Page 15 - ARNM-3-1

Advances in Radiotherapy
& Nuclear Medicine Diagnostics gude of biliary tract cancer

for perihilar cancer, and 76% and 74% for extrahepatic purely clinical pre-operative models and provided results
cancer, respectively. In a recent study, PET exhibited 90% comparable to post-operative models. To enhance the
94
99
sensitivity and 78% specificity for diagnosing pCCA. diagnostic performance of PET/CT imaging in iCCA,
63
Another study on the clinical role of 18-FDG PET-CT in it can be combined with MRI, as demonstrated by Jiang
100
patients with suspected and potentially operable biliary et al. Another emerging technology in CCA imaging
tract cancer found a sensitivity of 84.0% and a specificity is simultaneous PET and MRI (PET/MRI). Theoretically,
of 79.3% for this imaging modality. In this study, PET-CT PET/MRI may be advantageous in this context by
showed no significant difference in detecting different combining the functional information from FDG-PET
morphological tumor types: Periampullary infiltrating, with the high contrast resolution of MRI to assess ductal
intraductal growing, or mass-forming. 95,96 Furthermore, involvement, although no significant studies have yet
data from a scientific study indicated that PET can reliably evaluated PET/MRI for this purpose. This technique
detect nodular bile duct cancer >1 cm in size. However, may be particularly useful in differentiating CCA from
95
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PET-CT has shown limited reliability in evaluating HCC. PET, particularly in combination with PET/
regional lymph node metastases, with a sensitivity of 12% CT or PET/MRI, is increasingly being used to assess the
and specificity of 96%. PET is a useful imaging test for molecular characteristics of malignant tumors in the
95
diagnosing distant metastases, monitoring treatment hepato-pancreato-biliary system (Table 1). In cases of
responses, and detecting recurrence. 93,96-98 It can identify suspected or confirmed HCC or biliary tract tumors, PET
metastatic lymph nodes, distant metastases, or clarify is performed using 11C-labeled acetate. This imaging
indeterminate lesions, especially in patients with primary method is crucial for evaluating tumor progression and
sclerosing cholangitis. However, due to its low sensitivity staging before making therapeutic decision-making.
96
(<70%), PET should only be considered in selected cases. Testing with 11C-labeled acetate is also recommended
In fact, distant metastases are more accurately identified to rule out potential metastases in distant organs, as PET
by CT, while EUS remains the gold standard for lymph demonstrates higher sensitivity, accuracy, and specificity
node evaluation. Fiz et al. demonstrated that PET-based in detecting metastases.
96
radiomics for iCCA can predict pathological data and The strong interaction between radioisotopes and tumor
enable reliable pre-operative prognostic assessment. The cells, such as increased glucose consumption and DNA
combined clinical and radiomic models outperformed synthesis, underscores PET’s important role. PEt allows for

Table 1. Selected studies evaluating the use of magnetic resonance imaging in diagnosing cholangiocarcinoma

Authors Title Year of Conclusions
publication
Wang et al. 71 The value of an MRI-based radiomics model in predicting the 2024 MRI radiomics model can be used to predict survival and
survival and prognosis of patients with eCCA prognosis in patients with eCCA
Xu et al. 67 MRI-based radiomics nomogram for preoperatively 2023 MRI can differentiate cholangiocarcinoma from metastatic
differentiating intrahepatic mass-forming cholangiocarcinoma colorectal cancer
from resectable colorectal liver metastases
Sheng et al. 69 Contrast-enhanced MRI could predict the response of 2022 Pre-treatment contrast-enhanced MRI can be used to
systemic therapy in advanced iCCA predict therapeutic response to systemic therapy for
advanced iCCA
Zhang et al. 68 iCCA: MRI texture signature as predictive biomarkers of 2021 MRI texture signature may serve as a potential predictive
immunophenotyping and survival biomarker for immunophenotyping and overall survival in
patients with iCCA
Xin et al. 72 Hilar cholangiocarcinoma: Value of high-resolution enhanced 2020 High-resolution MRI (HR-MRI) can predict the ability of
MRI for pre-operative evaluation cholangiocarcinoma to invade the vasculature
Min et al. 73 Intrahepatic mass-forming cholangiocarcinoma: Arterial 2019 MRI arterial enhancement pattern may serve as a
enhancement patterns at MRI and prognosis prognostic marker in the pre-operative evaluation of
patients with resectable intrahepatic bile duct cancer
presenting as masses
Koh et al. 70 Intrahepatic mass-forming cholangiocarcinoma: prognostic 2016 Hepatobiliary phase MRI images may be a prognostic
value of pre-operative gadoxetic acid-enhanced MRI factor after surgery for intrahepatic massive bile duct
carcinomas
Abbreviations: MRI: Magnetic resonance imaging; eCCA: Extrahepatic cholangiocarcinoma; CCA: Cholangiocarcinoma; iCCA: Intrahepatic
cholangiocarcinoma.

Volume 3 Issue 1 (2025) 7 doi: 10.36922/arnm.4557