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Mattila A, Helminen O, Pynnönen E, Sironen A, Elomaa E, Nevalainen M. Preoperative MRCP Can Rule Out Choledocholithiasis in Acute Cholecystitis with a High Negative Predictive Value: Prospective Cohort Study with Intraoperative Cholangiography. J Gastrointest Surg 2023; 27:2396-2402. [PMID: 37578567 DOI: 10.1007/s11605-023-05790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) provides a noninvasive and fast modality for imaging the biliary tree when choledocholithiasis is suspected. Guidelines suggest that MRCP is recommended when strong or moderate signs of common bile duct (CBD) stones are present. Well-performed prospective studies are scarce regarding the sensitivity and specificity of preoperative MRCP in patients with acute cholecystitis in comparison with intraoperative cholangiography, ERCP, or choledochoscopy. METHODS We performed a prospective, observational population-based feasibility study in Central Finland Hospital Nova between January 2019 and December 2019. We examined the diagnostic performance of preoperative MRCP on consecutive patients with acute cholecystitis scheduled for index admission cholecystectomy. The accuracy of MRCP was verified with IOC, choledochoscopy, or ERCP. The interobserver reliability of the image quality of MRCP and the sensitivity and specificity of choledocholithiasis were observed independently by three experienced radiologists. RESULTS A total of 180 consecutive patients diagnosed with acute cholecystitis followed by index admission cholecystectomy were identified. MRCP was performed in 113/180 (62.8%) patients, and complementary perioperative imaging of the bile ducts was performed in 72/113 (63.7%) patients. The incidence of choledocholithiasis was high (29.2%). In acute cholecystitis, the sensitivity (76.2-85.7%) and specificity (84.3-92.2%) of MRCP were equally compared to the literature with unselected patient groups. The best visibility was observed in the common hepatic duct, the inferior CBD, and the central hepatic duct. The interobserver reliability was excellent for determining the size and quantity of CBD stones. CONCLUSION In acute cholecystitis, MRCP yields high negative predictive value regarding detection of choledocholithiasis. If CBD stones were discovered, the interobserver reliability was excellent when measuring the size and number of CBD stones. The best-visualized area was the distal part of the biliary tract, which provides good preoperative workup if choledocholithiasis is present.
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Affiliation(s)
- Anne Mattila
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland.
| | - Olli Helminen
- Research Unit of Translational Medicine, University of Oulu and Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - Emilia Pynnönen
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Antti Sironen
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Eeva Elomaa
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Mika Nevalainen
- Medical Research Center Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu and Department Radiology Oulu University Hospital, Oulu, Finland
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Shintani S, Inatomi O, Bamba S, Imai T, Tomozawa Y, Inoue A, Ota S, Takeda Y, Fujimoto T, Nishida A, Kutsumi H, Watanabe Y, Andoh A. Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla. Jpn J Radiol 2023:10.1007/s11604-023-01406-1. [PMID: 36892785 DOI: 10.1007/s11604-023-01406-1] [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: 09/26/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction. METHODS Patients who underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis due to common bile duct stones were retrospectively enrolled. Stone impaction was defined by endoscopic findings as a reference standard. Two abdominal radiologists blinded to clinical information interpreted CT images to record the presence of the BPDS. The diagnostic accuracy of the BPDS to diagnose stone impaction was analyzed. Clinical data related to the severity of acute cholangitis were compared between patients with and without the BPDS. RESULTS A total of 40 patients (mean age 70.6 years; 18 female) were enrolled. The BPDS was observed in 15 patients. Stone impaction occurred in 13/40 (32.5%) cases. Overall accuracy, sensitivity, and specificity were 34/40 (85.0%), 11/13 (84.6%), and 23/27 (85.2%), respectively; 14/16 (87.5%), 5/6 (83.3%), and 9/10 (90.0%) for iso-attenuating stones; and 20/24 (83.3%), 6/7 (85.7%), and 14/17 (82.4%) for high-attenuating stones. Interobserver agreement of the BPDS was substantial (κ = 0.68). In addition, the BPDS was significantly correlated with the number of factors in the systemic inflammatory response syndrome (P = 0.03) and total bilirubin (P = 0.04). CONCLUSION The BPDS was a unique CT imaging finding to identify common bile duct stone impaction regardless of stone attenuation with high accuracy.
