Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

Zusammenfassung

Vorstellung der Diagnostik, Indikationsstellung und verschiedener Therapieoptionen bei Patienten mit Cholangiokarzinom (CC) basierend auf einer Analyse der aktuellen Literatur zu dem Thema sowie der klinischen Konzeption. Die Diagnostik zur Abklärung beinhaltet ein Labor mit Cholestaseparametern sowie den Tumormarkern CA19 – 9 und CEA. Nach einer orientierenden Sonografie zur Abklärung einer Raumforderung (ICC) und erweiterten Gallenwegen (ECC) sollte – sofern keine Kontraindikationen vorliegen – eine kontrastverstärkte MRT mit MRCP durchgeführt werden. Die diagnostische Treffsicherheit des CC liegt für die Sonografie bei Werten von 37 – 84 % (abhängig von der Lokalisation), für die Computertomografie (CT) bei 79 – 94 %, für die MRT und MRCP bei 95 %. Anschließend kann eine ERCP geplant werden, insbesondere wenn eine Stentversorung der Gallenwege und/oder eine endoskopisch gestützte histologische Sicherung angestrebt wird. Therapeutisch gelten als kurative Maßnahmen nur die chirurgische Resektion oder auch selten die Lebertransplantation, jedoch befinden sich viele Patienten nicht mehr in einem operablen Stadium. Neben systemischen Chemotherapieansätzen stehen als lokoregionäre Therapieverfahren die transarterielle Chemoembolisation (TACE), die hepatische arterielle Infusion (HAI), Drug-Eluting-Beads-Therapie (DEB) sowie thermoablative Verfahren wie die laserinduzierte Thermotherapie (LITT), Mikrowellenablation (MWA) und Radiofrequenzablation (RFA) zur Verfügung.

Abstract

To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 – 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37 – 84 % (depending on the location) for ultrasound, 79 – 94 % for computed tomography (CT), and 95 % for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI) – also known as chemoperfusion –, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.

Key words

bile ducts - ablation procedures - transarterial chemoembolization (TACE) - hepatic arterial infusion (HAI) - cholangiocarcinoma (CC) - magnetic resonance cholangiography (MRCP)

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