Evaluation Of Multi-detector Row CT In Preoperative TNM Staging And Classification Of Hilar Cholangiocarcinoma

The hilar cholangiocarcinoma (HC) denotes to the cancer which is located in the left hepatic duct,right hepatic duct, left right hepatic duct furcation and common hepatic duct paraxial mesoderm (also be called to Klaskin tumor). It is the most frequent malignant tumor in biliary passage and the second one in the liver primarily malignant tumor which is only less than the primary hepatic carcinoma. Owing to the special location, there are often not specificitical clinical manifestations before the duct is obstructed by the tumor so that most of the patients is visited as the jaundice.However,after the block of the duct, thehilar cholangiocarcinoma has special and typical distinct clinical manifestation as follows: (1) in progress gravated without pain obstructive jaundice. (2) hepatome- galy. (3) vesica-fellea can not to touch or vacuity. (4) Intrahepatic cholangiectasis. (5) without expanding of common hepatic duct. (6) tumeur in the fossa transversalis hepatic. At present, there are many imageological techniques to detect the hilar cholangiocarcinoma including type-B ultrasonic→CT→PTC→ERCP or MRCP→selective angiography. And MDCT technique can provide clinician to favor by means of the good qualities of the itshortcut, anodynia, not to create, accuracy and so on. The encroachment of the hilar cholangiocarcinoma to the biliary system, blood vessel, ganglia lymphatica transferring and vicinity other tissue structure transfer can be detect via observing the primitive axial view image and conjunction three-dimensional reconstruction image.Objective: investigating Evaluation of Multi-detector Row CT in preoperative TNM staging and classification of hilar cholangiocarcinomaMaterials and method: In this article, 46 examples of CT plain and enhancement scannings of hilar cholangiocarcinoma in our faculty are collected. The scanned patients will drink 600-1000ml water in 10-15 minutes before staging. The scanning body position is dorsal decubitus and scanning parameter is listed as follows: tube tension 120kv, tube current 360mA, every rotation time of a week 0.5s, pitch 1.375: 1, thick 1.25 mm/16i. Before the plain and enhancement scannings, 100ml (300 mgI/ml) Ultravist or Omnipaque is high pressrue injected through antecubital vein, injection velocity 3 ml/s, arterial phase, venous phase and delay time are 29s,35s,85s, respectively, after beginning the injection. The area of the plain and enhancement scannings is limited to consist of integral biliary system, and accomplished with airintake and Breathholding with scanning layer thick 5 mm, intermission 5 mm. The scanning incoming data is lamellar reconstitution with both 1.0 mm of the layer thick and interval equal and transmited to workstation. The reconstitution ways of volum rendering (VR), multi-planar reformation (MPR) and maximum intensity projection (MIP) are carried out in all cases. tumor information is observed including: (1) obstruction part, tumorous magnitude, scope, the scanning intensive modality, degree and so on. (2) encroachment to transfer situation which include the the liver parenchyma, surrounding organ, absorbent gland and blood vessel, as well as the information of abdominal cavity or long-range transfer. (3) other signs including intrahepatic bile duct degree and morphous, cholecys size, alteration of the liver morphous and so on.Result: The MDCT technique can show not only the growing condition of the hilar cholangiocarcinoma in the bile duct but also the condition of the surrounding organ, blood vessel, absorbent gland and long-range transfer. The accurate rate of classification using MDCT technique is 82.6%(38/46). The accurate rate of the TNM staging is 80.4% (37/46) of T staging, 73.9% (34/46) of N staging and 91.3% (42/46) of M staging respectively.Conclusion: MDCT technique has its distinct superiority to the preoperative TNM staging and classification and postop evaluation of the hilar cholangiocarcinoma so that it can provide convenient, across the board and effective check method for the clinic preliminary examination to increase the rate of accuracy of early diagnosis, which is significantly benefited to set up the treating scheme of operation.