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European Radiology

, Volume 15, Issue 8, pp 1634–1642 | Cite as

Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis

  • Robert N. GibsonEmail author
  • Janette M. Vincent
  • Tony Speer
  • Neil A. Collier
  • Keith Noack
Hepatobiliary-Pancreas

Abstract

To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were ≤5 mm and eight were ≤4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats.

Keywords

Computed tomography Bile ducts Intravenous cholangiography Choledocholithiasis 

Notes

Acknowledgments

Grants supporting this study were received from Royal Australian and New Zealand College of Radiologists; Schering, Berlin, Germany.

References

  1. 1.
    Baron RL (1997) Diagnosing choledocholithiasis: how far can we push helical CT? [editorial; comment]. Radiology 203:601–603Google Scholar
  2. 2.
    Neitlich JD, Topazian M, Smith RC, Gupta A, Burrell MI, Rosenfield AT (1997) Detection of choledocholithiasis: comparison of unenhanced helical CT and endoscopic retrograde cholangiopancreatography [see comments]. Radiology 203:753–757PubMedGoogle Scholar
  3. 3.
    Chan YL, Chan AC, Lam WW et al (1996) Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. Radiology 200:85–89Google Scholar
  4. 4.
    Reinhold C et al (1998) Choledocholithiasis: evaluation of MR cholangiography for diagnosis. Radiology 209:435–442PubMedGoogle Scholar
  5. 5.
    Reuther G, Kiefer B, Tuchmann A (1996) Cholangiography before biliary surgery: single-shot MR cholangiography versus intravenous cholangiography. Radiology 198:561–566Google Scholar
  6. 6.
    Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne H, Lee MJ (1999) The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol 54:604–614CrossRefGoogle Scholar
  7. 7.
    de Ledinghen V et al (1999) Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 49:26–31PubMedGoogle Scholar
  8. 8.
    Zidi SH, Prat F, Le Guen O, Rondeau Y, Pelletier G (2000) Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures. Gut 46:103–106CrossRefPubMedGoogle Scholar
  9. 9.
    Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197:109–115Google Scholar
  10. 10.
    Prat F, Chapat O, Ducot B et al (1998) Predictive factors for survival of patients with inoperable malignant distal biliary strictures: a practical management guideline. Gut 42:76–80Google Scholar
  11. 11.
    Stockberger SM, Wass JL, Sherman S, Lehman GA, Kopecky KK (1994) Intravenous cholangiography with helical CT: comparison with endoscopic retrograde cholangiography [see comments]. Radiology 192:675–680PubMedGoogle Scholar
  12. 12.
    Kwon AH, Uetsuji S, Yamada O, Inoue T, Kamiyama Y, Boku T (1995) Three-dimensional reconstruction of the biliary tract using spiral computed tomography. Br J Surg 82:260–263Google Scholar
  13. 13.
    Klein HM, Wein B, Truong S, Pfingsten FP, Gunther RW (1993) Computed tomographic cholangiography using spiral scanning and 3D image processing. Br J Radiol 66:762–767PubMedGoogle Scholar
  14. 14.
    Hoglund M, Muren C, Boijsen MW (1990) Computed tomography with intravenous cholangiography contrast: a method for visualizing choledochal cysts. Eur J Radiol 10:159–161; discussion 162–153CrossRefGoogle Scholar
  15. 15.
    Hase T, Kodama M, Shibata J et al (1997) Three-dimensional helical computed tomography with intravenous cholangiography for sclerosing cholangitis manifested as postcholecystectomy symptom. J Clin Gastroenterol 24:169–172CrossRefGoogle Scholar
  16. 16.
    Kinami S, Yao T, Kurachi M, Ishizaki Y (1999) Clinical evaluation of 3D-CT cholangiography for preoperative examination in laparoscopic cholecystectomy. J Gastroenterol 34:111–118CrossRefPubMedGoogle Scholar
  17. 17.
    Berggren P, Farago I, Gabrielsson N, Thor K (1997) Intravenous cholangiography before 1,000 consecutive laparoscopic cholecystectomies. Br J Surg 84:472–476CrossRefGoogle Scholar
  18. 18.
