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Lucius C, Flückiger A, Meier J, Möller K, Jenssen C, Braden B, Kallenbach M, Misselwitz B, Nolsøe C, Sienz M, Zervides C, Dietrich CF. Ultrasound of Bile Ducts-An Update on Measurements, Reference Values, and Their Influencing Factors. Diagnostics (Basel) 2025; 15:919. [PMID: 40218269 PMCID: PMC11988351 DOI: 10.3390/diagnostics15070919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/24/2025] [Accepted: 03/27/2025] [Indexed: 04/14/2025] Open
Abstract
Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data published between 1975 and end of 2024 were extracted, discussed, and complemented with the own experiences of the authors. The clinical implications are presented and discussed. Results: For the diameter of the common bile duct, reference values between 5 and 9 mm have been published. The main influencing factors are age and history of cholecystectomy, and other factors to be considered are discussed here. The cut-off for the common bile duct wall is set at 1.5 mm. The literature on measurements of intrahepatic bile ducts is scarce. A diameter of <2-3 mm can be considered normal. The method of ultrasound examination is presented here, as well as a comparison with other imaging methods and their clinical implications. Conclusions: Standardized measurement techniques and normal values in the context of influencing factors are crucial for the ultrasound examination of the bile system.
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Affiliation(s)
- Claudia Lucius
- Outpatient Department of Gastroenterology, IBD Centre Helios Hospital Berlin Buch, 13125 Berlin, Germany;
| | - Anja Flückiger
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland;
| | - Jennifer Meier
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, 3013 Bern, Switzerland;
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department for Internal Medicine, Krankenhaus Märkisch Oderland, 15344 Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Brandenburg Medical University, 16816 Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, UK;
- Medical Department B, University Muenster, 48149 Muenster, Germany
| | - Michael Kallenbach
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Dusseldorf, Germany
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Medizinische Klinik und Poliklinik II, LMU München, 80539 München, Germany
| | - Christian Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
- Institute for Clinical Medicine, Denmark University of Copenhagen, 1172 Kobenhavn, Denmark
| | - Michael Sienz
- Benedictine Congregation of St. Ottilien, St. Benedict Hospital Ndanda, Ndanda, Mtwara Region, Tanzania
| | | | - Christoph Frank Dietrich
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland;
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Yason K, Gonza KG, Michael O, William B, Munabi I, Michael K. Anatomical Variations of the Gallbladder and Bile Ducts: An MRI Study. Int J Hepatol 2024; 2024:3877814. [PMID: 39464874 PMCID: PMC11512644 DOI: 10.1155/2024/3877814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/10/2024] [Accepted: 09/06/2024] [Indexed: 10/29/2024] Open
Abstract
Background: The anatomy of the biliary tree is complex with anatomical variations which can be found in ~50% of the patients. Purpose: Existing research on these variations primarily stems from studies in developed countries, with uncertain applicability to the Ugandan population due to noted ethnic differences in incidence rates. Objective: The study was aimed at describing the anatomical variations of the gallbladder and bile ducts. Methods: This retrospective cross-sectional study conducted at Kampala MRI Centre from January 2017 to December 2022 analyzed MRCP images and reports from 231 patients to document gallbladder and bile duct variations. Results: 53.2% of patients exhibited typical cystic duct anatomy, and 51% had Type 1 variations in intrahepatic ducts. Importantly, the study identified a significant correlation between age and common bile duct diameter. Conclusion: The findings showed various anatomical variations that were slightly higher in the study population than those reported in the literature. This study emphasizes the critical need for comprehensive knowledge to enhance surgical safety, minimize iatrogenic trauma, and improve the accuracy of diagnostic imaging and hepatobiliary procedures.
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Affiliation(s)
- Kigundu Yason
- Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kirum Gonzaga Gonza
- Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Okello Michael
- Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Buwembo William
- Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian Munabi
- Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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Raza Z, Altayar O, Mahmoud T, Abusaleh R, Ghazi R, Early D, Kushnir VM, Lang G, Sloan I, Hollander T, Rajan E, Storm AC, Abu Dayyeh BK, Chandrasekhara V, Das KK. Clinical predictors of significant findings on EUS for the evaluation of incidental common bile duct dilation. Gastrointest Endosc 2024; 100:670-678.e1. [PMID: 38692515 DOI: 10.1016/j.gie.2024.04.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Although EUS is highly accurate for the evaluation of common bile duct (CBD) dilation, the yield of EUS in patients with incidental CBD dilation is unclear. METHODS Serial patients undergoing EUS for incidental, dilated CBD (per radiologist, minimum of >6 mm objectively) from 2 academic medical centers without active pancreaticobiliary disease or significantly elevated liver function test results were evaluated. Multivariable logistic regression identified predictors of EUS with significant findings and a novel prediction model was derived from one center, internally validated with bootstrapping, and externally validated at the second center. RESULTS Of 375 patients evaluated, 31 (8.3%) had significant findings, including 26 choledocholithiasis, 1 ampullary adenoma, and 1 pancreatic mass. Predictors of significant findings with EUS included age of ≥70 years (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-10.0), non-biliary-type abdominal pain without chronic pain (OR, 6.1; 95% CI, 2.3-17.3), CBD diameter of ≥15 mm or ≥17 mm with cholecystectomy (OR, 6.9; 95% CI, 2.7-18.7), and prior ERCP (OR, 6.8; 95% CI, 2.1-22.5). A point-based novel clinical prediction model was created: age of ≥70 years = 1, non-biliary-type abdominal pain without chronic pain = 2, prior ERCP = 2, and CBD dilation = 2. A score of <1 had 93% (development) and 100% (validation) sensitivity and predicted a <2% chance of having a significant finding in both cohorts while excluding the need for EUS in ∼30% of both cohorts. Conversely, a score of ≥4 was >90% specific for the presence of significant pathology. CONCLUSIONS Less than 10% of patients undergoing EUS for incidental CBD dilation had pathologic findings. This novel, externally validated, clinical prediction model may reduce low-yield, invasive evaluation in nearly one-third of patients.
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Affiliation(s)
- Zain Raza
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Osama Altayar
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rami Abusaleh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rabih Ghazi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dayna Early
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Gabriel Lang
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Ian Sloan
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Thomas Hollander
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Koushik K Das
- Division of Gastroenterology, Washington University, St. Louis, Missouri, USA.
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Thom C, Yaworsky J, Livingstone K, Han D, Ottenhoff J. Utility of Common Bile Duct Identification on Biliary Ultrasound in Emergency Department Patients. Open Access Emerg Med 2024; 16:221-229. [PMID: 39221419 PMCID: PMC11366253 DOI: 10.2147/oaem.s468678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Background Biliary ultrasound is often utilized in the evaluation of abdominal pain in the Emergency Department (ED). Common bile duct (CBD) identification is traditionally a standard component of the biliary ultrasound examination but can be challenging to perform for the novice sonographer. Previous work has demonstrated that CBD dilatation is rare in cases of cholecystitis with normal liver function tests (LFTs). We sought to assess the frequency of CBD dilatation in the subset of ED patients undergoing hepatobiliary ultrasound who have normal LFTs and an absence of gallstones or biliary sludge on ultrasound. We also performed an assessment of changes in CBD diameter by age and cholecystectomy status. Methods This was a retrospective chart review at a single academic ED. Patients were enrolled in the study if they underwent a radiology performed (RP) hepatobiliary ultrasound within the 2 year study period. Records were reviewed for the presence of gallstones or sludge, CBD diameter, age, clinical indication for the ultrasound, and LFTs. Descriptive analyses were performed, and interobserver agreement among data abstractors was assessed by K analysis for the presence of CBD dilatation. The Mann-Whitney test was utilized to assess statistical significance in the comparison of differences between CBD diameters amongst age groups. Results Of 1929 RP hepatobiliary ultrasounds performed in the study period, 312 were excluded and 1617 met inclusion criteria. Amongst these, there were 506 patients who had normal LFTs and an ultrasound with no stones or sludge. Ten patients within this group had a dilated CBD > 7 mm (1.98%, 95% CI of 1.08% to 3.6%). We also noted a statistically significant increase in CBD size in the older age cohort and in those individuals with a history of cholecystectomy. Conclusion CBD dilation in ED patients who present with normal LFTs and an absence of gallstones and biliary sludge is rare. Physicians should be reassured that the routine identification of the CBD on ultrasound in this setting is of low yield and need not be pursued.
