Resectability of liver tumours evaluated by computed tomography

In a retrospective study of CT examinations of liver tumours in 37 patients intra- and extrahepatic tumour growth was estimated in order to see if resectability could be predicted. The findings were compared with the evaluation at laparatomy. Four out of 15 tumours, resectable according to CT, turned out to be unresectable and 9 out of 37 CT examinations did not reveal the total extent of tumour growth. A more reliable preoperative radiologic assessment may be obtained by improvement of current CT techniques, by computed tomographic angiography, intraoperative ultrasound or MR imaging.     

进展期胃癌手术切除率的CT分期评价

目的 评价进展期胃癌术前CT分期与手术切除率的相互关系。材料与方法连续性搜集经手术与病理证实的进展期胃癌病例50例,其中25例术前经CT评估,25例术前无CT扫描。将手术及病理结果与CT扫描进行对照。结果25例术前经CT分期评估,手术切除病灶22例(88％),3例未能手术切除(12％)。25例术前无CT扫描评估,手术切除病灶16例(64％)。术前肿瘤CT扫描T分期准确性为96％(24／25)。结论准确的术前CT分期对进展期胃癌的恰当处理是必要的。     

Accuracy of CT prediction of poor prognostic features in colonic cancer

Whilst imaging of poor prognostic features in rectal cancers has assisted pre-operative treatment stratification, such features have yet to be evaluated in colonic cancers. This study aims to develop criteria for identifying poor prognostic features in colonic tumours and assess the accuracy of CT prediction against histopathology. Criteria were developed for predicting T-stage and N-stage, the presence of extramural vascular invasion and involvement of the retroperitoneal surgical margin (RSM). These criteria were tested on 33 patients with colonic cancer who underwent pre-operative high-resolution CT of their tumour. Two radiologists (Obs 1 and Obs 2) identified independently these poor prognostic features and the results were compared with the final histopathological results. Histological agreement and interobserver variation were calculated using the kappa test. Accuracy of CT prediction of tumour extension beyond muscularis propria was 82% (Obs 1) and 70% (Obs 2). Correct prediction of RSM involvement was 76% (95% confidence interval (CI): 57.8-88.9%) and 79% (95%CI: 61.1-91%) for Obs1 and Obs 2, respectively, with significant agreement between observers (kappa = 0.455, p = 0.050). Prognosis was correctly predicted using CT in 82% (95%CI: 61.5-81.2%) (Obs1) and 85% (95%CI: 68.1-94.9%) (Obs2) with moderate agreement (kappa = 0.459, kappa = 0.527, respectively) with histology. In conclusion, CT has potential as the imaging modality of choice in the pre-operative prediction of poor prognostic features in colonic cancers and could play a role in future treatment stratification.     

The role of computed tomography in the staging of bladder cancer.

Computed tomography of the pelvis has been performed in 60 patients with epithelial bladder tumours. The CT findings have been compared with the clinical staging (T-stage), lymphography (N-stage) and wherever possible the surgical staging (P-stage). Although the intraluminal tumour was visualised in a high proportion of examinations, the greatest value of CT is in the accurate delineation of the extravesical extension of the growth. This is likely to be the primary role of CT in the staging of bladder cancer. Difficulties in detecting invasion of contiguous organs, particularly the prostate, and the failure to demonstrate nodal involvement within the pelvis were noted. The technique has clear advantages over more invasive investigations and the additional information provided over and above clinical staging is seen as a major advance in the assessment of these tumours.     

胰腺癌的可切除性评价(经动脉双期螺旋CT与血管造影的对比分析)

分别采用经动脉双期螺旋ＣＴ扫描和选择性血管造影,对胰腺癌的可切除性进行术前前瞻性评价,以确定各自的临床应用价值。方法对１５例胰腺癌术前均行选择性造影及经动脉增强双期螺旋ＣＴ扫描,对胰腺癌的临床应用价值。结论经动脉双期螺旋ＣＴ扫描弥补了血管造影的不足,能够更为准确,全面地评价胰腺癌的可切除术,具有较高的临床应用价值。     