    Couse N, Egan T, Delaney P (1996) Intravenous cholangiography reduces the need for endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy [see comments]. Br J Surg 83:335Google Scholar
  19. 19.
    Grunshaw ND, Lansdown MRJ, Milkins RC et al (1993) The intravenous cholangiogram-time for reappraisal in the age of laparoscopic cholecystectomy. Minim Invasive Ther 2:S36Google Scholar
  20. 20.
    Jansen M, Truong S, Treutner KH, Neuerburg J, Schraven C, Schumpelick V (1999) Value of intravenous cholangiography prior to laparoscopic cholecystectomy. World J Surg 23:693–696; discussion 697Google Scholar
  21. 21.
    Kwon AH, Inui H, Imamura A, Uetsuji S, Kamiyama Y (1998) Preoperative assessment for laparoscopic cholecystectomy: feasibility of using spiral computed tomography. Ann Surg 227:351–356CrossRefGoogle Scholar
  22. 22.
    Lindsey I, Nottle PD, Sacharias N (1997) Preoperative screening for common bile duct stones with infusion cholangiography: review of 1,000 patients. Ann Surg 226:174–178CrossRefGoogle Scholar
  23. 23.
    Patel JC, McInnes GC, Bagley JS, Needham G, Krukowski ZH (1993) The role of intravenous cholangiography in pre-operative assessment for laparoscopic cholecystectomy. Br J Radiol 66:1125–1127Google Scholar
  24. 24.
    Chopra S, Chintapalli KN, Ramakrishna K, Rhim H, Dodd GD III (2000) Helical CT cholangiography with oral cholecystographic contrast material. Radiology 214:596–601PubMedGoogle Scholar
  25. 25.
    Soto JA, Velez SM (1999) Choledocholithiasis: diagnosis with oral contrast-enhanced CT cholangiography. Am J Roentgenol 172:943–948Google Scholar
  26. 26.
    Polkowski M, Palucki J, Regula J, Tilszer A, Butruk E (1999) Helical computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients. Gut 45:744–749 [Record as supplied by publisher]Google Scholar
  27. 27.
    Cabada Giadas T, Sarria Octavio de Toledo L, Martinez-Berganza Asensio MT et al (2002) Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis. Abdom Imaging 27:61–70CrossRefGoogle Scholar
  28. 28.
    Lindsell DR (1990) Ultrasound imaging of pancreas and biliary tract. Lancet 335:390–393CrossRefGoogle Scholar
  29. 29.
    Laing F, Jeffrey R, Wing V (1984) Improved visualization of choledocholithiasis by sonography. Am J Roentgenol 143:949–952Google Scholar
  30. 30.
    Cronan JJ (1986) US diagnosis of choledocholithiasis: a reappraisal. Radiology 161:133–134Google Scholar
  31. 31.
    Stott MA, Farrands PA, Guyer PB, Dewbury KC, Browning JJ, Sutton R (1991) Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound 19:73–76Google Scholar
  32. 32.
    Laing AD, Gibson RN (1999) Magnetic resonance cholangiopancreatography. Australas Radiol 43:284–293CrossRefGoogle Scholar
  33. 33.
    Stabile Ianora AA, Memeo M, Scardapane A, Rotondo A, Angelelli G (2003) Oral contrast-enhanced three-dimensional helical-CT cholangiography: clinical applications. Eur Radiol 13:867–873PubMedGoogle Scholar
  34. 34.
    Nilsson U (1987) Adverse reactions to iotroxate at intravenous cholangiography. A prospective clinical investigation and review of the literature. Acta Radiol 28:571–575Google Scholar
  35. 35.
    Fulcher AS, Turner MA (1998) Pitfalls of MR cholangiopancreatography (MRCP). J Comput Assist Tomogr 22:845–850CrossRefGoogle Scholar
  36. 36.
    Itoh S, Ikeda M, Ota T, Satake H, Takai K, Ishigaki T (2003) Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 13:277–285PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Robert N. Gibson
    • 1
    Email author
  • Janette M. Vincent
    • 1
  • Tony Speer
    • 2
  • Neil A. Collier
    • 3
  • Keith Noack
    • 2
  1. 1.Department of Radiology, Royal Melbourne HospitalUniversity of MelbourneMebourneAustralia
  2. 2.Department of GastroenterologyRoyal Melbourne HospitalMebourneAustralia
  3. 3.Department of SurgeryRoyal Melbourne HospitalMebourneAustralia

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