Abdominal radiology (New York) · 2026
Evaluating the performance of multiphasic CT in assessing biliary tumor extent and resectability in perihilar cholangiocarcinoma: insights from a Western population.
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Kim Tae-Hyung, Law Wyanne, El Homsi Maria, Argiriadi Pamela, Rosen Ally, Kuten Jonathan, Silliman Danielle, Rodriguez Lee, Jarnagin William, Do Richard
Аннотация
PURPOSE: To evaluate the diagnostic performance of multiphasic CT using an adapted version of the Korean Society of Abdominal Radiology standardized reporting template, to assess tumor extent of perihilar CCA in a Western population, as well as to investigate inter-reader agreement of tumor extent assessment and resectability (predicting R0 resection) using the standardized reporting template.
METHODS: This retrospective study included 97 patients with perihilar cholangiocarcinoma who underwent curative-intent surgery without neoadjuvant therapy. Four abdominal radiologists independently reviewed preoperative multiphasic CT using a modified KSAR structured template to assess biliary tumor extent, vascular involvement, and resectability. Diagnostic performance was evaluated using sensitivity, specificity, and accuracy, with pathology as the reference standard. Inter-reader agreement was assessed using kappa statistics, and concordant reads (agreement by ≥ 2 readers) were analyzed. Subgroup analyses were performed based on CT quality and presence of biliary intervention.
RESULTS: CT demonstrated generally low to moderate sensitivity (0-80%), whereas specificity consistently high (65-97%) for assessing biliary tumor extent, with accuracy ranging from 62 to 91% across anatomical sites. Sensitivity slightly increased with concordant reads and in patients with optimal CT quality and no prior biliary intervention. Prediction of R0 resection was limited, with AUC values near 0.5 for all readers. Inter-reader agreement was fair for biliary extent (κ = 0.23-0.35) and lower for vascular involvement and resectability.
CONCLUSION: Multiphasic CT has limited sensitivity but high specificity in evaluating biliary tumor extent. Structured reporting, high-quality imaging before biliary intervention, and multi-reader or multidisciplinary approaches may improve diagnostic accuracy and preoperative planning.
METHODS: This retrospective study included 97 patients with perihilar cholangiocarcinoma who underwent curative-intent surgery without neoadjuvant therapy. Four abdominal radiologists independently reviewed preoperative multiphasic CT using a modified KSAR structured template to assess biliary tumor extent, vascular involvement, and resectability. Diagnostic performance was evaluated using sensitivity, specificity, and accuracy, with pathology as the reference standard. Inter-reader agreement was assessed using kappa statistics, and concordant reads (agreement by ≥ 2 readers) were analyzed. Subgroup analyses were performed based on CT quality and presence of biliary intervention.
RESULTS: CT demonstrated generally low to moderate sensitivity (0-80%), whereas specificity consistently high (65-97%) for assessing biliary tumor extent, with accuracy ranging from 62 to 91% across anatomical sites. Sensitivity slightly increased with concordant reads and in patients with optimal CT quality and no prior biliary intervention. Prediction of R0 resection was limited, with AUC values near 0.5 for all readers. Inter-reader agreement was fair for biliary extent (κ = 0.23-0.35) and lower for vascular involvement and resectability.
CONCLUSION: Multiphasic CT has limited sensitivity but high specificity in evaluating biliary tumor extent. Structured reporting, high-quality imaging before biliary intervention, and multi-reader or multidisciplinary approaches may improve diagnostic accuracy and preoperative planning.