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Affiliation(s)
- Christopher Thom
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Justin Yaworsky
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kevin Livingstone
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David Han
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jakob Ottenhoff
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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Beyer G, Kasprowicz F, Hannemann A, Aghdassi A, Thamm P, Volzke H, Lerch MM, Kühn JP, Mayerle J. Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study. Gut 2023; 72:1738-1744. [PMID: 36828626 PMCID: PMC10423481 DOI: 10.1136/gutjnl-2021-326106] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Changes of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper reference ranges are missing. DESIGN Cross-sectional whole body MRI data from the population-based Study of Health in Pomerania were analysed. The width of the common bile duct (CBD) and the pancreatic duct (PD) was determined. We aimed to describe the distribution of physiological duct diameters on MRCP in a population of healthy subjects and to identify factors influencing duct size. RESULTS After excluding pre-existing pancreaticobiliary conditions, CBD and PD diameters from 938 and 774 healthy individuals, respectively, showed a significant increase with age (p<0.0001) and exceeded the conventional upper reference limit of normal in 10.9% and 18.2%, respectively. Age-dependent upper reference limits of duct diameters were delineated with non-parametric quantile regression, defined as 95th percentile: for CBD up to 8 mm in subjects <65 years and up to 11 mm in subjects ≥65 years. For the PD reference diameters were up to 3 mm in subjects <65 years and up to 4 mm in subjects ≥65 years. CONCLUSIONS This is the first population-based study delineating age-adjusted upper reference limits of CBD and PD on MRCP. We showed that up to 18.2% of healthy volunteers would have needed diagnostic workup, if the conventional reference values were used. The utilisation of the adapted reference levels may help to avoid unnecessary investigations and thus to reduce healthcare expenditure and test-related adverse events.
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Affiliation(s)
- Georg Beyer
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Kasprowicz
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Patrick Thamm
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Henry Volzke
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
- Institute for Community Medicine, Clinical Epidemiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, Carl-Gustav-Carus, Dresden, Sachsen, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Kim Y, Kim SS, Kwon D, Im D, Lee K, Yoon H. Computed tomographic quantitative evaluation of common bile duct size in normal dogs: A reference range study considering body weight. Front Vet Sci 2023; 10:1137400. [PMID: 37065230 PMCID: PMC10097882 DOI: 10.3389/fvets.2023.1137400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionCommon bile duct (CBD) measurements are important for the evaluation of biliary systemic disorders. However, in veterinary medicine, reference ranges for specific body weights (BW) and correlation between CBD diameter and BW have not been studied. This study aimed to establish normal reference ranges of CBD diameter for different BW groups and to analyse correlation between CBD diameter and BW in dogs without hepatobiliary disease. Additionally, normal reference ranges of CBD to aorta ratio (CBD: Ao ratio) were established which is not affected by BW.MethodsCBD diameter was measured at three different sites: porta hepatis (PH), duodenal papilla (DP) level and mid-portion (Mid) between these points using computed tomography (CT) in 283 dogs without hepatobiliary disease.ResultsThe reference range of CBD diameter at PH level: 1.69 ± 0.29 mm (Class 1; 1 kg ≤ BW < 5 kg), 1.92 ± 0.35 mm (Class 2; 5 kg ≤ BW < 10 kg), 2.20 ± 0.43 mm (Class 3; 10 kg ≤ BW < 15 kg), 2.79 ± 0.49 mm (Class 4; 15 kg ≤ BW < 30 kg); Mid-level: 2.06 ± 0.25 mm (Class 1), 2.43 ± 0.37 mm (Class 2), 2.74 ± 0.52 mm (Class 3), 3.14 ± 0.44 mm (Class 4); DP level: 2.33 ± 0.34 mm (Class 1), 2.90 ± 0.36 mm (Class 2), 3.35 ± 0.49 mm (Class 3), and 3.83 ± 0.50 mm (Class 4). There was a significant difference in CBD diameter at each level among all BW groups. Furthermore, BW and CBD diameter showed positive linear correlation at each level. We devised CBD: Ao ratio at each level that showed no significant difference between the different BW groups; PH level: 0.34 ± 0.05; Mid-level: 0.42 ± 0.06; DP level: 0.47 ± 0.06.ConclusionIn conclusion, since the CBD diameter for each BW is significantly different, different normal reference ranges of CBD diameter should be applied for each BW, and the CBD: Ao ratio can be used regardless of the BW.
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Affiliation(s)
- Yein Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Sung-Soo Kim
- Department of Veterinary Medical Imaging, VIP Animal Medical Centre, Seoul, Republic of Korea
| | - Danbee Kwon
- Department of Veterinary Medical Imaging, Bundang Leaders Animal Medical Centre, Seongnam, Republic of Korea
| | - Deokho Im
- Department of Veterinary Medical Imaging, Nel Animal Medical Center, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- *Correspondence: Hakyoung Yoon
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Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE): A Retrospective Study. Surg Laparosc Endosc Percutan Tech 2023; 33:62-68. [PMID: 36630657 PMCID: PMC9889197 DOI: 10.1097/sle.0000000000001135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n=56) and a remote LC group (group B, n=29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B.Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals.Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups. RESULTS In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter ( P <0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group ( P <0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter ( P <0.05). CONCLUSIONS This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.
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Sundaram KM, Morgan MA, Itani M, Thompson W. Imaging of benign biliary pathologies. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:106-126. [PMID: 35201397 DOI: 10.1007/s00261-022-03440-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/21/2023]
Abstract
Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Malak Itani
- Mallinkckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA
| | - William Thompson
- Department of Radiology, University of New Mexico, Albuquerque, USA
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Utilizing CT to identify clinically significant biliary dilatation in symptomatic post-cholecystectomy patients: when should we be worried? ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4126-4138. [PMID: 36104482 DOI: 10.1007/s00261-022-03660-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients. METHODS In this IRB approved retrospective study, two attending radiologists independently reviewed CT imaging for 118 post-cholecystectomy patients, who were subsequently evaluated with MRCP, ERCP, or EUS, prompted by findings on the CT and clinical status. Measurements of the common duct (CD) were obtained at the porta hepatis, distal duct, and point of maximal dilation on axial and coronal CT scans. Patients were grouped by whether they required intervention after follow-up imaging. Pertinent baseline lab values and patient demographics were reviewed. RESULTS Of the 118 post-cholecystectomy patients, 38 patients (31%) required intervention, and 80 patients (69%) did not require intervention after follow-up imaging. For both readers, axial and coronal CD diameters were significantly higher in the 'intervention required' vs 'no intervention' groups at all locations (p value < 0.05). There was good to excellent inter-reader agreement at all locations (ICC 0.68-0.92). Pertinent baseline lab values including AST (p = 0.043), ALT (p = 0.001), alkaline phosphatase (p = 0.0001), direct bilirubin (p = 0.011), total bilirubin (p = 0.028), and WBC (p = 0.043) were significantly higher in the 'intervention required' group. CD thresholds of 8 mm yielded the highest sensitivities (76-95%), and CD thresholds of 12 mm yielded the highest specificities (65-78%). CD combined with bilirubin levels increased sensitivity and specificity, compared to using either feature alone. CONCLUSION Dilated CD on CT combined with bilirubin levels increases the sensitivity and specificity for identifying patients needing intervention. We recommend that a post-cholecystectomy patient who presents with a CD diameter > 10 mm on CT and elevated bilirubin levels should undergo further clinical and imaging follow-up.
