Helical CT without contrast in choledocholithiasis diagnosis

Cuenca, Isabel; Martínez, Luis Alberto Corona; Homs, M. Pérez

doi:10.1007/s003300000609

Cited by 40 publications

(6 citation statements)

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“…Specificities quoted for detection of CBDS vary between 84% (when performed without biliary contrast)32 and 100% 31 35. Sensitivities quoted in the same studies range from 65 to 93%.…”

Section: 0 Identifying Patients With Probable Cbdsmentioning

confidence: 87%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

507

374

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The last 30 years have seen major developments in the management of gallstone-related disease, which in the United States alone costs over 6 billion dollars per annum to treat. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widely available and routine procedure, whilst open cholecystectomy has largely been replaced by a laparoscopic approach, which may or may not include laparoscopic exploration of the common bile duct (LCBDE). In addition, new imaging techniques such as magnetic resonance cholangiography (MR) and endoscopic ultrasound (EUS) offer the opportunity to accurately visualise the biliary system without instrumentation of the ducts. As a consequence clinicians are now faced with a number of potentially valid options for managing patients with suspected CBDS. It is with this in mind that the following guidelines have been written.

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“…Specificities quoted for detection of CBDS vary between 84% (when performed without biliary contrast)32 and 100% 31 35. Sensitivities quoted in the same studies range from 65 to 93%.…”

Section: 0 Identifying Patients With Probable Cbdsmentioning

confidence: 87%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

507

374

View full text Add to dashboard Cite

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“…Our overall sensitivity was 50%–88%, which is roughly comparable to the previously stated sensitivities range of 70%–88% on unenhanced CT.[ 9 15 21 ] The major differences were in both the specificity and accuracy. The former dropped from a published range of 92%–100% to 50%–71%, whereas the latter dropped from a published range of 85%–94% to 59%–74%.…”

Section: Discussionmentioning

confidence: 99%

Detectability of choledocholithiasis on CT: The effect of positive intraduodenal enteric contrast on portovenous contrast-enhanced studies

Ajlan

Mesurolle

Stein

et al. 2015

Saudi J Gastroenterol

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Background/Aim:To retrospectively assess the accuracy of intravenous (IV) contrast-enhanced multidetector CT (MDCT) in choledocholithiasis detectability, in the presence and absence of positive intraduodenal contrast.Patients and Methods:Over a 3-year period, patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within a week from a portovenous (PV)-enhanced abdominal CT were identified. The final cohort consisted of 48 CT studies in which the entire common bile duct (CBD) length was visualized (19 males, 29 females; mean age, 68 years). We identified two groups according to the absence (n = 31) or presence (n = 17) of positive intraduodenal contrast. CT section thickness ranged from 1.25 to 5 mm. Two radiologists, blinded to clinical information and ERCP results, independently evaluated the CT images. Direct CBD stone visualization was assessed according to previously predefined criteria, correlating with original electronic CT reports and using ERCP findings as the reference standard. A third reader retrospectively reviewed all discordant results. The diagnostic performances of both observers and interobserver agreement were calculated for both groups.Results:77%–88% sensitivity, 50%–71% specificity, and 71%–74% accuracy were obtained in the group without positive intraduodenal contrast, versus 50%–80% sensitivity, 57%–71% specificity, and 59%–71% accuracy in the group with positive intraduodenal contrast. With the exception of the positive predictive value (PPV), all diagnostic performance parameters decreased in the positive intraduodenal contrast group, mostly affecting the negative predictive value (NPV) (71%–78% vs 50%–67%).Conclusion:PV-enhanced MDCT has moderate diagnostic performance in choledocholithiasis detection. A trend of decreasing accuracy was noted in the presence of positive intraduodenal contrast.

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“…If immediate access to MR cholangiopancreatography is limited, then CT is an alternative to diagnostic ERCP with 80% sensitivity and 100% specificity (24). However, it is mandatory in this scenario that an unenhanced, thinly collimated series through the liver and common bile duct be included in the study to improve detection of stones and to avoid misinterpretation of a common bile duct stone as an enhancing mass (Fig 19).…”

Section: Choledocholithiasismentioning

confidence: 94%

From the RSNA Refresher Courses

Hanbidge¹,

Buckler²,

O’Malley³

et al. 2004

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154

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Acute cholecystitis is the most common cause of acute pain in the right upper quadrant (RUQ), and urgent surgical removal of the gallbladder is the treatment of choice for uncomplicated disease. However, cross-sectional imaging is essential because more than one-third of patients with acute RUQ pain do not have acute cholecystitis. In addition, patients with complications of acute cholecystitis, such as perforation, are often best treated with supportive measures initially and elective cholecystectomy at a later date. Ultrasound (US) is the primary imaging modality for assessment of acute RUQ pain; US is both sensitive and specific in demonstrating gallstones, biliary dilatation, and features that suggest acute inflammatory disease. Occasionally, additional imaging modalities are indicated. Computed tomography is valuable, especially for confirming the extent and nature of the complications of acute cholecystitis. Magnetic resonance cholangiopancreatography is helpful in complicated ductal disease (eg, recurrent pyogenic cholangiohepatitis) when more detailed diagnostic information is required for treatment planning, whereas endoscopic retrograde cholangiopancreatography is used when biliary intervention is required (eg, treatment of choledocholithiasis). Successful imaging with all modalities requires familiarity with both the characteristic and the unusual features of a wide variety of pathologic conditions. In addition, potential pitfalls must be recognized and avoided.

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Helical CT without contrast in choledocholithiasis diagnosis

Cited by 40 publications

References 0 publications

Guidelines on the management of common bile duct stones (CBDS)

Guidelines on the management of common bile duct stones (CBDS)

Detectability of choledocholithiasis on CT: The effect of positive intraduodenal enteric contrast on portovenous contrast-enhanced studies

From the RSNA Refresher Courses

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