Ultra-High Gradient Thin-Slice Oblique Coronal Zoomed DWI for Perihilar and Distal Cholangiocarcinomas: Improved Tumor Depiction for Precise Surgical Planning.

Authors

Lingsong Zhou, Beixuan Zheng, Xianling Qian, Xuhao Song, Jili Chen, Caixia Fu, Houbao Liu, Ruofan Sheng, Mengsu Zeng

Published in

Academic radiology. Oct 16, 2026. Epub Oct 16, 2026.

Abstract

Accurate preoperative assessment of extrahepatic cholangiocarcinoma (eCCA) remains challenging with conventional imaging. This study aimed to investigate the value of thin-slice oblique coronal zoomed diffusion-weighted imaging (OC-Z-DWI) on an ultra-high gradient system for eCCA (including both perihilar and distal subtypes) assessment.
This prospective study enrolled 93 patients with pathologically diagnosed eCCA (54 males, 66.8 ± 9.0 years; 62 perihilar and 31 distal) and 43 patients without eCCA (19 males, 62.9 ± 11.8 years). All patients underwent conventional magnetic resonance imaging and OC-Z-DWI on an ultra-high gradient system (200 mT/m amplitude). Image quality of OC-Z-DWI was evaluated, and diagnostic performance and lesion sizing were compared between the conventional protocol and one incorporating OC-Z-DWI.
OC-Z-DWI showed good scoring in noise, artifacts, and overall image quality (mean 3.83 ± 0.41, 3.65 ± 0.56, and 3.80 ± 0.43, respectively). Adding OC-Z-DWI to the conventional protocol significantly improved lesion edge sharpness (3.89 ± 0.31 vs 3.60 ± 0.53, P < 0.001), lesion conspicuity (3.94 ± 0.25 vs 3.75 ± 0.46, P < 0.001), diagnostic confidence (3.86 ± 0.38 vs 3.58 ± 0.65, P < 0.001), and diagnostic performance (AUC 0.917 vs 0.869, P = 0.018). Lesion size measurements with the OC-Z-DWI-based protocol demonstrated strong pathological correlation (r = 0.822), with lower pathological-imaging diameter discrepancy than the conventional protocol (median 4.0 mm vs 7.0 mm, P < 0.001). These improvements were consistent across both perihilar and distal subgroups. Furthermore, R0 resection patients exhibited a stronger imaging-pathology sizing correlation than R1 patients (r = 0.891 vs 0.528, P = 0.021).
Ultra-high gradient thin-slice OC-Z-DWI provides high-quality images for eCCA characterization. Adding OC-Z-DWI to the conventional magnetic resonance protocol enhances lesion delineation, diagnostic performance, and tumor sizing accuracy, delivering more precise preoperative information to optimize surgical planning.

PMID:
42888058
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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