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Govindan S, Tamrat NE, Liu ZJ. Effect of Ageing on the Common Bile Duct Diameter. Dig Surg 2021; 38:368-376. [PMID: 34673652 DOI: 10.1159/000519446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of the study was to determine if the common bile duct (CBD) diameter increases physiologically with age and investigate whether gallstones lead to changes in CBD diameter. METHOD Our study is composed of 721 patients in 2 groups: 517 asymptomatic patients and 204 gallstones patients who underwent MRCP. Their CBD diameter was measured at its widest visible portion on MRCP. Simple linear regression of the average of these measurements was used to investigate the relationship between age and CBD diameter in both populations. Subjects were further divided into 8 subgroups age-wise, respectively, and their means compared decade-wise using ANOVA. Furthermore, each subgroup mean from both populations was compared with each other using a t test. RESULTS Among the 517 subjects, the mean CBD diameter was 5.3663 mm ± 1.43546 and correlated with age (p < 0.01), dilating at 0.07 mm/year. The mean diameter of our oldest group was 7.9 mm, resulting in a plausible upper limit of 8 mm for the asymptomatic population. The mean CBD diameter of the cholelithiasis population was 5.6738 mm ± 1.40986 and also correlated with age (p < 0.01). The mean CBD diameter of the age groups from the cholelithiasis population was larger than that from the asymptomatic population, but none were statistically significant. CONCLUSION Although the CBD increases physiologically with age, there is no significant difference in CBD size between the general population and the cholelithiasis patients at any particular age. Gallstones do not independently dilate the CBD.
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Affiliation(s)
- Shankara Govindan
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China,
| | - Nebiyu Elias Tamrat
- Department of Urology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zi Jun Liu
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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Barakat MT, Banerjee S. Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department. World J Hepatol 2020; 12:1289-1298. [PMID: 33442455 PMCID: PMC7772725 DOI: 10.4254/wjh.v12.i12.1289] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/12/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Biliary dilation is frequently related to obstruction; however, non-obstructive factors such as age and previous cholecystectomy have also been reported. In the past two decades there has been a dramatic increase in opiate use/dependence and utilization of cross-sectional abdominal imaging, with increased detection of biliary dilation, particularly in patients who use opiates.
AIM To evaluate associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index utilizing our institution’s integrated informatics platform.
METHODS One thousand six hundred and eighty-five patients (20% sample) presenting to our Emergency Department for all causes over a 5-year period (2011-2016) who had undergone cross-sectional abdominal imaging and had normal total bilirubin were included and analyzed.
RESULTS Common bile duct (CBD) diameter was significantly higher in opiate users compared to non-opiate users (8.67 mm vs 7.24 mm, P < 0.001) and in patients with a history of cholecystectomy compared to those with an intact gallbladder (8.98 vs 6.72, P < 0.001). For patients with an intact gallbladder who did not use opiates (n = 432), increasing age did not predict CBD diameter (r2 = 0.159, P = 0.873). Height weakly predicted CBD diameter (r2 = 0.561, P = 0.018), but weight, body mass index, ethnicity and gender did not.
CONCLUSION Opiate use and a history of cholecystectomy are associated with CBD dilation in the absence of an obstructive process. Age alone is not associated with increased CBD diameter. These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter. Further prospective study is warranted.
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Affiliation(s)
- Monique T Barakat
- Divisions of Adult and Pediatric Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94305, United States
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94304, United States
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12
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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13
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Chen H, Jorissen R, Walcott J, Nikfarjam M. Incidence and predictors of common bile duct stones in patients with acute cholecystitis: a systematic literature review and meta-analysis. ANZ J Surg 2020; 90:1598-1603. [PMID: 31743951 DOI: 10.1111/ans.15565] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 05/17/2025]
Abstract
BACKGROUND Acute cholecystitis (AC) is a surgical condition that is usually managed by emergency surgery. The presence of common bile duct stones (CBDS) in this setting mandates definitive treatment to avoid complications such as cholangitis. The incidence of CBDS in the setting of AC is poorly defined. METHODS A systematic English literature search was conducted in PubMed, MEDLINE and Embase to determine the incidence of CBDS in patients presenting with AC. Outlier studies identified by funnel plot analysis were excluded and the incidence of CBDS was identified. The mean CBD diameter and liver function test values of patients with AC and CBDS were calculated. RESULTS Data were extracted from 19 studies representing a total 4057 patients with AC. Routine biliary imaging was not performed in all studies. The pooled incidence of CBDS was 13.7% (95% confidence interval 11.8-15.9). The incidence of unsuspected retained CBDS was 1.1%. Histologically confirmed cases of AC had a similar rate of CBDS compared to those diagnosed clinically. The mean CBD diameter of patients with AC and CBDS was 7.2 mm compared to 5.8 mm without. Liver function test values in the presence of CBDS were more likely to be deranged, with gamma-glutamyltransferase the most sensitive and specific marker for CBDS in the setting of AC. CONCLUSION CBDS is present in a significant proportion of patients presenting with AC. Routine biliary imaging is advised in all patients presenting with AC where possible.
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Affiliation(s)
- Hongyi Chen
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Robert Jorissen
- Systems Biology and Personalised Medicine Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - James Walcott
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
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Worku MG, Enyew EF, Desita ZT, Moges AM. Sonographic measurement of normal common bile duct diameter and associated factors at the University of Gondar comprehensive specialized hospital and selected private imaging center in Gondar town, North West Ethiopia. PLoS One 2020; 15:e0227135. [PMID: 31971959 PMCID: PMC6977745 DOI: 10.1371/journal.pone.0227135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background The biliary tree is a three-dimensional system of channels that bile flows from the hepatocytes to the gallbladder and to the intestine. Size of the common bile duct (CBD) is a predictor of biliary obstruction and, therefore, its measurement is an important component of biliary system evaluation. Factors like age, height, weight, BMI, previous cholecystectomy, drugs, and type of imaging modality affect CBD diameter, but the duct significantly dilated due to obstructive biliary pathology. Objective To measure the normal CBD diameter and its association with age, sex, and anthropometric measurement at the University of Gondar Comprehensive Specialized Hospital and selected private imaging center, Gondar town, Northwest Ethiopia, 2019. Methods and materials Institutional based cross-sectional study was conducted on 206 subjects without any history of hepatobiliary abnormality. The CBD measured at the proximal part just caudal to the porta hepatis. Descriptive analysis, student t-test, one way ANOVA, correlation and both bivariable and multivariable linear regression analysis were implemented. In bivariable linear regression variables with p-value, less than 0.2 were selected for multivariable analysis and in multivariable linear regression analysis variables with P-Value less than 0.05 were considered as statistically significant. Results The mean age of the study participants was 39.4 (range 18–87). The mean diameter of the CBD was 3.64mm 95%CI (3.52, 3.77), which ranges from 1.8 to 5.9 mm, with 65% of the participant having CBD diameter less than 4mm. The diameter of CBD significantly associated with age with a linear trend. The mean diameter in a rural area was greater than subjects living in an urban area. Independent t-test showed no statistically significant difference in CBD diameter between male and female subjects. Conclusion The lower limit of the CBD diameter for this study was similar to most of the studies, but the upper limit was found to be slightly lower. The diameter was significantly associated with age along the linear trend and it was progressively increased from the lower age group onwards. The diameter of CBD did not show statistically significant association with any of the anthropometric measurement.
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Affiliation(s)
- Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
- * E-mail:
| | - Engdaw Fentahun Enyew
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Zerubabel Tegegne Desita
- Department of Radiology, University of Gondar, college of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Abebe Muche Moges
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
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15
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Agunloye A, Ayede A, Olatunji R. Normal ultrasonographic dimensions of the gallbladder and common bile duct in neonates. WEST AFRICAN JOURNAL OF RADIOLOGY 2020. [DOI: 10.4103/wajr.wajr_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Does measurement of the hepatic artery velocity improve the sonographic diagnosis of cholangitis? Abdom Radiol (NY) 2019; 44:4004-4010. [PMID: 31673717 DOI: 10.1007/s00261-019-02284-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the frequency of elevated peak systolic proper hepatic artery velocity (HAV) in patients with acute cholangitis and to determine the diagnostic performance of this metric relative to existing criteria. METHODS Between 9/2016 and 11/2017, 107 patients clinically suspected to have cholangitis were referred for an abdominal ultrasound. Of these, 56 patients had HAV measurements and were included in the final analysis. Clinical and imaging features, including HAV, HAV resistive index (RI), portal vein velocity (PVV), biliary dilation, and presence of an obstructive etiology were extracted. The diagnostic performance of HAV was compared to the existing available clinical criteria (Charcot's triad and 2018 Tokyo Guidelines). Elevated HAV was defined as HAV > 100 cm/s. Presence of cholangitis was determined by the discharge summary following medical workup and admission or observation. RESULTS 32% had cholangitis while 68% did not. Average HAV for patients with cholangitis was 152 ± 54 cm/s versus 91 ± 44 cm/s for those without (p < 0.0001; t test). The HAV was elevated in 83% of patients with cholangitis. When considered in isolation, an elevated HAV had a high negative predictive value (90%), was more accurate (77%; 95% confidence interval 64-87%) than Charcot's triad (73%; 60-83%), and had similar accuracy compared to 2018 Tokyo Guidelines (79%; 66-88%). Substitution of conventional imaging criteria with elevated HAV in the 2018 Tokyo Guidelines yielded the highest overall accuracy of 84% (72-92%). CONCLUSION HAV is elevated in the majority of patients with cholangitis. Substitution of an elevated HAV for conventional sonographic criteria is more accurate than existing clinical criteria in identifying patients with cholangitis.
