Role of US in the detection, characterization, and staging of cholangiocarcinoma

Cholangiocarcinoma is a rare tumor with a broad range of pathologic and clinical manifestations that demonstrates a myriad of imaging findings. Recent experience indicates that a more definitive role is possible for ultrasonography (US) in the evaluation of cholangiocarcinoma. Dilatation of the intrahepatic bile ducts is the most frequently seen US abnormality in patients with ductal cholangiocarcinoma. Klatskin tumors classically manifest as segmental dilatation and nonunion of the right and left ducts at the porta hepatis. Papillary and nodular ductal cholangiocarcinoma are relatively easy to see at US: Papillary tumors resemble polypoid intraluminal masses, whereas nodular cholangiocarcinoma manifests as a discrete smooth mass with associated mural thickening. Infiltrating ductal cholangiocarcinoma at the porta hepatis is the most common subtype but is the most difficult to appreciate at US. Peripheral cholangiocarcinoma may be either nodular or infiltrating at US: The nodular form predominates and appears as a solitary mass with a distinct right lobe predilection, whereas the infiltrative form is rare and manifests as a diffusely abnormal liver echotexture. In capable hands, modern high-resolution US equipment with color Doppler imaging capability is highly sensitive in the detection, characterization, and determination of the potential for resectability of cholangiocarcinoma. Thus, use of US may obviate more invasive procedures in some patients and help identify those patients for whom further investigation would be contributory.