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Concordance of imaging modalities and cost minimization in the diagnosis of pediatric choledochal cysts

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Abstract

Purpose

Given evolving imaging technologies, we noted significant variation in the diagnostic evaluation of pediatric choledochal cysts (CDC). To streamline the diagnostic approach to CDC, and minimize associated expenses, we compared typing accuracy and costs of ultrasound (US), intraoperative cholangiography (IOC), and magnetic resonance cholangiopancreatography (MRCP).

Methods

Records of 30 consecutive pediatric CDC patients were reviewed. Blinded to all clinical data, two pediatric radiologists reviewed all US, MRCPs, and IOCs to type CDCs according to the Todani classification. When compared with pathologic findings, the concordance between and accuracy of each diagnostic test were determined. Inflation-adjusted procedure charges and collections for imaging modalities were analyzed.

Results

Mean typing accuracy overlapped for US, IOC, and MRCP. Inter-rater reliability was 87 % for US (κ = 0.77), 80 % for IOC (κ = 0.62), and 60 % for MRCP (κ = 0.37). MRCP procedure charges ($1204.69) and collections ($420.85) exceeded IOC and US combined ($264.80 charges, p = 0.0002; $93.40 collections, p = 0.0021).

Conclusion

Our data support the use of US alone in the diagnosis of pediatric CDC when no intrahepatic biliary ductal dilatation is visualized. However, when dilated intrahepatic ducts are encountered on US, MRCP should be utilized to distinguish a type I from a type IV CDC, which may alter the operative approach.

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Acknowledgments

The authors would like to acknowledge Cathey Carney for her assistance in identifying the study cohort and compiling cost data for this project.

Ethical standards statement

This study was considered to pose minimal risk to participants and was therefore considered an exempted study in terms of human subject research and informed consent by the Vanderbilt University Medical Center Institutional Review Board (IRB# 110122). It has therefore been conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Suite 7102, Doctor’s Office Tower, Nashville, TN, 37232-9780, USA

    Andrew J. Murphy, Jason R. Axt, Colin A. Martin & Harold N. Lovvorn III

  2. Department of Pediatric Radiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, 37232, USA

    Seth J. Crapp & Gabriella L. Crane

Authors
  1. Andrew J. Murphy
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  2. Jason R. Axt
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  3. Seth J. Crapp
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  4. Colin A. Martin
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  5. Gabriella L. Crane
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  6. Harold N. Lovvorn III
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Correspondence to Andrew J. Murphy.

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Murphy, A.J., Axt, J.R., Crapp, S.J. et al. Concordance of imaging modalities and cost minimization in the diagnosis of pediatric choledochal cysts. Pediatr Surg Int 28, 615–621 (2012). https://doi.org/10.1007/s00383-012-3089-3

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  • DOI: https://doi.org/10.1007/s00383-012-3089-3

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