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Moreno CC, Mittal PK, Miller FH. Nonfetal Imaging During Pregnancy: Acute Abdomen/Pelvis. Radiol Clin North Am 2019; 58:363-380. [PMID: 32044012 DOI: 10.1016/j.rcl.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364-A Clifton Road Northeast Suite AT-627, Atlanta, GA 30327, USA.
| | - Pardeep K Mittal
- Department of Radiology, Medical College of Georgia, 1120 15th Street, BA-1411, Augusta, GA 30912, USA
| | - Frank H Miller
- Body Imaging Section and Fellowship, MRI, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 800, Chicago, IL 60611, USA
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18
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De Silva SL, Pathirana AA, Wijerathne TK, Gamage BD, Dassanayake BK, De Silva MM. Transabdominal Ultrasonography in Symptomatic Choledocholithiasis - Usefulness in Settings with Limited Resources. J Clin Imaging Sci 2019; 9:31. [PMID: 31508266 PMCID: PMC6712550 DOI: 10.25259/jcis-38-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis. Methods: This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results. Results: A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms (P < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant (P < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%. Conclusion: Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC.
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Affiliation(s)
| | - Ajith Aloka Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Thejana Kamil Wijerathne
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Bawantha Dilshan Gamage
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Mohan Malith De Silva
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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19
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Jones M, Necas M. The performance of ultrasound in determining the cause of biliary dilation. SONOGRAPHY 2018. [DOI: 10.1002/sono.12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Martin Necas
- The University of Auckland; Auckland New Zealand
- Waikato District Health Board; Hamilton New Zealand
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20
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Moharamzad Y, Abbasi S, Sanei Taheri M, Faghihi Langroudi T. Association between common bile duct diameter and abdominal aorta calcium score. Abdom Radiol (NY) 2018; 43:2097-2102. [PMID: 29214447 DOI: 10.1007/s00261-017-1431-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE There is evidence of association between aging and increase in the normal upper limit of the common bile duct (CBD) diameter. As aging is a documented risk factor for atherosclerosis, and the possible effect that atherosclerosis can have on the CBD diameter via affecting its smooth muscle contractility and blood flow, we decided to determine the association between CBD diameter and atherosclerosis in the abdominal aorta (AA). METHODS A total of 99 asymptomatic patients (53 males and 46 females; age range of 18-88 years) without history of cholecystectomy who underwent abdominal contrast-enhanced CT scan were included. The CBD diameter was measured. The atherosclerosis of AA was quantified by Agatston score. RESULTS Mean (± SD) CBD diameter was 6.14 (± 1.95) mm; range = 2.4-12.7 mm. Agatston score was 0 in 59 patients. In the remaining 40 patients, median (interquartile range, IQR) Agatston score was 497.5 (2026.3). Mean (± SD) CBD diameter in patients with Agatston score > 0 was 7.39 (± 2.07) mm compared to 5.29 (± 1.32) mm in patients without calcification plaque (P < 0.001). A moderate correlation was seen between CBD diameter and Agatston score (ρ = 0.43; P = 0.005). CONCLUSION Although the exact cause of increased CBD diameter with advancing age is not understood, a general atherosclerotic process which occurs with aging may affect smooth muscle of the CBD. Whether an upper limit for normal CBD should be defined or not when evaluating dilated CBD for patients with subclinical or clinical atherosclerosis needs further studies.
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Affiliation(s)
- Yashar Moharamzad
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
| | - Sahar Abbasi
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran.
| | - Taraneh Faghihi Langroudi
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
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Abstract
OBJECTIVE The normal diameter of the extrahepatic bile duct (EHD) in children has been poorly studied. Prior studies have enrolled small subject numbers, have studied only specific pediatric age groups, or have potential bias due to loosely defined exclusion criteria. We sought to establish parameters for the normal diameter of the EHD in children from birth to late adolescence, including premature infants. METHODS A 12½-month institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective chart review of all transabdominal ultrasounds performed on children (younger than 18 years) was conducted at a single pediatric tertiary referral center. Exclusion criteria included a past medical history of any pancreaticobiliary or hepatology disorder. New abnormal findings related to the liver, biliary system, or pancreas were also excluded. Recorded EHD measurements from review of the radiology reports were compiled. Estimated mean and 95% prediction intervals of EHD were calculated and reported for 6 nonoverlapping pediatric age groups. RESULTS A total of 1016 ultrasounds on unique patients were included within the study. Estimated mean values and calculated 95% prediction intervals (in parentheses) for the diameter of the EHD were prematurity, 0.7 (0.3-1.7) mm; 0 to 2 months, 1.0 (0.4-2.3) mm; 3 to 11 months, 1.2 (0.5-2.9) mm; 1 to 4 years, 1.4 (0.6-3.3) mm; 5 to 12 years, 1.9 (0.8-4.3) mm; 13 to 17 years, 2.3 (1.0-5.2) mm. CONCLUSIONS Our derived data of normal predicted parameters of the EHD diameter in children of all age groups will help guide clinicians in identifying those patients outside the norm that may benefit from additional testing.
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22
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CT evaluation of common duct dilation after cholecystectomy and with advancing age. ACTA ACUST UNITED AC 2016; 40:1581-6. [PMID: 25421790 DOI: 10.1007/s00261-014-0308-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate common duct (CD) dilation by computed tomography (CT) in patients with intact gallbladders and diameter change over time in remote and interval cholecystectomy patients, frequency of visualization of the CD, and its relationship to age. METHODS This IRB-approved retrospective study evaluated baseline CD diameter, intrahepatic biliary dilation, and interval duct diameter change in patients with CTs ≥ 2 years apart (n = 324), in block-randomized order by two blinded board-certified radiologists. 272 patients were divided into three groups: (1) prior cholecystectomy before the first CT, (2) cholecystectomy between the first and last CTs, and (3) no cholecystectomy. A subset of 191 nonoperated patients was evaluated for age-related dilation. RESULTS Group 1 ducts were significantly larger than the other groups at both baseline and follow-up CTs (p < 0.001). Group 2 showed a greater increase in duct size than the other groups at follow-up (p < 0.001). The CD was measurable in 89% of the CT studies. In nonoperated patients, there was a statistically significant correlation between CD size and increasing age (p < 0.001), although the CD size remained within normal size limits. CONCLUSION Remote cholecystectomy patients have larger CD diameters than the nonoperated and interval cholecystectomy groups. Greater increase in ductal diameter occurred between studies in the interval cholecystectomy patients, suggesting that dilation occurs after cholecystectomy. Also, the CD dilates slightly with age in nonoperated patients.
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Angelis CD, Marietti M, Bruno M, Pellicano R, Rizzetto M. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World J Gastrointest Endosc 2015; 7:799-805. [PMID: 26191344 PMCID: PMC4501970 DOI: 10.4253/wjge.v7.i8.799] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/23/2014] [Accepted: 05/27/2015] [Indexed: 02/05/2023] Open
Abstract
In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among non-jaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects.
