Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma
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To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC).
This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT − attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT − attenuation value at unenhanced CT)] × 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed.
The median washout ratio was 29.4 %. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027).
The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC.
• Dynamic contrast study can evaluate the aggressiveness of extrahepatic cholangiocarcinoma.
• A lower washout ratio was an independent prognostic factor for overall survival.
• CT can predict survival and inform decisions on surgical options or chemotherapy.
KeywordsExtrahepatic cholangiocarcinoma Multidetector computed tomography Prognosis Contrast enhancement pattern Pathology
Abbreviations and acronyms
attenuation on delayed phase contrast-enhanced scans
attenuation on portal venous scans
The scientific guarantor of this publication is Professor Hiroshi Honda. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 16 K10282. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Study subjects or cohorts have not been previously reported.
Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.
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