Prediction of clinical outcome in treated neuroendocrine tumours of carcinoid type using functional volumes on 111In-pentetreotide SPECT imaging

The quantification of the tumour volume is essential for the assessment of therapy-induced changes. Traditional methods of assessing the response of neuroendocrine tumours using radiological methods yield poor results, particularly within the liver. The aim of this study was to establish whether it would be possible to identify a method using functional volumes to predict the response of tumours to various therapies. Twenty-two patients with neuroendocrine tumours of carcinoid type in the liver were treated with chemotherapy, chemo-embolization or 90Y-radiolabelled somatostatin analogues. All patients underwent 111In-pentetreotide single-photon emission computed tomography (SPECT) and computed tomography (CT) scan pre- and post-treatment. The tumour functional volume, a measure of metabolically active tumour tissue, was calculated from the SPECT images using a 10-point display; regions of interest were drawn around 50% of the maximum tumour activity, slice by slice, and then multiplied by the slice thickness (9.3 mm). Any difference in functional volume was compared with the CT response, using the Response Evaluation Criteria in Solid Tumours (RECIST), and clinical outcome. At 6 months after treatment, 14 patients showed a good clinical response, as measured by a reduction in pain, flushing or abdominal symptoms; the functional volume of the tumours in these patients decreased by a mean of 25% (range, 1-52%). Of the eight patients who showed no symptomatic relief, or in whom symptoms worsened, the functional volume increased by a mean of 74%. Using a change in functional volume of more than 25% as significant, SPECT predicted 13 of the 22 (59%) clinical outcomes correctly; if a 10% change was used, 18 of the 22 (81.1%) clinical outcomes were correctly predicted. However, CT, using RECIST, only predicted eight of the 22 (36%) clinical outcomes correctly. The assessment of the total functional volume by SPECT quantification is more useful than CT in monitoring tumour response after treatment, and the changes in functional volumes after therapy correlate well with the clinical response.     

Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses

Purpose

This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses.

Materials and methods

Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies.

Results

Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%.

Conclusions

MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen.     

The importance of magnetic resonance tomography in the diagnosis and staging of renal cell carcinoma]

The use of magnetic resonance imaging (MRI) for diagnosis and preoperative staging of renal cell carcinoma was evaluated in 79 patients with 88 tumors. Gradient-echo and spin-echo images before and after intravenous administration of Gadolinium-DTPA were compared with the results of computed tomography (CT) and histologic staging. The two imaging techniques had comparable results: T-stage was predicted correctly with CT in 78.4% and with MRI in 84.0% of the cases, while the N-stage was accurately assessed in 81.8% and 79.5%, respectively. MRI had some advantages in diagnosing perirenal tumor spread and in excluding an infiltration beyond Gerota's fascia. Therefore, MRI is a true alternative to CT for staging large renal cell carcinomas and especially for patients with contraindications for iodinated contrast agents.     

进展期胃癌CT表现及术前评估价值分析

目的探讨进展期胃癌的CT表现及于术可切除性的术前评估价值。方法分析100例进展期胃癌的CT表现．对术前评估与手术结果进行对比研究。结果胃底贲门癌26例,胃体癌39例,胃窦癌20例,病变占据两个分区以上者15例。100例胃癌均显示胃壁有不同程度的增厚,部分胃壁有软组织肿块形成,黏膜㈨有溃疡形成,胄腔及贲门狭窄,贲门管壁增厚,食管下段受累以及周围组织器官侵犯等．CT检查对进展期胃癌的诊断符合率高,肿瘤检出率可达100％,术前判断为可切除组的病例中手术切除率达91．2％,于术前判断为不町切除组的病例中手术切除率仅为15．0％。结论CT检查对肿瘤可切除性的术前评估有较高的临床价值,值得推广心用     

99mTc-MIBI in the assessment of response to chemotherapy and detection of recurrences in bone and soft tissue tumours of the extremities.

