Comparison of computed tomographic finding of the intraductal and periductal cholangiocarcinoma.

Objective: To compare the CT findings of the intraductal and periductal cholangiocarcinoma (CCA) in Srinagarind Hospital.

Material And Method: The authors retrospectively reviewed the abdominal CT images (taken between January 2004 and December 2005) of 60 patients with pathologicalproof of CCA. There were 34 and 26 cases of the intraductal and periductal CCA, respectively. The bile duct dilatation, size and location of the intraductal and infiltrative extraductal masses, ductal wall enhancement and other associated findings (i.e., biliary stones, ascites, intra-abdominal lymphadenopathy and distant metastases) were compared and analyzed using the chi2 and Fisher exact tests.

Results: All cases of the intraductal and periductal CCA showed bile duct dilatation. The intraductal mass was seen in all cases of the intraductal CCA but none in the periductal CCA (p = 0.00). All intraductal mass sizes were >1 cm. Most (77%, n = 20/26) cases of the periductal CCA had an infiltrative extraductal mass, whereas none were found in the intraductal CCA (p = 0.00). Ductal wall enhancement was found in 73% (n = 19/26) of the periductal CCA and 26% (n = 9/34) of the intraductal CCA cases (p = 0.01). Only one case in each group presented with biliary stones. Half (50%, n = 13/26) and 12% (n = 3/26) of the periductal CCA cases demonstrated with intra-abdominal lymphadenopathy and ascites, respectively, vs. none in the intraductal CCA (p = 0.00 and 0.07, respectively). No distant metastasis was found in either group.

Conclusion: The CT findings that helped to diferentiate the intraductal from periductal CCA include: the intraductal mass, an infiltrative extraductal mass, ductal wall enhancement and other associated findings such as intra-abdominal lymphadenopathy. Features of the intraductal CCA included the intraductal mass without intra-abdominal lymphadenopathy and ductal wall enhancement about 26% (9/34 cases).