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Affiliation(s)
- Shuhei Shintani
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan.
| | - Shigeki Bamba
- Department of Endoscopy, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Imai
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan.,Department of Radiology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Yoshiya Takeda
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
| | - Takehide Fujimoto
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
| | - Atushi Nishida
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
| | - Hiromu Kutsumi
- Department of Center for Clinical Research, Shiga University of Medical Science, Otsu, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan
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Sundaram KM, Morgan MA, Depetris J, Arif-Tiwari H. Imaging of benign gallbladder and biliary pathologies in pregnancy. Abdom Radiol (NY) 2023; 48:1921-1932. [PMID: 36790454 DOI: 10.1007/s00261-023-03832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
The rising incidence combined with pregnancy-related physiological changes make gallbladder and biliary pathology high on the differential for pregnant patients presenting with right upper abdominal pain. Imaging plays a crucial role in determining surgical versus non-surgical management in pregnant patients with biliary or gallbladder pathology. Ultrasound (first-line) and magnetic resonance with magnetic resonance cholangiopancreatography (second-line) are the imaging techniques of choice in pregnant patients with suspected biliary pathology due to their lack of ionizing radiation. MRI/MRCP offers an excellent non-invasive imaging option, providing detailed anatomical detail without known harmful fetal side effects. This article reviews physiological changes in pregnancy that lead to gallstone and biliary pathology, key imaging findings on US and MRI/MRCP, and management pathways.
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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
| | - Jena Depetris
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, 1501 N. Campbell Avenue, Tuscon, AZ, USA
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Chang H, Bates DDB, Gupta A, LeBedis CA. Use of MR in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:479-499. [PMID: 35995475 DOI: 10.1016/j.mric.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed.
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Affiliation(s)
- Hailey Chang
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - David D B Bates
- Department of Radiology, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
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Agostini ÂDFP, Hochhegger B, Forte GC, Susin LA, Difini JPM. ACCURACY OF ABBREVIATED PROTOCOL OF MAGNETIC RESONANCE CHOLANGIO-PANCREATOGRAPHY IN THE DIAGNOSIS OF CHOLEDOCHOLITHIASIS. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:188-192. [PMID: 35830027 DOI: 10.1590/s0004-2803.202202000-35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. OBJECTIVE The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. METHODS This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. RESULTS A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). CONCLUSION An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.
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Affiliation(s)
| | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brasil
| | - Gabriele Carra Forte
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-Graduação em Medicina e Serviço de Saúde, Porto Alegre, RS, Brasil
| | - Luiza Aguirre Susin
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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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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Abstract
Imaging of the biliary system has improved and has allowed MR to become a key noninvasive tool for evaluation of the biliary system. A variety of magnetic resonance cholangiopancreatography techniques have been developed, with improved visualization of the biliary system and biliary pathology. Key avenues of advancement include increasing the speed of acquisition, improving spatial resolution, and reducing artifacts. T1-weighted imaging using gadolinium-based hepatobiliary contrast agents allows for evaluation in additional indications, such as liver donor evaluation, biliary leak identification, and choledochal cyst confirmation. There is potential for further increased utility of MR in the evaluation of the biliary system.
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Affiliation(s)
| | - Frank H Miller
- Body Imaging Section and Fellowship, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 800, Chicago, IL 60611, USA
| | - Benjamin M Yeh
- University of California - San Francisco, 505 Parnassus Avenue, M391 Box 0628, San Francisco, CA 94143-0628, USA
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