AIM: This prospective study is focused on the assessment of tumour response in a group of 28 bone sarcoma patients using (99m)Tc-MIBI scintigraphy. METHODS: The quantitative changes in MIBI uptake before and after chemotherapy were measured and associated with the pathological evaluation of the degree of tumour necrosis. Besides this, another group of 40 patients with bone and soft tissue tumours was studied in order to evaluate the diagnostic efficacy of (99m)Tc-MIBI scintigraphy versus computed tomography (CT) and/or magnetic resonance imaging (MRI) in detecting the status of the disease and its recurrences. After injection of 555-740 MBq of (99m)Tc-MIBI, regional and whole body images were acquired at 20 and 60 min. The lesion/normal (L/N) uptake ratio was calculated in both early and delayed images and the washout rate (WR%) of (99m)Tc-MIBI was obtained. Following 3-4 courses of chemotherapy, bone tumours were assessed by comparing the uptake ratio in the viable tumours with the amount of necrotic processes described in the surgically removed specimens. RESULTS: In the first group of patients the rate of tumour response to chemotherapy, calculated according to the percentage of necrosis and the (99m)Tc-MIBI uptake ratios, was as follows: complete response in 12 patients, partial response in 8 and no response in 8 patients. Linear regression analysis of quantitative changes in (99m)Tc-MIBI uptake (expressed as changes percent) and of (99m)Tc-MIBI uptake ratio showed a positive correlation (r=0.77), whereas it showed a negative correlation with the changes in the washout ratio (r=-0.32). In the second group of patients (40 patients) (99m)Tc-MIBI scintigraphy proved to be able to detect recurrences of bone and soft tissue tumours. The sensitivity, specificity and accuracy of (99m)Tc-MIBI scan versus CT and/or MRI were calculated and they resulted 93%, 95% and 92% versus 86%, 75% and 84%, respectively. CONCLUSION: The application of (99m)Tc-MIBI scan in the management of patients treated with chemotherapy may allow an early identification of the non-responder patients and lead to a choice of different strategies (alternative chemotherapy or salvage surgery).     

The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder

Our objective was to assess the ability of dual-phase helical CT (DHCT) to predict resectability of carcinoma of gallbladder (CaGB). Thirty-two consecutive patients suspected of having CaGB on clinical examination and sonography presented to our centre over 10-month period. All these 32 patients underwent DHCT. Fifteen patients were considered inoperable and 2 had xanthogranulomatous cholecystitis. The remaining 15 patients (10 women, 5 men; age range 33-72 years) underwent surgery and had histopathological confirmation of CaGB and were included in the study based on the following criteria: presence of mass in gallbladder fossa on sonography and DHCT, and confirmation at surgery and histopathological examination. Axial reconstructions of 2 mm were obtained (collimation 3 mm, table speed 4.5 mm/s) for arterial (scan delay 20 s) and venous (scan delay 60 s) phases on a helical scanner. The criteria used for unresectability were: distant metastasis (liver, peritoneum, lymph nodes), extensive local contiguous organ spread, involvement of secondary biliary confluence of both lobes of liver, tumoral invasion of main portal vein, or proper hepatic artery or simultaneous invasion of one side hepatic artery and the other side portal vein. The CT findings related to unresectability were correlated with surgical findings. On the basis of CT findings, 10 patients were unresectable and 5 were resectable. Of the 10 patients considered unresectable, 9 had tumours that were unresectable at surgery (sensitivity 100%, positive predictive value 90%). Five patients had more than one reason and 4 had one reason alone for being unresectable (lymph nodes, n=2; hepatic metastasis, n=1; and vascular invasion, n=1). All 5 patients considered resectable based on CT findings had resectable tumours at surgery (negative predictive value 100%). The overall accuracy of CT was 93.3%. Dual-phase helical CT comprehensively evaluates CaGB and may be a useful tool in preoperative staging of this tumour in determining resectability.     

Wilms' tumour: pre- and post-chemotherapy CT appearances.

