The interpretation of hepatocholangial laboratory test results is challenging. Possible liver biochemical tests include the evaluation of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, 5'-nucleotidase, lactate dehydrogenase, bilirubin, and albumin levels, as well as prothrombin time and international normalized ratio. When liver enzyme levels are elevated, R-values are generally used for diagnosis. A 62-year-old woman presented to our hospital with the chief complaint of abdominal pain and was consequently diagnosed with gallstone hepatitis based on her blood test results. Generally, gallstone hepatitis manifests as elevated liver enzyme levels showing a hepatocellular pattern, while common bile duct obstructions show a cholestatic pattern. Since gallstone hepatitis is indistinguishable from viral and ischemic hepatitis in the early stages of onset, it is vital to monitor changes in symptoms, biochemical tests, and imaging results over time to diagnose this disease.

Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed.

To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1 W SE) coronal sequence added to the lumbar MRI protocol for low back pain.

In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images.

Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images.

Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

• Adult
• Biliary Tract Diseases/diagnostic imaging
• Biliary Tract Diseases/etiology
• Cholecystectomy, Laparoscopic
• Colic/diagnostic imaging
• Colic/etiology
• Conservative Treatment
• Diagnosis, Differential
• Female
• Gallstones/complications
• Gallstones/diagnosis
• Gallstones/diagnostic imaging
• Gallstones/surgery
• Hospitalization
• Humans
• Liver Function Tests
• Primary Health Care
• Ultrasonography

Background and objectives: Opinions differ regarding the optimal diagnostic methods for patients with suspected choledocholithiasis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In all patients with suspected choledocholithiasis LUS was performed during laparoscopic cholecystectomy to evaluate biliary stones. According to availability, part of the patients had pre-operative MRCP. Data for diagnostic accuracy and main outcomes were collected prospectively and analyzed retrospectively; Results: Choledocholithiasis was detected in 178 of 297 patients by LUS (59.93%) and in 39 of 87 patients by MRCP (44.8%), p = 0.041. LUS yielded a sensitivity of 99.4%, a specificity of 94.3%, a positive predictive value of 96.1% and a negative predictive value of 99.1%. However, pre-operative MRCP had a sensitivity of 61.7%, a specificity of 92.3%, a positive predictive value of 94.9% and a negative predictive value of 51.1%. Moreover, of the 47 patients with no choledocholithiasis by MRCP, in 23 cases it was later detected by LUS (a false negative MRCP finding—38.3%), p < 0.001. Median duration of hospitalization was significantly shorter in patients evaluated without pre-operative MRCP—8 days (interquartile range – IQR 11–6) vs. 11 days (IQR 14–9), p = 0.001; Conclusions: LUS may reduce the role of pre-operative MRCP and can become a rational alternative to MRCP as a primary imaging technique for the detection of choledocholithiasis.

• choledocholithiasis
• laparoscopic ultrasonography
• magnetic resonance cholangio-pancreatography

• Biliary-clinical
• ERCP
• choledocholithiasis
• liver enzymes

To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.

Files were reviewed of 1039 patients who were admitted to the Share’e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria: (1) a diagnosis of biliary colic or symptomatic cholelithiasis; (2) at least two biochemical blood tests performed; and (3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological findings.

Three-quarters of the patients were women, whose average age of 37 years was younger than the average of the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients’ admissions. Alanine aminotransferase (ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALKP) - all these increases were statistically significant (P < 0.05). AST showed the sharpest decline followed by bilirubin and ALT. GGT and ALKP did not fall. A sharp rise and fall in liver enzymes, especially during the first day, most prominently in AST and ALT, was seen in 70% percent of cases. In 65% of cases trans-abdominal sonography did not give diagnostic findings.

Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.

• Biliary colic
• Symptomatic cholelithiasis
• Gallstones
• Liver enzymes
• Aspartate aminotransferase
• Alanine aminotransferase
• Enzyme pattern
• Diagnostic tool
• Emergency department

• Aged
• Biomarkers/blood
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangitis
• Cholecystectomy, Laparoscopic/methods
• Choledocholithiasis/diagnosis
• Choledocholithiasis/enzymology
• Choledocholithiasis/surgery
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Transaminases/blood

• biliary stone disease
• effects of aging
• elderly
• management
• presentation

• Gallstones/diagnosis
• Gallstones/prevention & control
• Gallstones/therapy
• Humans
• Practice Guidelines as Topic

• Biliary Tract/abnormalities
• Bilirubin/metabolism
• Cholesterol/metabolism
• Gallbladder/abnormalities
• Gallbladder/metabolism
• Gallbladder/surgery
• Gallstones/complications
• Gallstones/epidemiology
• Gallstones/physiopathology
• Humans
• Risk Factors

The diagnosis of associated choledocholithiasis prior to cholecystectomy for patients with gallstones is important for the surgical decision and treatment efficacy. However, whether ultrasound is sufficient for preoperative diagnosis of choledocholithiasis remains controversial, with different opinions on whether routine magnetic resonance cholangiopancreatography (MRCP) is needed to detect the possible presence of common bile duct (CBD) stones.

In this study, a total of 413 patients with gallstones who were admitted to the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University in China for a period of 3 years and underwent both ultrasound and MRCP examinations were retrospectively analysed. After reviewing and screening these cases according to the literature, 11 indicators including gender, age, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, γ-aminotransferase, CBD diameter, and concurrent acute cholecystitis were selected and comparatively analysed.

Among the 413 patients, a total of 109 cases showed concurrent gallstones and choledocholithiasis, accounting for 26.39 % of all cases. Among them, 60 cases of choledocholithiasis were revealed by ultrasound examination, accounting for 55.05 %, while 49 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP instead (the missed diagnosis rate of ultrasound was 44.95 %). The results of statistical analysis suggested that alanine aminotransferase, acute cholecystitis, and CBD diameter were the three most relevant factors for missed diagnosis by ultrasound.

The accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high. However, elevated alanine aminotransferase, concurrent acute cholecystitis, and CBD diameter were identified as key factors that may affect the accuracy of the diagnosis. Thus, routine preoperative MRCP examination is suggested for patients with gallstones to rule out possible concomitant CBD stones.

• aging
• common bile duct stone
• endoscopic retrograde cholangiopancreatography
• liver function test
• transabdominal ultrasound scan

• Abdominal Pain/etiology
• Cholangiopancreatography, Endoscopic Retrograde
• Choledocholithiasis/complications
• Choledocholithiasis/diagnosis
• Choledocholithiasis/diagnostic imaging
• Choledocholithiasis/physiopathology
• Humans
• Liver Function Tests
• Logistic Models
• Multivariate Analysis
• Prevalence