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Ultrasound measurements of the bile ducts and gallbladder: normal ranges and effects of age, sex, cholecystectomy, and pathologic states. Ultrasound Q 2015; 30:41-8. [PMID: 24901778 DOI: 10.1097/ruq.0b013e3182a80c98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objectives of this study were to determine the normal values and ranges for bile duct and gallbladder measurements, adjusted for demographic data, and to assess the effects of a variety of pathologic states on these values. METHODS Four thousand one hundred nineteen abdominal ultrasounds were retrospectively analyzed. The values for the extrahepatic bile duct (EHD), left (LIHD) and right (RIHD) intrahepatic ducts, gallbladder wall thickness, and gallbladder volume in "normal" patients were evaluated with respect to age, sex, ethnicity, and cholecystectomy status. These values were compared using multivariate analysis to those in a variety of diseased states, including cirrhosis, fatty liver, gallstones, sludge, cholecystitis, and biliary obstruction. RESULTS One thousand four hundred eighty-four of the 4119 examinations were classified as normal. The mean EHD, RIHD, LIHD, and gallbladder wall thickness and volume measurements in normal patients were 3.8 ± 1.6 mm, 1.9 ± 1.9 mm, 1.9 ± 1.1 mm, 2.6 ± 1.6 mm, and 242 ± 234 mL, respectively.There were small increases in EHD diameter with age (+0.02 ± 0.11 mm/y, P < 0.001), female sex (+0.3 ± 1.6 mm, P < 0.0001), and cholecystectomy (+1.0 ± 1.6 mm, P < 0.0001) and a small decrease with fatty liver (-0.4 ± 1.6 mm, P = 0.0003). The gallbladder wall was thicker in patients with gallstones (+0.4 ± 1.4 mm, P = 0.0049), sludge (+0.5 ± 1.4 mm, P = 0.0019), and acute cholecystitis (+3.1 ± 1.6 mm, P < 0.0001). With biliary obstruction, the mean EHD, RIHD, LIHD, and gallbladder volume measurements were 6.0 ± 2.1 mm, 4.2 ± 1.4 mm, 4.1 ± 1.4 mm, and 171 ± 207 mL, respectively (P < 0.0001 for all values). CONCLUSIONS This study clarifies normal values and ranges for bile duct and gallbladder measurements, adjusted for demographic data, and evaluates these measurements in a variety of common pathologic states.
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Lal N, Mehra S, Lal V. Ultrasonographic measurement of normal common bile duct diameter and its correlation with age, sex and anthropometry. J Clin Diagn Res 2014; 8:AC01-4. [PMID: 25653927 DOI: 10.7860/jcdr/2014/8738.5232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ultrasonography is the diagnostic method of choice for visualization and rational work-up of abdominal organs. The dilatation of the common bile duct helps distinguish obstructive from non-obstructive causes of jaundice. Availability of normal measurements of the common bile duct is therefore important. There exists significant variations in the anthropometric features of various populations, regions and races. AIM Study was conducted to obtain data on sonographically measured diameters of common bile duct in a series of normal Rajasthani population and to measure its correlation with age, sex and anthropometry. SETTING AND DESIGN Cross-sectional hospital-based study conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, India. MATERIALS AND METHODS Study included 200 participants with equal proportion belonging to either sex. Common bile duct was measured at three locations- at the porta hepatis, in the most distal aspect of head of pancreas and mid-way between these points. Anthropometric measurements including height, weight, chest circumference, circumference at transpyloric plane, circumference at umbilicus and circumference at hip were obtained using standard procedures. STATISTICAL ANALYSIS Univariable analysis with measures of frequency and standard deviation and bivariable analysis using correlation. RESULTS Mean age of study subjects was 34.5 years (Range 18-85 years). Mean diameters of the common bile duct in the three locations were: proximal, 4.0 mm (SD 1.02 mm); middle, 4.1 mm (SD 1.01 mm); and distal, 4.2 mm (SD 1.01 mm) and overall mean for all measures 4.1 mm (SD 1.01 mm). Average diameter ranged from 2.0 mm to 7.9 mm, with 95 percent of the subjects having a diameter of less than 6 mm. We observed a statistically significant relation of common bile duct with age, along with a linear trend. There was no statistically significant difference in common bile duct diameter between male and female subjects. The diameter did not show any statistically significant correlation with any of the anthropometric measurements. CONCLUSION Our study reported the upper limit of normality as 7.9 mm. The diameter increased progressively from 3.9 mm among those aged 18-25 years to 4.7 mm among those in the age group more than 55 years. This was found to be statistically significant. Ductal diameters beyond these limits should prompt the need for further investigations.
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Affiliation(s)
- Nidhi Lal
- Demonstrator, Department of Anatomy, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Simmi Mehra
- Associate Professor, Department of Anatomy, Mahatma Gandhi Medical College and Hospital , Jaipur, India
| | - Vivek Lal
- Regional Medical Advisor (East), GLRA-India
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Unexplained common bile duct dilatation with normal serum liver enzymes: diagnostic yield of endoscopic ultrasound and follow-up of this condition. J Clin Gastroenterol 2014; 48:e67-70. [PMID: 24045275 DOI: 10.1097/mcg.0b013e3182a8848a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is scant literature about common bile duct (CBD) dilatation with normal liver function tests (LFTs). AIMS The aims of this study were to assess the diagnostic yield of endoscopic ultrasound (EUS) in patients with CBD dilatation, normal LFTs, and prior inconclusive imaging tests, and to assess the natural history of these subjects. METHODS We retrospectively reviewed our EUS database for patients referred for evaluation of CBD dilatation, normal LFTs, and prior inconclusive imaging. We excluded patients with a prior endoscopic retrograde cholangiopancreatography or a history of biliary obstruction, pancreatitis, or jaundice. Follow-up data were retrieved from medical records or by calling the general practitioners, referring specialists, patients, or their closest relatives. RESULTS A total of 57 patients were enrolled. The mean CBD diameter was 12.5±3.6 mm. The majority of patients (50.8%) were asymptomatic. Abnormal EUS findings were recorded in 12 (21%) subjects: 6 patients had a periampullary diverticulum, 2 had ampullary adenoma, 2 had signs of chronic pancreatitis, 1 had a cancer of the pancreatic head, and 1 had a 7 mm CBD stone. Neither age, sex, prior cholecystectomy, clinical presentation, CBD diameter, nor a dilated main pancreatic duct were predictors of abnormal EUS findings. None of the patients complained of biliary symptoms or showed abnormal LFTs on long-term follow-up. CONCLUSIONS CBD dilatation with normal liver chemistry is not always a benign condition. Even when prior imaging tests are negative, EUS may allow to diagnose conditions overlooked by standard diagnostic imaging.
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Kim CW, Chang JH, Lim YS, Kim TH, Lee IS, Han SW. Initial large diameter of common bile duct is associated with long-term dilatation of bile duct after endoscopic extraction of stones. J Dig Dis 2014; 15:35-41. [PMID: 23992116 DOI: 10.1111/1751-2980.12100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the time and extent of recovery of dilated common bile duct (CBD) after the extraction of CBD stones and to identify the factors related to the long-term dilatation of the CBD after stone removal. METHODS Data of 329 consecutive patients undergoing endoscopic extraction of CBD stones from January 2008 to December 2012 were retrospectively reviewed. Finally, 44 patients were enrolled in the study. RESULTS The CBD diameter significantly decreased after stone extraction (P < 0.001). However, the CBD diameter in patients who were followed up for 1 week and longer and <1 week did not differ significantly. The diameter decreased more in patients with an initial CBD diameter ≥ 15 mm than in those with an initial CBD diameter <15 mm before stone extraction (P = 0.007), but the normalization of dilated CBD was less frequent in patients with a large initial CBD diameter. The factors related to the long-term dilatation of CBD (>10 mm for >6 months) were initial CBD diameter, the largest diameter of CBD stone and endoscopic papillary large balloon dilatation. Initial CBD diameter was an independent factor with multivariate analysis (OR 1.754, P = 0.017). CONCLUSIONS The CBD diameter recovers rapidly after the extraction of CBD stones. An initial large CBD diameter before stone extraction is associated with the long-term dilatation of CBD.
