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Utilizing CT to identify clinically significant biliary dilatation in symptomatic post-cholecystectomy patients: when should we be worried?

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients.

Methods

In this IRB approved retrospective study, two attending radiologists independently reviewed CT imaging for 118 post-cholecystectomy patients, who were subsequently evaluated with MRCP, ERCP, or EUS, prompted by findings on the CT and clinical status. Measurements of the common duct (CD) were obtained at the porta hepatis, distal duct, and point of maximal dilation on axial and coronal CT scans. Patients were grouped by whether they required intervention after follow-up imaging. Pertinent baseline lab values and patient demographics were reviewed.

Results

Of the 118 post-cholecystectomy patients, 38 patients (31%) required intervention, and 80 patients (69%) did not require intervention after follow-up imaging. For both readers, axial and coronal CD diameters were significantly higher in the ‘intervention required’ vs ‘no intervention’ groups at all locations (p value < 0.05). There was good to excellent inter-reader agreement at all locations (ICC 0.68–0.92). Pertinent baseline lab values including AST (p = 0.043), ALT (p = 0.001), alkaline phosphatase (p = 0.0001), direct bilirubin (p = 0.011), total bilirubin (p = 0.028), and WBC (p = 0.043) were significantly higher in the ‘intervention required’ group. CD thresholds of 8 mm yielded the highest sensitivities (76–95%), and CD thresholds of 12 mm yielded the highest specificities (65–78%). CD combined with bilirubin levels increased sensitivity and specificity, compared to using either feature alone.

Conclusion

Dilated CD on CT combined with bilirubin levels increases the sensitivity and specificity for identifying patients needing intervention. We recommend that a post-cholecystectomy patient who presents with a CD diameter > 10 mm on CT and elevated bilirubin levels should undergo further clinical and imaging follow-up.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, McGaw Medical Center of Northwestern University, Chicago, IL, USA

    Imo I. Uko & Roberta Catania

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Cecil Wood, Amir A. Borhani, Jeanne M. Horowitz, Helena Gabriel, Paul Nikolaidis, Frank H. Miller & Linda C. Kelahan

  3. Northwestern Feinberg School of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA

    Edward Nguyen & Annie Huang

  4. Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Rajesh Keswani

  5. Northwestern Memorial Hospital, 251 E Huron St, Chicago, IL, 60611, USA

    Imo I. Uko, Cecil Wood, Edward Nguyen, Annie Huang, Roberta Catania, Amir A. Borhani, Jeanne M. Horowitz, Helena Gabriel, Rajesh Keswani, Paul Nikolaidis, Frank H. Miller & Linda C. Kelahan

  6. Chicago, IL, 60611, USA

    Imo I. Uko

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Uko, I.I., Wood, C., Nguyen, E. et al. Utilizing CT to identify clinically significant biliary dilatation in symptomatic post-cholecystectomy patients: when should we be worried?. Abdom Radiol 47, 4126–4138 (2022). https://doi.org/10.1007/s00261-022-03660-9

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