MRCP for Cholangiocarcinoma and Viability of Artificial Intelligence to Oncological Care in Pakistan: A Case Report and Literature Review

Abstract

Introduction: Cholangiocarcinoma (CCA) is a primary malignancy arising from cholangiocytes of the biliary tract. In majority of the cases, late presentations are noted, where there is vascular encasement with perineural and lymphatic invasion. Curative resection with negative tumor margins is a viable option in only 30% patients. Objective: To describe a clinical case of cholangiocarcinoma with respect to the diagnostic radiological perspective and radiomics-artificial intelligence in Pakistan. Case Presentation: A 60 years old male patient visited a tertiary care hospital with complaints of jaundice, weight loss and off and on fever over past few months. On MRCP, moderate intra and extrahepatic biliary dilatation with abrupt, irregular narrowing of proximal common bile duct revealing a ‘gloved finger appearance’ was documented. The coronal reformatted MRCP imaging findings showed intrahepatic biliary duct dilatation with abrupt irregular cut off at the proximal CBD. The diagnostic radiological findings pointed to a malignant stricture, possibly cholangiocarcinoma. On obtaining biopsy proceedings of the suspicious mass, a final diagnosis was made of adenocarcinoma of the common hepatic duct (cholangiocarcinoma). While the patient ultimately underwent surgery at the hospital, there was loss to follow-up post diagnostic radiological/pathological confirmation of the case, and surgical intervention. Conclusion: While we relied on MRCP findings, the conventional imaging choice for CCA, we envision that AI, a novel technique, will be an essential step in radiological diagnosis, oncological prognosis, and surgical treatment options. Radiomics knowledge systems are a technology of the future that will help in primarily identifying, segmenting, and extracting features from regions of interest.