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Affiliation(s)
- Chang Whan Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Landry D, Tang A, Murphy-Lavallée J, Lepanto L, Billiard JS, Olivié D, Sylvestre MP. Dilatation of the bile duct in patients after cholecystectomy: a retrospective study. Can Assoc Radiol J 2013; 65:29-34. [PMID: 23453523 DOI: 10.1016/j.carj.2012.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/02/2012] [Accepted: 09/22/2012] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Retrospective assessment of impact of cholecystectomy, age, and sex on bile duct (BD) diameter. MATERIALS AND METHODS We retrospectively reviewed abdominal contrast-enhanced multidetector computed tomography and laboratory reports of 290 consecutive patients (119 men; mean age, 55.9 years) who presented without cholestasis to the emergency department of our institution between June 2009 and August 2010. BD diameters were measured in 3 locations, by 2 independent observers, twice, at 1-month intervals. Reproducibility and agreement were evaluated by intraclass correlation coefficients and Bland-Altman analyses. The effects of cholecystectomy, age, and sex on BD diameter were analysed with linear mixed models. RESULTS BD diameter inter-reader reproducibility and agreement were excellent at the level of the right hepatic artery (intraclass correlation coefficient, 0.94). Sixty-one patients (21.0%) had a history of cholecystectomy. Among them, the 95th percentile of BD diameters at hepatic artery level was 7.9 mm (<50 years) and 12.3 mm (≥50 years). Among those without cholecystectomy, BD diameter was 6.2 mm (<50 years) and 7.7 mm (≥50 years). Cholecystectomy was associated with significantly larger BD diameters in both age groups (P < .001). Older age was associated with larger BD diameters (P = .004). Sex had no impact on BD diameter (P = .842). CONCLUSION Patients after cholecystectomy may present with an enlarged BD unrelated to cholestasis. The BD diameter increases with age. Clinicians should rely on cholecystectomy status, age, and laboratory results to determine needs of further investigation.
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Affiliation(s)
- David Landry
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Jessica Murphy-Lavallée
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada.
| | - Luigi Lepanto
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Marie-Pierre Sylvestre
- Biostatistics Services, University of Montreal Hospital Research Center (CRCHUM), Centre de recherche du CHUM, Montréal, Québec, Canada
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Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography. Surg Endosc 2012; 27:303-7. [PMID: 22903627 DOI: 10.1007/s00464-012-2445-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 06/07/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Increased common bile duct (CBD) diameter has been attributed to aging and previous cholecystectomy. These relationships are, however, controversial and based mainly on old studies and methodologies. Our objective is to evaluate the relationship between age, cholecystectomy, and other clinical factors and CBD diameter, as measured by endoscopic ultrasound (EUS). METHODS We carried out a retrospective cohort study including patients who underwent EUS in our institution. Patients with an obstructing lesion of the bile ducts, previous sphincter manipulation, or insufficient data were excluded. CBD diameter was measured as a routine part of the examination, in the most distal extrapancreatic portion, between its two exterior margins. The patients were divided into five age groups. The mean CBD diameter in each group was calculated and compared with the other groups. Effects of cholecystectomy, gender, time from operation, and elevated liver enzymes were also evaluated. RESULTS Six hundred forty-seven patients were included in the study (66% women). Twenty-three percent were postcholecystectomy. There was no difference between the first three groups regarding CBD diameter, but it was significantly wider in groups 4 and 5 (p < 0.001). In all age groups, the postcholecystectomy patients had significantly wider CBD than those with an intact gallbladder (in all groups, p < 0.01). CONCLUSIONS This EUS study confirms that the CBD dilates significantly after the age of 70 years, but even in the most elderly patients, with an intact gallbladder, the normal CBD does not exceed 7.6 mm, thus a wider CBD warrants further investigation. The single additional factor contributing to dilatation of the CBD was cholecystectomy. A linear regression equation is proposed for the prediction of CBD diameter.
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Park SM, Kim WS, Bae IH, Kim JH, Ryu DH, Jang LC, Choi JW. Common bile duct dilatation after cholecystectomy: a one-year prospective study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:97-101. [PMID: 22880184 PMCID: PMC3412191 DOI: 10.4174/jkss.2012.83.2.97] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/20/2012] [Accepted: 05/31/2012] [Indexed: 01/29/2023]
Abstract
PURPOSE Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year. METHODS Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively. RESULTS The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after cholecystectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. CONCLUSION Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.
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Affiliation(s)
- Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
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Cheng Y, Lin Y, Xiong X, Wu S, Lu J, Cheng N. The human umbilical cord: A novel substitute for reconstruction of the extrahepatic bile duct. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Urquhart P, Speer T, Gibson R. Challenging clinical paradigms of common bile duct diameter. Gastrointest Endosc 2011; 74:378-9. [PMID: 21683353 DOI: 10.1016/j.gie.2011.03.1256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/30/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Paul Urquhart
- RoyalMelbourne Hospital Parkville, Victoria, Australia
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Senturk S, Miroglu TC, Bilici A, Gumus H, Tekin RC, Ekici F, Tekbas G. Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT. Eur J Radiol 2010; 81:39-42. [PMID: 21144686 DOI: 10.1016/j.ejrad.2010.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 11/03/2010] [Indexed: 12/20/2022]
Abstract
This study aims to collect data by multidetector computed tomography (MDCT) on the diameter of the normal common bile duct (CBD) and the diameter of CBD after cholecystectomy. In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 604 patients without cholecystectomy. The patients were divided into 6 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the six age groups. The mean diameter of the CBD of 46 patients who had cholecystectomy was calculated. The results were compared with age matched control group by Student's t test. The largest diameter of CBD ranged from 1.8 to 11.8mm. The mean of the largest diameter of 604 subjects was 4.77 ± 1.81. The diameter of the CBD significantly increased with age. Mean largest CBD diameters of postcholecystectomy subjects (7.28 ± 2.37) were significantly greater than age matched control group. In conclusion the diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6mm in most of the subjects. An upper limit of 8mm appears reasonable after the age of 50; and an upper limit of 10mm seems appropriate for cholescystectomized subjects.
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Affiliation(s)
- Senem Senturk
- Dicle University, School of Medicine, Radiology Department, 21280 Diyarbakir, Turkey.
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Abstract
Ultrasound is a pivotal study for evaluation of the biliary tree. In particular, the size of the extrahepatic bile duct is a critical measurement and has been a contentious issue since the early days of diagnostic ultrasound. This article reviews the history and ongoing issues regarding sonography of the normal-size duct and a variety of factors that may affect its size, including age, prior surgery, congenital abnormalities, anatomical variations, and medications. Other related sonographic issues are discussed including abnormal nondilated ducts and abnormal intraluminal contents such as sludge or air that make evaluation of the duct more difficult, particularly in patients with primary sclerosing cholangitis and prior liver transplantation. Ultimately, the luminal size of the extrahepatic duct should be considered as a single part of the entire assessment of the biliary tree that must also include the intrahepatic and pancreatic ducts, the pattern of dilatation (variable vs progressively dilated to a single point of obstruction), any wall thickening, intraluminal sludge, calculi or mass, and extraluminal compression. Clinical symptoms and abnormal laboratory values should prompt further evaluation despite a normal appearance of the bile duct, whereas pursuit of an isolated finding of an enlarged duct without supporting clinical data may not be warranted.
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35
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Rezaee A, Narouie B, Ghasemi-Rad M, Nosair E, Mohebi F, Sharareh Sanei Sistani. Is Opioid Addiction a Sufficient Predicting Factor for Common Bile Duct Dilatation? A Sonographic Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010; 26:137-142. [DOI: 10.1177/8756479310366470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
In the absence of hepatobiliary symptoms, opioid consumption has been shown to cause dilatation of the common bile duct (CBD). The main objective of this study was to measure with sonography CBD diameters in opioid addicts as compared with nonaddicts. The research was done on 208 individuals; 104 were opioid addicts using various routes of administration (inhalation, oral, or intravenous), and 104 had no history of addiction (control group). All patients underwent abdominopelvic sonography, and the internal diameters of the proximal part of the CBD were recorded. The average CBD diameter in the control group was 4.13 ± 1.14 mm, which significantly increased to 8.16 ± 2.54 mm in the case group. A significant increase in the average diameter of CBD in the case group with the oral route was 10.7 ± 2.26 mm, compared with 7.5 ± 1.64 mm and 7.6 ± 3.05 mm, respectively, for those using inhalation and intravenous routes. The diameter of CBD was age dependent. The dilatation of the CBD detected by sonography occurring in opioid addicts in all age groups was attributed principally to the effect of opioids. Oral administration of opioid caused the highest dilatation effect on CBD.
