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European Radiology

, Volume 27, Issue 6, pp 2563–2569 | Cite as

Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma

  • Yoshiki Asayama
  • Akihiro Nishie
  • Kousei Ishigami
  • Yasuhiro Ushijima
  • Yukihisa Takayama
  • Daisuke Okamoto
  • Nobuhiro Fujita
  • Takao Ohtsuka
  • Tomoharu Yoshizumi
  • Shinichi Aishima
  • Yoshinao Oda
  • Hiroshi Honda
Gastrointestinal
  • 335 Downloads

Abstract

Objectives

To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC).

Methods

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.

Results

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).

Conclusions

The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC.

Key points

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.

Keywords

Extrahepatic cholangiocarcinoma Multidetector computed tomography Prognosis Contrast enhancement pattern Pathology 

Abbreviations and acronyms

DPA

attenuation on delayed phase contrast-enhanced scans

EHC

extrahepatic cholangiocarcinoma

ICC

intrahepatic cholangiocarcinoma

PA

precontrast attenuation

PVPA

attenuation on portal venous scans

WR

washout ratio

Notes

Acknowledgments

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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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Yoshiki Asayama
    • 1
  • Akihiro Nishie
    • 2
  • Kousei Ishigami
    • 2
  • Yasuhiro Ushijima
    • 2
  • Yukihisa Takayama
    • 2
  • Daisuke Okamoto
    • 2
  • Nobuhiro Fujita
    • 2
  • Takao Ohtsuka
    • 3
  • Tomoharu Yoshizumi
    • 4
  • Shinichi Aishima
    • 5
    • 6
  • Yoshinao Oda
    • 6
  • Hiroshi Honda
    • 2
  1. 1.Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Departments of Clinical RadiologyKyushu UniversityFukuokaJapan
  3. 3.Departments of Surgery and OncologyKyushu UniversityFukuokaJapan
  4. 4.Departments of Surgery and SciencesKyushu UniversityFukuokaJapan
  5. 5.Pathology and Microbiology, Faculty of MedicineSaga UniversitySagaJapan
  6. 6.Departments of Anatomic Pathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

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