Accuracy
of Biliary
Duct
Ultrasound:
Downloaded from www.ajronline.org by 117.56.227.157 on 10/08/15 from IP address 117.56.227.157. Copyright ARRS. For personal use only; all rights reserved
HARVEY
Thirty
patients
were
studied
L. NEIMAN1
by diagnostic
ultrasound
Comparison AND
basis,
the
caliber
obstructive
of the from
biliary
duct
nonobstructive
system hepatobiliary
and,
A. MINTZER1
in approximately 65% of cases. In the two patients with obstructive jaundice and a normal ultrasound study, the percutaneous transhepatic cholangiog ram demonstrated only minimal dilatation of the intrahepatic biliary radicals and common bile duct. The degree of confidence was also assessed; diagnoses were judged as possible, probable, and definite.
and
percutaneous transhepatic or surgical cholangiography to evaluate diagnostic accuracy in difterentiating obstructive from nonobstructIve hepatobiliary disease. Correct recognition of biliary duct caliber was accomplished by ultrasound in 86% of cases, and was most accurate (89%) in patients with dilated intrahepatic biliary radicals. Diagnostic ultrasound is sufficiently accurate to be a useful screening tool for deter-
mining
RICHARD
In
on this
71%
of
definite.
disease.
and
or
Methods
single
final
biliary or
was
reported
diagnoses,
of
report.
radicals
branched
as
a degree
are seen
tubular
as straight
structures.
These
obstruction
was
also
of
gas,
despite
investigated.
In three
cases
bed could not be seen because
multiple
attempts
on
different
days.
Of
the remaining 15 cases, the etiology was identified in ii and not suggested in four. In patients ultimately shown by intraoperative cholangiography or percutaneous transhepatic cholangiography to have nonobstructive jaundice, the diagnosis was primarily alcoholic or infectious hepatitis. Discussion
Our analysis confirms the observation that biliary duct dilatation can be confidently recognized by ultrasound. The status of the intrahepatic biliary radicals is more easily assessed than the size of the common bile duct. While it would seem that the differentiation of biliary
Ultrasound performed on a Picker Echoview 8A gray scale system using a 2.25 MHz 19 mm diameter, 10 cm internal focus transducer. Images were recorded with a Dunn camera. Chiba needle cholangiography was performed by the by Okuda
to the
intrahepatic
curved,
biliary
of hepatitis. studies were
described
added
diagnosis correct
the area of the pancreatic
nostic ultrasound and operative cholangiography. These 30 represent all patients who had undergone both diagnostic ultrasound and cholangiographic examination during a 6 month period in 1976. All patients with obstruction were surgically proven. Many of the nonobstructed cases were also surgically proven; however, several had overwhelming clinical evidence of nonobstructive disease. For the most part these cases proved
techniques
the
are best visualized in longitudinal, single pass, breathholding sections of the liver from the midline to 4-5 cm to the right (fig. 2). Not infrequently, the ducts were also seen to advantage in the left lobe on transverse scans (fig. 3). The accuracy of ultrasound in evaluating the cause of
Twenty-five patients were studied by both diagnostic ultrasound and Chiba needle percutaneous transhepatic cholangiography. An additional five patients were studied with diag-
to be examples
cases remaining
was
Dilated
Several reports in the literature show that the gallbladder, common bile duct, and intrahepatic biliary ducts can be visualized by ultrasound, but none compare the relative accuracy of the modality with a standard [1-5]. The introduction of Chiba needle percutaneous transhepatic cholangiography has enabled comparison of ultrasound observations with in vivo anatomic information.
the
In the
uncertainty
Subjects
with Cholangiography
et al. [6].
ducts from not a major
Results
hepatic concern
vessels would be a problem, in patients with obstruction.
this
Correct description of biliary duct caliber was achieved by ultrasound in 89% of cases with dilated ducts and
The diagnostic accuracy of ultrasound compared to cholangiography is indicated in table 1 Ultrasound demonstrated dilatation of the common bile duct or intrahepatic biliary radicals in 16 of 18 patients; all were ultimately shown to have obstructive jaundice by percutaneous transhepatic cholangiography (fig. 1). In patients with nondilated ducts, ultrasound was accurate in nine of ii patients. In a twelfth, the ultrasound study was nondiagnostic because of excessive amounts of gas. The intrahepatic biliary radicals were the most accurate marker of obstructive jaundice, since their ultrasound status correlated with the ultimate diagnosis in 89% of cases. The common bile duct was convincingly identified .
Received October 8, 1976; accepted Presented at the annual meeting of I
Department
requests
to
H.
Am J Roentgenol
of Radioiogy, L. Neiman.
129 :979-982,
McGaw
TABLE Diagnostic
1977
Accuracy
Dilated Ducts
.