Pre-operative chemotherapy is used in our institution for patients with Wilms' Tumours (WT) when surgical 'operability' is in doubt. To date, the computed tomographic (CT) appearances of chemotherapy-induced changes in WT have not been described. We have analysed CT examinations of 18 children undergoing pre-operative chemotherapy to assess the effects of treatment on size, extent and qualitative changes of the tumour. Clinical response to chemotherapy was associated with a reduction in tumour size of at least 50%. Cystic changes were commonly seen within tumours following chemotherapy. CT did not reliably differentiate lymph nodes involved by tumour from those showing only reactive change. Pre-chemotherapy CT scans were incorrect in predicting liver invasion in 4/18 (22%) cases: of these, two were right-sided tumours, and two were bilateral.     

Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability.

OBJECTIVE. Several authorities advocate the use of preoperative angiography to determine the resectability of pancreatic and periampullary tumors, claiming that CT alone is not sufficiently accurate for this purpose. Our objective was to assess the value of CT in predicting surgical resectability in patients with malignant biliary obstruction. MATERIALS AND METHODS. We performed a retrospective analysis of 380 consecutive cases of malignant biliary obstruction spanning a 4-year period. Most patients (230) were treated nonoperatively. Sixty-seven patients had surgery, pathologic confirmation of malignancy, and preoperative CT scans available for review. The CT scans were assessed for surgical resectability of tumor by an interpreter who did not know the patient's history. RESULTS. Forty-two patients had pancreatic adenocarcinoma, six had ampullary carcinoma, seven had cholangiocarcinoma, and 12 had other malignant neoplasms. Of 47 patients with tumors thought to be unresectable on the basis of CT findings, 42 had tumors that were found to be unresectable at surgery (positive predictive value, 89%). Of 20 patients with tumors thought to be resectable, 16 had tumors that were surgically resectable (positive predictive value, 80%). CT did not show metastases to duodenal lymph nodes (n = 2), portal vein infiltration (n = 1), and small hepatic metastases (n = 1). Visualization of most of these at angiography would not be expected. The CT finding of infiltration of the periarterial fat around the celiac or superior mesenteric arteries was reliable for predicting surgical unresectability. Lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability. CONCLUSION. Although some findings on CT that suggest unresectability are less reliable than others, the accuracy of CT compares favorably with reports on the accuracy of angiography for assessing tumor resectability in cases of malignant biliary obstruction. The addition of angiography to the examination of patients with potentially resectable lesions is not justified when high-quality, thin-section dynamic CT has been performed.     

螺旋CT双期增强对胰腺癌病人的术前评估

目的 探讨螺旋CT双期增强对胰腺癌可切除性术前评估的价值。方法 对1999年5月～2003年3月期问行螺旋CT双期增强扫的45例诊断为胰腺癌病人的CT图像与22例手术结果进行对比研究，通过显示胰腺癌的部位、大小以及肿块对周围血管侵犯程度、远处器官转移以及后腹膜淋巴结转移，作出能否切除的术前评价。结果 45例胰腺癌病人中18例位于胰头，16例位于胰体尾，11例位于胰尾；27例患接受手术治疗，其中22例术前SCT认为肿瘤可切除，实际成功切除17例，成功切除的阳性预测值达77％，其他5例SCT认为肿瘤不能切除，实际手术均不能切除。结论 螺旋CT双期增强扫描可作为一种评价胰腺癌术前能否手术切除的有效方法。     

CT volumetry for gastric carcinoma: association with TNM stage

Objectives

We evaluated the feasibility of performing CT volumetry of gastric carcinoma (GC) and its correlation with TNM stage.

Methods

This institutional review board-approved retrospective study was performed on 153 patients who underwent a staging CT study for histologically confirmed GC. CT volumetry was performed by drawing regions of interest including abnormal thickening of the stomach wall. Reproducibility of tumour volume (Tvol) between two readers was assessed. Correlation between Tvol and TNM/peritoneal staging derived from histology/surgical findings was evaluated using ROC analysis and compared with CT evaluation of TNM/peritoneal staging.

