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Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability.
D J Gulliver1, M E Baker, C A Cheng
1Department of Radiology, Duke University Medical Center, Durham, NC 27710.
AJR. American Journal of Roentgenology
|September 1, 1992
Summary
Computed tomography (CT) accurately predicts tumor resectability in malignant biliary obstruction, often outperforming angiography. High-quality CT can eliminate the need for additional preoperative angiography in many cases.
Area of Science:
- Radiology
- Surgical Oncology
- Gastroenterology
Background:
- Preoperative angiography is advocated by some for assessing pancreatic and periampullary tumor resectability.
- Computed tomography (CT) is questioned for its accuracy in determining resectability compared to angiography.
Purpose of the Study:
- To evaluate the accuracy of CT in predicting surgical resectability for patients with malignant biliary obstruction.
Main Methods:
- Retrospective analysis of 380 patients with malignant biliary obstruction over 4 years.
- Review of preoperative CT scans from 67 surgically treated patients with confirmed malignancy.
- Assessment of CT scans for tumor resectability by an independent interpreter.
Main Results:
- CT correctly identified unresectable tumors in 42 of 47 cases (89% positive predictive value).
- CT correctly identified resectable tumors in 16 of 20 cases (80% positive predictive value).
- CT identified unresectability reliably when periarterial fat infiltration was present.
Conclusions:
- CT accuracy for predicting tumor resectability in malignant biliary obstruction is comparable to angiography.
- High-quality, thin-section dynamic CT can negate the need for supplementary angiography in potentially resectable cases.