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Affiliation(s)
- Ahmad Rezaee
- Zahedan University of Medical Sciences, Zahedan, Iran
| | - Behzad Narouie
- Ali-ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Iran,
| | | | - Emad Nosair
- University of Sharjah, Sharjah, United Arab Emirates
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36
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Park JS, Lee DH, Jeong S, Cho SG. Determination of Diameter and Angulation of the Normal Common Bile Duct using Multidetector Computed Tomography. Gut Liver 2009; 3:306-10. [PMID: 20431765 PMCID: PMC2852735 DOI: 10.5009/gnl.2009.3.4.306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/20/2009] [Indexed: 12/27/2022] Open
Abstract
Background/Aims Common bile duct stones are associated with the extent of dilation of the common bile duct as well as its angulation. Multidetector computed tomography (MD CT) has a good resolution for the definition of the anatomical features of the common bile duct. Methods The multiplanar reformation images of 398 patients that underwent multidetector CT for the diagnosis of disorders not related to the bile duct were examined. The diameter and angulation were categorized by gender and age. Results The average diameter and angulation of the common bile duct was 6.7 mm and 132.6°. There was a statistically significant correlation between age and the common bile duct diameter. The Pearson correlation analysis for age and diameter resulted in a value of 0.415 (p<0.001). And the common bile duct (CBD) diameter in people older than 51 years of age showed a significant difference compared to the subjects younger than 50 years of age (p<0.01). However, the degree of angulation has no correlation with age. Conclusions We suggest that CBD diameters in patients more than 50 years of age can be more than 7 mm and be within normal limits.
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Affiliation(s)
- Jin-Seok Park
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Abstract
The investigation of biliary dilatation forms a routine part of gastroenterology practice. In developed countries, biliary dilatation is usually the result of obstruction of bile flow by either stones or mitotic lesions of the pancreas or biliary tree, and standard radiologic and endoscopic techniques are used to identify and relieve the obstruction. In the absence of an obvious cause, however, the investigation and management of biliary dilatation can prove challenging, particularly while trying to minimize invasive studies. This review examines factors thought to influence bile duct size in the absence of obvious obstructing pathology and looks at some causes of biliary dilatation that are unusual and potentially difficult to diagnose.
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Affiliation(s)
- Alan Coss
- Pacific Gastroenterology Associates, #770-1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada
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38
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Tse F, Barkun JS, Romagnuolo J, Friedman G, Bornstein JD, Barkun AN. Nonoperative imaging techniques in suspected biliary tract obstruction. HPB (Oxford) 2006; 8:409-25. [PMID: 18333096 PMCID: PMC2020758 DOI: 10.1080/13651820600746867] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evaluation of suspected biliary tract obstruction is a common clinical problem. Clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment plan. In the present summary, the literature on competing technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed. Patients with obstructive jaundice secondary to choledocholithiasis or pancreaticobiliary malignancies are the primary focus of this review. Algorithms for the management of suspected obstructive jaundice are put forward based on current evidence. Published data suggest an increasing role for EUS and other noninvasive imaging techniques such as MRCP, and hCT following an initial transabdominal ultrasound in the assessment of patients with suspected biliary obstruction to select candidates for surgery or therapeutic ERCP. The management of patients with a suspected pancreaticobiliary condition ultimately is dependent on local expertise, availability, cost, and the multidisciplinary collaboration between radiologists, surgeons, and gastroenterologists.
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Affiliation(s)
- Frances Tse
- Division of Gastroenterology, McMaster University Medical Centre, McMaster UniversityHamilton OntarioCanada
| | - Jeffrey S. Barkun
- Division of Gastroenterology, Montreal General Hospital and Royal Victoria Hospital Sites, McGill University Health CentreMontreal QuebecCanada
| | - Joseph Romagnuolo
- Division of Gastroenterology and Hepatology, Medical University of South CarolinaCharleston SCUSA
| | - Gad Friedman
- Division of Gastroenterology, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityMontreal QuebecCanada
| | | | - Alan N Barkun
- Division of Gastroenterology, Montreal General Hospital and Royal Victoria Hospital Sites, McGill University Health CentreMontreal QuebecCanada
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Abstract
The use of ultrasound technology in the emergency department(ED) is a recent and fast-growing phenomenon. Ultrasound is an extremely valuable tool for the evaluation of gallbladder (GB) dis-ease in the ED for several reasons: this disease is a common medical problem, cholecystitis can present in different ways clinically,the nature of the GB allows it to be well visualized by ultrasound,and ultrasound has many benefits and few complications associated with its use. This article reviews the focused examination of the GB, with specific attention to test characteristics (sensitivity,specificity, positive predictive value, and negative predictive value)when performed by emergency physicians in the ED.
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Affiliation(s)
- Kaushal Shah
- St. Luke's-Roosevelt/Columbia University, Department of Emergency Medicine, University Hospital of Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA.
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Bachar GN, Cohen M, Belenky A, Atar E, Gideon S. Effect of aging on the adult extrahepatic bile duct: a sonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:879-885. [PMID: 14510259 DOI: 10.7863/jum.2003.22.9.879] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Accepted: 06/05/2003] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine whether the size of the extrahepatic bile duct increases with age in adults. METHODS We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct. RESULTS There were 126 men and 125 women aged 20 to 94 years (mean +/- SD, 52.5 +/- 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 +/- 1.14 mm; middle, 3.72 +/- 1.28 mm; and distal, 4.28 +/- 1.18 mm. The overall mean for all measures was 3.66 +/- 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 +/- 0.862 mm in the patients younger than 50 years and 4.19 +/- 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y. CONCLUSIONS This study revealed an age-dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in elderly persons be set at 8.5 mm.
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Affiliation(s)
- Gil N Bachar
- Department of Radiology, Rabin Medical Center, Petah Tiqva, Israel.
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42
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Abstract
An understanding of underlying biliary pathology and the corresponding subtle changes reflected at imaging can greatly improve imaging accuracy in evaluating the biliary tract. The optimal demonstration of biliary tract imaging findings requires attention to specific imaging and contrast techniques, regardless of the modality used.
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Affiliation(s)
- Richard L Baron
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Boraschi P, Gigoni R, Braccini G, Lamacchia M, Rossi M, Falaschi F. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography. Acta Radiol 2002. [PMID: 12485257 DOI: 10.1034/j.1600-0455.2002.430610.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). MATERIAL AND METHODS A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size > or = 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. RESULTS CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. CONCLUSION MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.
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Affiliation(s)
- P Boraschi
- Second Department of Radiology, Pisa University Hospital, Pisa, Italy
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44
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Abstract
Ultrasound is considered to be the initial imaging modality of choice for evaluation of bile ducts. In this article, sonographic anatomy of the bile ducts and ultrasound findings in congenital, inflammatory, neoplastic, and other abnormalities of bile ducts are described. Roles of color Doppler ultrasound and newer applications, such as harmonic imaging and three-dimensional ultrasound, in evaluation of bile ducts are discussed.
