1. Interventional Radiology Role in Caring for Primary Sclerosing Cholangitis and Cholangiocarcinoma
Dustin Thompson, MD
Associate Staff  |  Interventional Radiology
Associate Program Director | Interventional Radiology Fellowship
Clinical Assistant Professor of Radiology  |  Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Cleveland Clinic  |  9500 Euclid Ave. L10  |  Cleveland, OH (216)

2. Goals Know what an Interventional Radiologist is
Know what bile ducts look like
Know some of the interventional radiology procedures available

3. Biliary anatomy
This image has been released as part of an open knowledge project by Cancer Research UK. If re-used, attribute to Cancer Research UK / Wikimedia Commons

4. CT of dilated bile ducts

5. Hilar mass on magnetic resonance cholangiopancreatography (MRCP)

6. When to get more invasive
Imaging studies show an abnormality
Elevated bilirubin levels
Elevated liver enzymes
Infection in the biliary system

7. Endoscopic retrograde cholangiopancreatography (ERCP) versus percutaneous transhepatic cholangiography (PTHC)
When ERCP can't reach its goal
Altered anatomy due to surgery
Difficulty finding ampulla
Mass or stricture too tight to pass with ERCP

8. Initial cholangiogram

9. Internal external biliary drain

10. Left sided biliary tube after right hepatectomy for cholangiocarcinoma

11. Multiple biliary drains required due to hilar mass

13. Bridging to resection or transplant
Portal vein embolization
Intra-arterial treatments
Bland embolization
Transarterial Chemoembolization (TACE)
Radioembolization 90Y
Ablation

14. Portal vein embolization
Dual blood supply to the liver
Hepatic arteries supply bile ducts and are recruited by tumors
Portal veins supply majority of blood flow to normal liver
Portal vein embolization performed to induce growth of normal liver on the opposite side

15. Portal vein embolization

16. Intra-arterial treatments
Arterial embolization is performed to target tumors that have recruited blood supply and to preserve normal liver
Bland embolization
Transarterial Chemoembolization (TACE)
Drug eluting beads (DEB-TACE)
90Y Radioembolization (SIR SPHERE, THERASPHERE)

17. Hepatic angiogram and chemo embolization or radioembolization

18. Ablation
Radiofrequency
Microwave

19. Conclusions
Difficult to perform “gold standard” randomized controlled trials due to variability of patients, disease process, and multiple number of available treatments
Optimal care depends on multiple consultants
Important to have varied approaches to the disease that can be adapted to patient’s specific situation

20. Goals Know what an Interventional Radiologist is
Know what bile ducts look like
Know some of the interventional radiology procedures available

21. To learn more
Arellano R, Sahani D. Imaging of cholangiocarcinoma, Dig Dis Interv 2017; 01(01):
Ierardi, A.M., Angileri, S.A., Patella, F. et al. The Role of Interventional Radiology in the Treatment of Intrahepatic Cholangiocarcinoma. Med Oncol (2017) 34: 11
Ray CE Jr, Edwards A, Smith MT, Leong S, Kondo K, Gipson M, et al. Metaanalysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol. 2013;24(8):1218–26

22. Thank you!