Cholangiocarcinoma and Malignant Biliary Obstruction 81

摘要: Cholangiocarcinomas (CC) are malignant neoplasms arising from biliary epithelium. Although it is an uncommon malignancy, the second most common primary hepatobiliary malignancy and incidence increasing globally (Malhi Gores 2006). CC can be classified according to anatomic location as intrahepatic or extrahepatic, with extrahepatic further hilar distal extrahepatic. Familiarity diverse imaging clinical manifestations depending on different morphologic types of important for accurate diagnosis assessment resectability. The classification proposed by Liver Cancer Study Group Japan (Yamasaki 2003) classifies mass-forming, periductal-infiltrating, intraductal-growing types. Risk factors include sclerosing cholangitis (PSC), chronic hepatolithiasis, recurrent pyogenic (RPC), choledocholithiasis, parasitic infestation, viral hepatitis, bile duct adenoma, papillomatosis, Caroli’s disease, choledochal cyst, Thorotrast, smoking, typhoid carrier state. However, in many cases, no risk factor identified. PSC a development Western countries (Burak et al. 2004), whereas infestation Clonorchis sinensis Opisthorchis viverrini (Kim 2006, 2007) RPC 2006) East Southeast Asia. Chronic hepatitis B C virus infections have recently been recognized both West Radiological plays crucial role staging obstruction. Ultrasound often used initial test suspected CT commonly disease well follow-up. MR helpful adjuvant modality provide superior tissue characterization highquality noninvasive cholangiography. In practice, multimodality approach challenging cases. This chapter reviews typical patterns other causes obstruction cross-sectional imaging.