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Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla

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Japanese Journal of Radiology Aims and scope Submit manuscript

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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Abbreviations

BPDS:

Bile duct penetrating duodenal wall sign

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

SIRS:

Systemic inflammatory response syndrome

MRCP:

Magnetic resonance cholangiopancreatography

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Funding

All authors disclosed no financial relationships relevant to this study.

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Authors and Affiliations

  1. Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, 520-2192, Japan

    Shuhei Shintani, Osamu Inatomi, Takayuki Imai, Yoshiya Takeda, Takehide Fujimoto, Atushi Nishida & Akira Andoh

  2. Department of Endoscopy, Shiga University of Medical Science, Otsu, Japan

    Shigeki Bamba

  3. Department of Radiology, Shiga University of Medical Science, Otsu, Japan

    Yuki Tomozawa, Akitoshi Inoue, Shinichi Ota & Yoshiyuki Watanabe

  4. Department of Radiology, Nagahama Red Cross Hospital, Nagahama, Japan

    Shinichi Ota

  5. Department of Center for Clinical Research, Shiga University of Medical Science, Otsu, Japan

    Hiromu Kutsumi

Authors
  1. Shuhei Shintani
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  2. Osamu Inatomi
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  3. Shigeki Bamba
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  4. Takayuki Imai
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  9. Takehide Fujimoto
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  11. Hiromu Kutsumi
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  13. Akira Andoh
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Corresponding author

Correspondence to Osamu Inatomi.

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The authors declare that they have no conflicts of interest.

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The study was conducted in agreement with the Declaration of Helsinki and received approval from the ethics committee of Shiga University of Medical Sciences and conformed to its guidelines (Approval No.: R2020-145).

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Shintani, S., Inatomi, O., Bamba, S. et al. Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla. Jpn J Radiol 41, 854–862 (2023). https://doi.org/10.1007/s11604-023-01406-1

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  • DOI: https://doi.org/10.1007/s11604-023-01406-1

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