Results

Tvol was successfully performed in all patients. Reproducibility among readers was excellent (r?=?0.97; P?=?0.0001). The median Tvol of GC showed an incremental trend with T-stage (T1?=?27 ml; T2?=?32 ml; T3?=?53 ml and T4?=?121 ml, P?P?=?0.0001), M-stage (0.87, P?=?0.0001), peritoneal metastases (0.87, P?=?0.0001) and final stage (≥stage 2:0.89; ≥stage 3:0.86 and stage 4:0.87, P?=?0.0001), with moderate accuracy for N-stage (≥N1:0.75; ≥N2:0.74 and N3:0.75, P?=?0.0001). Tvol was significantly (P?Conclusion CT volumetry may provide useful adjunct information for preoperative staging of GC.

Key Points

? CT volumetry of gastric carcinoma is feasible and reproducible. ? Tumour volume <19.4 ml predicts T1-stage gastric cancer with 91 % sensitivity and 100 % specificity (P?=?0.0001). ? Tumour volume >95.7 ml predicts metastatic gastric cancer with 87 % sensitivity and 78.5 % specificity (P?=?0.0001). ? CT volumetry may be a useful adjunct for staging gastric carcinoma.     

Assessing resectability of lung cancer: the role of computed tomography of the mediastinum, upper abdomen and head

In order to assess the value of computed tomography (CT) of the mediastinum, upper abdomen and head in the assessment of resectability of lung cancer, the CT findings of 262 patients, of whom 198 underwent thoracotomy, were analyzed retrospectively and the stagings obtained at CT and thoracotomy were compared. Mediastinal CT reliably predicted resectability when there was no evidence of mediastinal involvement. However, it was often impossible to determine whether tumour with apparent mediastinal infiltration on CT was resectable or not. The sole finding of lymph node enlargement did not permit differentiation of benign from malignant lymphadenopathy when the lymph node diameter was less than 25 mm and the lymphadenopathy was confined to one lymph node station. Upper abdominal metastases were found in 6.1% and brain metastases in 4.6% of patients and neither the histological type nor other features of the tumour were found to be useful predictors of their presence. The large number of non-specific findings decreased the utility of abdominal CT. The appropriate strategy for the pre-operative evaluation of patients with lung cancer is discussed.     

CT for predicting the resectability of lung cancer. A prospective study.

In order to assess the accuracy of CT in predicting the resectability of lung cancer, a prospective study was performed on 96 patients undergoing thoracotomy. The tumors were classified preoperatively according to the TNM classification and the new international staging system for lung cancer, and scored as being resectable by lobectomy or pulmectomy, potentially resectable by lobectomy or pulmectomy, or nonresectable. Of the tumors predicted to be resectable or potentially resectable, 86.6% and 63% were radically resected, respectively, and the need for lobectomy versus pulmectomy was correctly estimated in 81.3% of them. The insufficiency of CT for defining lymph node metastases and infiltrative tumor growth was considered a marked disadvantage of the method.     

CT criteria for venous invasion in patients with pancreatic head carcinoma

The purpose of the study was to evaluate CT criteria for venous invasion in patients with potentially resectable carcinoma of the pancreatic head, with surgical and histopathological correlation. In 113 patients evaluated with spiral CT for suspected pancreatic head carcinoma, several CT criteria for venous invasion were scored prospectively for the portal vein (PV) and the superior mesenteric vein (SMV): length of tumour contact with PV/SMV (0 mm, < 5 mm, > 5 mm); circumferential involvement of the vein (0 degree, 0-90 degrees, 90-180 degrees, > 180 degrees); degree of stenosis; irregularity of the vessel margin; and tumour convexity towards vessel. 65 patients underwent surgery. Pancreatic head carcinoma was proven and pathology of the vascular margin was obtained in 50 of these patients. CT findings for single and combined criteria were correlated with pathology in these 50 patients, 30 of whom showed venous ingrowth. Invasion was found in all cases with SMV narrowing (n = 7), PV contour involvement > 90 degrees (n = 6), PV narrowing (n = 5) and PV wall irregularity (n = 3). The vascular ingrowth rate was 88% (15/17) for tumour concavity towards the PV or SMV. Poor predictors of ingrowth were length of tumour contact with PV > 5 mm (78% ingrowth, 14/18) and contour involvement of the SMV > 90 degrees (83% ingrowth, 10/12). Absence of vascular ingrowth could not be predicted in 100%. In conclusion, CT criteria can predict a high risk of invasion in potentially resectable tumours. Narrowing of the SMV and the PV seems the most reliable criterion, as well as circumferential involvement of the PV > 90 degrees. The best combination of criteria was tumour concavity with circumferential involvement > 90 degrees (sensitivity 60% and positive predictive value 90%).     

Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

Purpose

To investigate the value of response monitoring in both the primary tumour and axillary nodes on sequential PET/CT scans during neoadjuvant chemotherapy (NAC) for predicting complete pathological response (pCR), taking the breast cancer subtype into account.

Methods

In 107 consecutive patients 290 PET/CT scans were performed at baseline (PET/CT1, 107 patients), after 2 – 3 weeks of chemotherapy (PET/CT2, 85 patients), and after 6 – 8 weeks (PET/CT3, 98 patients). The relative changes in SUVmax (from baseline) of the tumour and the lymph nodes and in both combined (after logistic regression), and the changes in the highest SUVmax between scans (either tumour or lymph node) were determined and their associations with pCR of the tumour and lymph nodes after completion of NAC were assessed using receiver operating characteristic (ROC) analysis.

Results

A pCR was seen in 17 HER2-positive tumours (65 %), 1 ER-positive/HER2-negative tumour (2 %), and 16 triple-negative tumours (52 %). The areas under the ROC curves (ROC-AUC) for the prediction of pCR in HER2-positive tumours after 3 weeks were 0.61 for the relative change in tumours, 0.67 for the combined change in tumour and nodes, and 0.72 for the changes in the highest SUVmax between scans. After 8 weeks equivalent values were 0.59, 0.42 and 0.64, respectively. In triple-negative tumours the ROC-AUCs were 0.76, 0.84 and 0.76 after 2 weeks, and 0.87, 0.93 and 0.88 after 6 weeks, respectively.

Conclusion

In triple-negative tumours a PET/CT scan after 6 weeks (three cycles) appears to be optimally predictive of pCR. In HER2-positive tumours neither a PET/CT scan after 3 weeks nor after 8 weeks seems to be useful. The changes in SUVmax of both the tumour and axillary nodes combined correlates best with pCR.     

Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria

PURPOSE: To retrospectively assess the accuracy of combined multiphasic computed tomography (CT) and direct cholangiography for evaluation of the resectability of hilar cholangiocarcinoma, on the basis of revised criteria for unresectability, by using surgery as the reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. From 1998 to 2003, 55 patients (37 men, 18 women; mean age +/- standard deviation, 59 years +/- 12) with surgically proved hilar cholangiocarcinomas who underwent preoperative CT (single-detector row CT, n = 26; multi-detector row CT, n = 29) and cholangiography were included for study. The authors' revised criteria for unresectable tumor were contralateral hepatic artery invasion; main or contralateral portal vein invasion longer than 2 cm; biliary extension to the contralateral secondary confluence, farther than 2 cm from hepatic hilum; enlarged lymph nodes at the celiac, portacaval, and paraaortic area; and other ancillary findings. Tumor resectability based on these parameters was determined at imaging by two radiologists in consensus. Mann-Whitney U test and weighted kappa coefficient of agreement were used for accuracy determination. RESULTS: For depiction of portal vein invasion (in 26 patients), CT yielded an accuracy of 85.5%. Arterial invasion was found at surgery in 19 patients, with CT providing an accuracy of 92.7%. For prediction of node involvement (15 patients, 27%), CT yielded an accuracy of 83.6%. The extent of ductal involvement could be accurately predicted in 46 patients (84%) (weighted kappa = 0.767). In 30 of 42 patients with disease classified as resectable according to revised criteria, disease was found to be resectable at surgery (71.4% positive predictive value). In 11 of 13 patients with disease classified as unresectable according to revised criteria, unresectable disease was confirmed (84.6% negative predictive value). Overall accuracy of resectability was 74.5%. CONCLUSION: Combined interpretation of CT and direct cholangiographic images by using our revised criteria resulted in overall accuracy of 74.5% for prediction of resectability for hilar cholangiocarcinoma.