Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Table 1 Patients that should undergo to screening programs and the techniques that should be applied

Predisposing factors	Diagnostic technique	Worrisome features
Intrahepatic lithiasis and recurrent pyogenic cholangitis	MR	Stenosis progression, distal bile duct dilatation, intraductal polypoid mass > 1 cm.
PSC	MR + ERCP	Irregular bile duct stenosis, bilateral bile duct dilatation, ipsilateral lobar atrophy. ERCP bile duct sampling can simplify differential diagnosis.
Intrahepatic fluke	US/MR	Central intrahepatic and main bile duct dilation with stenosis identificationa.

MR: Magnetic resonance; PSC: Primary sclerosing cholangitis; ERCP: Endoscopic retrograde pacreatoduodenoscopy; US: Ultrasound.

^a: Ultrasound, computed tomography and magnetic resonance findings for intrahepatic fluke are diffuse and uniform dilatation of peripheral intrahepatic bile ducts with no dilatation of central intrahepatic and main bile ducts, without focal obstruction lesions, with increased echogenity of bile ducts and non-shadowing echogenic foci within bile ducts (eggs or flukes).