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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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Evaluating the performance of multiphasic CT in assessing biliary tumor extent and resectability in perihilar cholangiocarcinoma: insights from a Western population

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Tae-Hyung Kim,
  • Wyanne Law,
  • Maria El Homsi,
  • Pamela Argiriadi,
  • Ally Rosen,
  • Jonathan Kuten,
  • Danielle Silliman,
  • Lee Rodriguez,
  • William Jarnagin,
  • Richard Do

摘要

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.