Improved sonographic visualization of choledocholithiasis

Background/Aims: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones. Methods: From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP. Results: In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis. Conclusion: In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.

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“…US has a sensitivity of 90% and a specificity of 20–80%. CT has a sensitivity of 85% and a specificity of 88% [10, 11, 12]. …”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Cholangiopancreaticography as a Diagnostic Tool for Common Bile Duct Stones

Kats¹,

Kraai²,

Dijkstra³

et al. 2003

Dig Surg

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“…6 In literature older studies showed less sensitivity, accuracy in comparison to recent studies. 5,6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Our study also showed higher sensitivity and accuracy compare to older studies for choledocholithiasis. Introduction of newer ultrasound equipments with tissue harmonic imaging has attributed significantly for this difference.…”

Section: Measures Ofmentioning

confidence: 60%

Diagnostic Accuracy of Tissue Harmonic Imaging in Obstructive Jaundice

Titare¹,

Sonawane²,

Anand³

et al. 2015

jemds

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INTRODUCTION:Tissue harmonic imaging (THI) is a new ultrasound imaging technique providing the images which are much superior in quality compare to conventional ultrasound images by improving lateral resolution, signal to noise ratio and reducing side-lobe artifacts. AIM: Our aim is to estimate diagnostic accuracy of THI in diagnosing the cause of obstructive jaundice and to compare it with previous studies. MATERIAL AND METHODS: 125 cases of obstructive jaundice were evaluated with THI for the cause of obstructive jaundice by three radiologists separately during period of two year interval on Phillips HD 11 XE ultrasound scanner. Follow up done with ERCP, surgery and histopathology. CT and MRCP done wherever needed. Sensitivity, specificity, PPV, NPV, accuracy, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and Youden's index were calculated and compared with previous studies. RESULT: In our study we found choledocholithiasis as most common cause for obstructive jaundice. Sensitivity of 80%, 57.49%, 70.97% and specificity of 90%, 90.59%, 89.36% was noted for choledocholitiasis, neoplasm and benign stricture respectively. Accuracy of 86.4%, 80%, 84.8% was found for choledocholitiasis, neoplasm and benign stricture respectively. PPV of 81.81%, 74.19%, 68.75% and NPV of 88.88%, 81.91%, 90.32% was observed for choledocholithiasis, neoplasm and benign stricture respectively. Positive likelihood ratio of 8, 6.10, 6.67 and negative likelihood ratio of 0.22, 0.46, 0.32 was noted for choledocholithiasis, neoplasm and benign stricture respectively. Diagnostic odds ratio and Youden's index of 36 and 0.7, 13.02 and 0.48, 20.53 and 0.60 was seen for choledocholithiasis, neoplasm and benign stricture respectively. CONCLUSION: Introduction of THI in the modern ultrasound equipment had made improvement in the diagnosis of cause for biliary tract obstruction. Till today even with THI ultrasound doesn't have higher diagnostic value.

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“…and current sonographic visualization of ductal stones is reported to be approximately 75-80% (38,44,45). There are several pitfalls in sonographic detection of common duct stones.…”

Section: Biliary Diseasementioning

confidence: 96%

Pregnancy and abdominal pain: Value of ultrasound in diagnosis

Miller

Coughlin

1996

Emergency Radiology

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Ultrasound is noninvasive, safe, and versatile. It seems an ideal imaging modality in the pregnant patient, in whom ionizing radiation must be kept to a minimum, yet accurate imaging is important in directing treatment. The objective of our study was to investigate the value of ultrasound as a first-line imaging modality in pregnant women with abdominal pain.We prospectively studied 41 consecutive pregnant patients with abdominal pain over a 1-year period. The setting was a busy private practice in a large teaching hospital with both a primary and tertiary care referral base.Diagnoses were categorized into urologic, biliary, bowel, and obstetric/gynecologic pathology. There were 23 positive diagnoses of the 41 patients in the series, encompassing 13 cases of urinary pathology (calculi, pyelonephritis, and overdistention syndrome), 2 cases of bowel pathology (appendicitis and Crohn's disease), 6 cases of biliary disease (gallstones and a case of choledocholithiasis), and 2 cases of obstetric/gynecologic pathology (threatened abortion and corpus luteum cyst). Ultrasound correctly diagnosed 18 of these 23 cases. The remaining 5 false-negatives were 3 cases of urinary calculi, 1 case of appendicitis, and 1 case ofcholedocholithiasis. There were 18 true-negatives and no false-positives. The sensitivity of ultrasound in our series was 78%, specificity was 100%, and overall accuracy was 88%.Although there are limited numbers of specific diagnoses, we think that our patient population as a whole represents some of the more commonly evaluated complications in pregnancy. We conclude that sonography is a valuable first-line imaging modality in diagnosis of the pregnant patient with pain.T he pregnant patient with abdominal pain poses special limitations to diagnostic imaging. Ultrasonography, which has no known adverse effects on the fetus or mother, seems an ideal imaging modality in pregnant patients. The noninvasive nature of ultrasound allows the radiologist to combine clinical and imaging skills. This paper reviews the ultrasound findings in some common conditions which present with abdominal pain in pregnancy. As a basis for this review, we report our prospective experience with 41 pregnant patients presenting with abdominal pain.Over a 12-month period, 41 consecutive pregnant patients, age 15-39 years old, were referred for ultrasound with pain as the primary indication. At the time of presentation, 8 patients were in the first trimester, 16 were in the second, and 17 were in the third trimester of pregnancy.In our institution, the ultrasound examination is focused on the clinical question, i.e., "rule out ureteral calculus," but a brief survey of the remainder of the abdomen and pelvis is also performed. In cases specifically referred for renal pathology, Doppler sonography, including color imaging, is used as appropriate. Ureteral jets are sought in patients with suspected obstruction. Pathologic hydronephrosis is considered when the transverse diameter of the renal pelvis exceeds the norm for gestational age (1).T...

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Improved sonographic visualization of choledocholithiasis

Cited by 60 publications

References 12 publications

Magnetic Resonance Cholangiopancreaticography as a Diagnostic Tool for Common Bile Duct Stones

Magnetic Resonance Cholangiopancreaticography as a Diagnostic Tool for Common Bile Duct Stones

Diagnostic Accuracy of Tissue Harmonic Imaging in Obstructive Jaundice

Pregnancy and abdominal pain: Value of ultrasound in diagnosis

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