Abstract
Biliary carcinoma, biliary fistula with occasional gallstone ileus and primary sclerosing cholangitis (PSC) are serious
diseases and present specific diagnostic and therapeutic challenges. Stenting of biliary obstruction has also involved
problems, but the reports are contradictory and partly limited. The aim of the present work was to evaluate and compare
various imaging modalities in biliary diseases. The study also aimed to evaluate the usefulness of metallic stents in
malignant biliary obstruction.
The study population consisted of 210 patients with gallbladder carcinoma, bile duct carcinoma, biliary fistula, PSC or
malignant biliary obstruction and eight control patients with various hepatobiliary diseases. The imaging findings of 80
patients with gallbladder carcinoma, 58 patients with bile duct carcinoma, and 16 patients with biliary fistula were
reviewed. Nine patients with PSC underwent magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) of
the liver, ultrasonography (US) of the liver and the bile ducts and endoscopic retrograde cholangiography (ERC). Eight
control patients had had MRC and MRI of the liver and ERC. The medical records and radiographs of 39 patients with malignant
biliary obstruction treated with percutaneously inserted metallic stents were also analysed. The stents included 48
Wallstents and seven Memotherm stents.
In cases of gallbladder carcinoma, US visualised the primary tumour in 68 % and computed tomography (CT) in 57 % of the cases
examined, but both methods were insufficient for accurate staging. In bile duct carcinoma, US revealed the primary tumour in
63 % and CT in 44 % of the cases examined. Both methods were sensitive in diagnosing peripheral intrahepatic
cholangiocarcinoma, but inaccurate for more distal bile duct carcinoma or abdominal spread. The infiltrating type of
gallbladder carcinoma and bile duct carcinoma were difficult to detect. US and CT were sensitive in revealing bile duct
obstruction.
The patients with biliary fistula and gallstone ileus had undergone various examinations with pathological, but not
diagnostic results, and there was often a delay to diagnosis. Imaging did not reveal any of the ten spontaneous fistulas, but
CT showed one of the five cases of gallstone ileus, and Gastrografin® meal revealed the single case of Bouveret's
syndrome.
Fistulography or cholangiography revealed all but one of the six iatrogenic fistulas. A nonvisualised or shrunken gallbladder
at US should raise a suspicion of biliary enteric fistula in an appropriate clinical setting.
MRC-MRI depicted the changes of PSC correctly in nine patients (radiologist 1) and in eight patients with one false positive
finding (radiologist 2) in a blinded analysis. In the segmental comparison MRC missed especially bile duct dilatations. MRC
was too pessimistic in the evaluation of the predictors of poor outcome. US detected features suggestive of PSC in eight
patients (radiologist 3). US was unable to indicate the predictors of poor outcome.
Of the patients with metallic stents in malignant biliary obstruction, 30 % had early and 66 % late complications, including
stent obstructions, which occurred in 27 % of the patients at a mean of 4.4 months. The cause was mostly tumour ingrowth or
overgrowth. The 25-week and 50-week patency rates were 71 % and 42 %. The patency rates of the patients with
cholangiocarcinoma were significantly the lowest. There was also a tendency towards lower patency with less dilatation of the
stents, an increasing number of the stents, longer strictures and hilar strictures. Many other complications were infectious.
31 % of the patients had late reinterventions.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-5917-3 |
| Date | 06 March 2001 |
| Creators | Oikarinen, H. (Heljä) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2001 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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