Magnetic resonance cholangiopancreatography (MRCP)-based 3-dimensional biliary segmentation-reconstruction is feasible and seems to provide a better anatomical understanding in patients with malignant hilar stricture, compared to MRCP alone, according to a newly published study. The approach could help improve the endoscopic management of patients, according to the authors.

The feasibility and potential usefulness of MRCP-based handmade biliary 3D reconstruction for malignant hilar strictures was evaluated in 16 patients, aged 61 to 79 years. Of these, 11 had hilar cholangiocarcinoma (CCA) and 5 had cancer of the gallbladder.

The team of researchers led by Marine Camus, MD, PhD, from Sorbonne University in Paris, France, fashioned and reviewed a handmade 3-dimensional segmentation using a “3D slicer” together with an expert radiologist. The feasibility of biliary segmentation was the primary outcome.

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“Handmade segmentation was successful in all cases,” the researchers reported. The agreement between the MRCP interpretation and the 3-dimensional reconstruction was 37.5%, as per the Bismuth classification. 

The availability of 3-dimensional reconstruction before endoscopic retrograde cholangiopancreatography could have helped guide better stent placement in 11 cases, the authors of the study said. 

“A 3D mapping of the biliary tree could help improve the endoscopic management of these patients,” they wrote.

Hilar malignant strictures are associated with biliary cancers including hilar cholangiocarcinoma that has spread to the hilum.  

Endoscopic retrograde cholangiopancreatography is generally needed to diagnose the disease and for biliary drainage. However, the procedure requires high technical skill, and ERCP is very challenging in such cases.

CCA is responsible for around 15% of all primary liver tumors and it is the second most common primary malignancy of the liver, after hepatocellular carcinoma. The incidence of the disease has been increasing in recent years.

The study was published in the journal Clinics and Research in Hepatology and Gastroenterology.


Becq A, Szewczyk J, Salin G, et al. ERCP 2.0: biliary 3D-reconstruction in patients with malignant hilar stricture. Clin Res Hepatol Gastroenterol. 2023;26;47(7):102172. doi:10.1016/j.clinre.2023.102172