Radiological assessment of secondary biliary tree lesions: an update

Objective: To conduct a systematic literature review of imaging techniques and findings in patients with peribiliary liver metastasis. Methods: Several electronic datasets were searched from January 1990 to June 2017 to identify studies assessing the use of different imaging techniques for the detection and staging of peribiliary metastases. Results: The search identified 44 studies, of which six met the inclusion criteria and were included in the systematic review. Multidetector computed tomography (MDCT) is the technique of choice in the preoperative setting and during the follow-up of patients with liver tumors. However, the diagnostic performance of MDCT for the assessment of biliary tree neoplasms was low compared with magnetic resonance imaging (MRI). Ultrasound (US), without and with contrast enhancement (CEUS), is commonly employed as a first-line tool for evaluating focal liver lesions; however, the sensitivity and specificity of US and CEUS for both the detection and characterization are related to operator expertise and patient suitability. MRI has thus become the gold standard technique because of its ability to provide morphologic and functional data. MRI showed the best diagnostic performance for the detection of peribiliary metastases. Conclusions: MRI should be considered the gold standard technique for the radiological assessment of secondary biliary tree lesions.