CRITERIA AS IMAGING BIOMARKER TO PREDICT SURVIVAL AFTER Y90 IN ICC

Proc. Intl. Soc. Mag. Reson. Med. 25 (2017)
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