Comparison of the clinical characteristics and imaging findings of acute cholangitis with and without biliary dilatation

Hong, Min; Kim, S W; Kim, H C; Yang, D M

doi:10.1259/bjr/21182091

Cited by 15 publications

(13 citation statements)

References 22 publications

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“…Although methods for the direct imaging of AC have yet to be established, research suggests that transient hyperattenuation differences (THAD) in the hepatic parenchyma on early‐phase of dynamic CT as well as transient heterogeneous enhancement in the hepatic parenchyma on early‐phase of dynamic MRI may provide a specific imaging finding for AC . Other recent studies have also suggested that THAD may be useful for severity grading .…”

Section: Diagnostic Criteria For Acute Cholangitismentioning

confidence: 99%

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Kiriyama

Kozaka

Takada

et al. 2018

J Hepato Biliary Pancreat

475

425

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Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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Section: Diagnostic Criteria For Acute Cholangitismentioning

confidence: 99%

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Kiriyama

Kozaka

Takada

et al. 2018

J Hepato Biliary Pancreat

475

425

View full text Add to dashboard Cite

show abstract

“…However, (19) demonstrated that acute cholangitis without CBD dilatation is caused by CBD stones and sludge, with the latter also being implicated in the development of acute cholangitis (20). Interestingly, in one CBDdil(-) patient included in the present study, secretions of bile and sludge from the Ampulla of Vater were observed, indicating that sludge may be present during CBD without CBD dilatation.…”

Section: Discussionmentioning

confidence: 54%

Comparison of acute cholangitis with or without common bile duct dilatation

Tomizawa

Shinozaki

Hasegawa

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. To improve the management of patients with acute cholangitis, the present study compared laboratory test variables between acute cholangitis patients with or without common bile duct (CBD) dilatation [CBDdil(+) and CBDdil(-), respectively]. The medical records of patients diagnosed with acute cholangitis and subjected to endoscopic retrograde cholangiopancreatography between February 2008 and May 2015 were retrospectively analyzed. The present study consisted of 40 men (aged 69.4±8.8 years) and 37 women (aged 68.8±11.6 years). It was observed that CBDdil(-) patients were slightly younger than CBDdil(+) patients (P=0.0976), and levels of C-reactive protein (CRP) were significantly higher in CBDdil(-) patients than in CBDdil(+) patients (P=0.0392). In addition, logistic regression analysis indicated that CRP levels were associated with the presence of CBD dilatation (P=0.0392). These data indicate that patients with acute cholangitis without CBD dilatation tend to be younger and have higher levels of CRP. Thus, in acute cholangitis patients without CBD dilatation, diagnosis should be determined using clinical symptoms and laboratory data.

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“…THAD is a compensatory reaction to the decreased portal flow associated with hepatic pathologies [25,26]. Several studies have investigated the correlation between the degree of THAD and markers of inflammation such as C-reactive protein, leukocyte count, and the severity of acute cholecystitis, but have found discordant results [26][27][28][29]. Our study showed increased stiffness of the GB bed of the liver in acute cholecystitis, suggesting that only hyperemic changes, not necroinflammation, are associated with THAD.…”

Section: Discussionmentioning

confidence: 62%

Added value of 2D shear wave imaging of the gallbladder bed of the liver for acute cholecystitis

Lee

Park

et al. 2020

Ultrasonography

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Epub ahead of printPurpose: The purpose of this study was to evaluate whether shear wave elastography (SWE) and the shear wave dispersion slope (SWD) obtained from 2-dimensional shear wave imaging (2D-SWI) of the gallbladder (GB) bed of the liver could be helpful in the diagnosis of acute cholecystitis. Methods: We included 44 patients referred for abdominal ultrasonography (US) under the impression of acute cholecystitis from April 2018 to March 2019. Patients with chronic liver disease were excluded from this study. In addition to routine upper abdominal US, we performed 2D-SWI including liver stiffness measurements by SWE and SWD, which reflects tissue viscosity. 2D-SWI was performed at the GB bed of the liver through the right intercostal approach at least 3 times with different frames. We assessed typical US findings and the added value of 2D-SWI in diagnosing acute cholecystitis. Histopathologic results of surgical specimens were used as the standard of reference. If a surgical specimen was unavailable, a bile fluid test or clinical followup for more than 3 months served as the reference standard. Results: The optimal cutoff values for SWE and SWD were 8 kPa and 10.9 (m/sec)/kHz, respectively. In the univariate analysis, SWE, GB distension, and sludge were predictive factors of acute cholecystitis. In the multivariate analysis, categorized SWE was the only significant predictor (P<0.01). By using 2D-SWI, the diagnostic performance of two readers did not significantly increase, although the inter-reader agreement improved (k=0.654-0.778). Conclusion: 2D-SWI of the GB bed of the liver could be helpful for diagnosing acute cholecystitis.

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Comparison of the clinical characteristics and imaging findings of acute cholangitis with and without biliary dilatation

Cited by 15 publications

References 22 publications

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Comparison of acute cholangitis with or without common bile duct dilatation

Added value of 2D shear wave imaging of the gallbladder bed of the liver for acute cholecystitis

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