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Affiliation(s)
- Suhas G Parulekar
- University of Texas, M.D. Anderson Cancer Center, Texas Medical Center, Houston, Texas 77030-4095, USA
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Skalicky M, Dajcman D, Hojs R. Effect of cholecystectomy for gallstones on the surface of the papilla of Vater and the diameter of the common bile duct. Eur J Gastroenterol Hepatol 2002; 14:399-404. [PMID: 11943953 DOI: 10.1097/00042737-200204000-00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS To date, little is known about changes in the size of the papilla of Vater in patients with gallstones. Most of the research concerning these patients has investigated changes in the diameter of the common bile duct and pressure in the sphincter of Oddi region. The latest research has not confirmed the prevalent opinion that the common bile duct dilates after cholecystectomy; moreover, knowledge about changes in the form and size of the papilla of Vater remains poor. The aim of our research was to measure the surface of the papilla of Vater and the diameter of the periampullary pancreatic part of the common bile duct before surgery, then 3 months and 6 months after surgery, using endoscopic ultrasound. PATIENTS AND METHODS In patients with symptomatic gallstones but with no evidence of cholestasis or stones in the common bile duct, the surface of the papilla of Vater and the diameter of the periampullary pancreatic part of the common bile duct were measured before surgery by endoscopic ultrasound. In the postoperative period, measurements were repeated in patients with an early occurrence of nausea, distension, bloating and pain in the upper abdomen and in patients without any symptoms in the same time period. The surface of the normal papilla of Vater and the diameter of the periampullary pancreatic part of the common bile duct were determined in healthy subjects. RESULTS In all the patients included in our study, the surface of the papilla of Vater was enlarged before surgery and, after 3 months, was even larger. However, after 6 months, it was practically the same as before surgery. The diameter of the periampullary pancreatic part of the common bile duct before surgery and 6 months after surgery was within normal limits. However, a statistically significant and transient increase in the diameter was noticed in the third month after cholecystectomy. The results were almost the same for symptomatic and asymptomatic patients. CONCLUSION In patients with symptomatic gallstones, the surface of the papilla of Vater is increased while the diameter of the periampullary pancreatic part of the common bile duct is normal. Cholecystectomy is an intervention that causes an additional transient increase in the surface of the papilla of Vater and a transient increase in the diameter of the periampullary pancreatic part of the common bile duct. The surface of the papilla of Vater does not reach normal values but the diameter of the periampullary pancreatic part of the common bile duct is normalized 6 months after surgery. There is no relation between clinical disorders and changes in the morphology of the papilla of Vater and the periampullary pancreatic part of the common bile duct after cholecystectomy.
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Affiliation(s)
- Marjan Skalicky
- Clinical Department for Internal Medicine, General Hospital Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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Horrow MM, Horrow JC, Niakosari A, Kirby CL, Rosenberg HK. Is age associated with size of adult extrahepatic bile duct: sonographic study. Radiology 2001; 221:411-4. [PMID: 11687684 DOI: 10.1148/radiol.2212001700] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if the size of the extrahepatic bile duct increases with age in adults. MATERIALS AND METHODS A total of 258 consecutive patients 18 years and older, without known biliary or pancreatic disease, who were fasting to undergo routine abdominal sonography were examined. The transverse and anteroposterior dimensions of the extrahepatic bile duct were measured proximally at the porta hepatis, at the middle above the head of the pancreas, and distally at the head of the pancreas. Simple linear regression of the average of these measurements against age tested the hypothesis of a slope of 1.0 mm per decade. RESULTS The sample included a wide variety of ages: 55 years +/- 16 (mean +/- SD), with a range of 20-92 years, including 151 men and 107 women. One-tenth of the cohort were younger than 35 years old and one-tenth were older than 77 years old. The six measurements were proximal-transverse 3.5 mm +/- 1.0, proximal-anteroposterior 2.9 mm +/- 1.1, middle-transverse 3.9 mm +/- 1.2, middle-anteroposterior 3.4 mm +/- 1.2, distal-transverse 4.1 mm +/- 1.2, distal-anteroposterior 3.5 mm +/- 1.2. Least squares regression slope differed significantly from 0.1 mm per year (95% CI; -0.000703, +0.00110) and in fact contained zero. CONCLUSION Findings were not able to help confirm an association between age and size of the extrahepatic bile duct in an asymptomatic adult population.
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Affiliation(s)
- M M Horrow
- Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141-3098, USA.
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Abstract
Structural and functional changes in the biliary tract and pancreas associated with advanced age are well documented in the literature and must be taken into account in evaluating patients with possible biliary and pancreatic disorders. The relationship between normal, age-related physiologic changes and various pancreatico-biliary diseases is not well defined. Elderly patients may present with severe biliary and pancreatic disease that may pose difficult management problems because of coexisting medical illnesses. Despite these challenges, all but the most frail elderly patients can benefit from appropriate medical, endoscopic, and surgical therapy.
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Affiliation(s)
- S O Ross
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Florida, USA
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Bowie JD. What is the upper limit of normal for the common bile duct on ultrasound: how much do you want it to be? Am J Gastroenterol 2000; 95:897-900. [PMID: 10763933 DOI: 10.1111/j.1572-0241.2000.01925.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conventionally, the upper limit of normal for the common bile duct as measured by ultrasound is considered to be 6 mm. This review is a somewhat personalized account of how that number became the convention and cautions the reader to avoid being slavish in the use of this number. Two specific cautions are not to apply this limit to older patients and to consider where in the common bile duct the measurement was taken, as measurements taken closer to the pancreas may be larger than ones closer to the liver.
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Affiliation(s)
- J D Bowie
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Boraschi P, Braccini G, Gigoni R, Geloni M, Perri G. MR cholangiopancreatography: value of axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences. Eur J Radiol 1999; 32:171-81. [PMID: 10632554 DOI: 10.1016/s0720-048x(99)00002-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences with three-dimensional (3D) maximum intensity projection (MIP) images in patients with suspected pancreaticobiliary obstruction. MATERIAL AND METHODS MR cholangiopancreatography (MRCP) was performed in 108 consecutive patients with a non-breath-hold, fat-suppressed, 2D, heavily T2-weighted fast spin-echo sequence in coronal plane. Axial T1- and T2-weighted images were previously obtained. In addition, 3D reconstructions of the coronal images were analysed separately by using a MIP algorithm. Both two-dimensional (2D) (axial and coronal) and 3D MIP images were separately evaluated by two readers in conference and their results were compared with that of endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, surgery and/or imaging follow-up. Statistical analysis of 2D and 3D MRCP images in diagnosing the level and probable cause of pancreaticobiliary obstruction were separately calculated. RESULTS 106/108 of MRCP examinations were judged diagnostic by the two reviewers for adequacy of visualisation of the biliary and pancreatic ducts. Sensitivity, specificity, positive predictive value, negative predictive value and global diagnostic accuracy of 2D (axial and coronal) and 3D MRCP images in diagnosing the pancreaticobiliary obstruction were 94 and 57%,, 95 and 93%, 97 and 92%, 91 and 60%, 94 and 72% respectively. CONCLUSION Our results do indicate a higher global accuracy for axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences versus 3D MIP images in diagnosis of the level and probable cause of pancreaticobiliary obstruction and stress the limitations of 3D images in depiction of small intraductal pathology such as calculi and biliary neoplastic.
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Affiliation(s)
- P Boraschi
- 2nd Department of Radiology, Pisa University Hospital, Italy.
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Boraschi P, Neri E, Braccini G, Gigoni R, Caramella D, Perri G, Bartolozzi C. Choledocolithiasis: diagnostic accuracy of MR cholangiopancreatography. Three-year experience. Magn Reson Imaging 1999; 17:1245-53. [PMID: 10576709 DOI: 10.1016/s0730-725x(99)00075-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to evaluate the diagnostic accuracy of MR cholangiopancreatography (MRCP) in the detection of common bile duct stones. A series of 286 consecutive patients were referred for MRCP, that was performed with a 1.5 T MR unit, through a non-breath-hold, respiratory-triggered, fat-suppressed, two-dimensional, heavily T2-weighted fast spin-echo sequence in the coronal plane. Axial T1 and T2-weighted sequences were first obtained. Axial, coronal, and Maximum Intensity Projection images were evaluated by three independent readers, who were asked to determine whether stones were present or not inside the biliary tract. The findings of MRCP images were compared with endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, intra-operative cholangiography, surgical, or imaging follow-up findings. Two-hundred and seventy-eight out of 286 MRCP examinations were judged diagnostic by the three reviewers. Among the 278 patients included in our study group, biliary tract lithiasis was proved in 76 cases (27%). On the basis of reviewers' reading, MRCP had sensitivity 92-93%, specificity 97-98%, positive predictive value 91-93%, negative predictive value 97-98%, and the diagnostic accuracy ranged between 95% and 96% in the detection of calculi. Interobserver agreement was excellent (K = 0.84, kappa statistic). MRCP showed a high diagnostic accuracy and an excellent inter-observer agreement in the detection of common bile duct stones.
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Affiliation(s)
- P Boraschi
- 2nd Department of Radiology, Pisa University Hospital, Italy.
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