Ultrasound Percutaneous transhepatic cholangiography Operative cholangiography #{149} Two false
t Two false Two
979
1
in Recognizing Ducts
Technique
after revision August 12, 1977. the American Roentgen Ray Society, Washington, Medical Center of Northwestern University, 303
December
is
Dilated Nondilated Ducts
16/18*
9/12t
18/18 0
5/7j 5/5
negative.
positive failures.
and one failure.
D.C., September 1976. East Chicago Avenue, Chicago,
illinois
6061
1
.
Address
reprint
Downloaded from www.ajronline.org by 117.56.227.157 on 10/08/15 from IP address 117.56.227.157. Copyright ARRS. For personal use only; all rights reserved
980
NEIMAN
The
etiology
nosed
by
creatic
bed
of
the
obstruction
ultrasound. was
obstruction
not
was
is not
In those obscured
by gas,
suggested
is less ( 9.76, P < Walls et al. [7] in their =
cases
in 73%
aseasily
where the
Chiba needle percutaneous transhepatic raphy has proved to be a highly accurate
safe less,
means of studying the biliary percutaneous cholangiography
and
ultrasound
native, =
4.89,
p
cholangiography. not available giography
offers
although
of Biliary
Duct
Ultrasound:
Downloaded from www.ajronline.org by 117.56.227.157 on 10/08/15 from IP address 117.56.227.157. Copyright ARRS. For personal use only; all rights reserved
HARVEY
Thirty
patients
were
studied
L. NEIMAN1
by diagnostic
ultrasound
Comparison AND
basis,
the
caliber
obstructive
of the from
biliary
duct
nonobstructive
system hepatobiliary
and,
A. MINTZER1
in approximately 65% of cases. In the two patients with obstructive jaundice and a normal ultrasound study, the percutaneous transhepatic cholangiog ram demonstrated only minimal dilatation of the intrahepatic biliary radicals and common bile duct. The degree of confidence was also assessed; diagnoses were judged as possible, probable, and definite.
and
percutaneous transhepatic or surgical cholangiography to evaluate diagnostic accuracy in difterentiating obstructive from nonobstructIve hepatobiliary disease. Correct recognition of biliary duct caliber was accomplished by ultrasound in 86% of cases, and was most accurate (89%) in patients with dilated intrahepatic biliary radicals. Diagnostic ultrasound is sufficiently accurate to be a useful screening tool for deter-
mining
RICHARD
In
on this
71%
of
definite.
disease.
and
or
Methods
single
final
biliary or
was
reported
diagnoses,
of
report.
radicals
branched
as
a degree
are seen
tubular
as straight
structures.
These
obstruction
was
also
of
gas,
despite
investigated.
In three
cases
bed could not be seen because
multiple
attempts
on
different
days.
Of
the remaining 15 cases, the etiology was identified in ii and not suggested in four. In patients ultimately shown by intraoperative cholangiography or percutaneous transhepatic cholangiography to have nonobstructive jaundice, the diagnosis was primarily alcoholic or infectious hepatitis. Discussion
Our analysis confirms the observation that biliary duct dilatation can be confidently recognized by ultrasound. The status of the intrahepatic biliary radicals is more easily assessed than the size of the common bile duct. While it would seem that the differentiation of biliary
Ultrasound performed on a Picker Echoview 8A gray scale system using a 2.25 MHz 19 mm diameter, 10 cm internal focus transducer. Images were recorded with a Dunn camera. Chiba needle cholangiography was performed by the by Okuda
to the
intrahepatic
curved,
biliary
of hepatitis. studies were
described
added
diagnosis correct
the area of the pancreatic
nostic ultrasound and operative cholangiography. These 30 represent all patients who had undergone both diagnostic ultrasound and cholangiographic examination during a 6 month period in 1976. All patients with obstruction were surgically proven. Many of the nonobstructed cases were also surgically proven; however, several had overwhelming clinical evidence of nonobstructive disease. For the most part these cases proved
techniques
the
are best visualized in longitudinal, single pass, breathholding sections of the liver from the midline to 4-5 cm to the right (fig. 2). Not infrequently, the ducts were also seen to advantage in the left lobe on transverse scans (fig. 3). The accuracy of ultrasound in evaluating the cause of
Twenty-five patients were studied by both diagnostic ultrasound and Chiba needle percutaneous transhepatic cholangiography. An additional five patients were studied with diag-
to be examples
cases remaining
was
Dilated
Several reports in the literature show that the gallbladder, common bile duct, and intrahepatic biliary ducts can be visualized by ultrasound, but none compare the relative accuracy of the modality with a standard [1-5]. The introduction of Chiba needle percutaneous transhepatic cholangiography has enabled comparison of ultrasound observations with in vivo anatomic information.
the
In the
uncertainty
Subjects
with Cholangiography
et al. [6].
ducts from not a major
Results
hepatic concern
vessels would be a problem, in patients with obstruction.
this
Correct description of biliary duct caliber was achieved by ultrasound in 89% of cases with dilated ducts and
The diagnostic accuracy of ultrasound compared to cholangiography is indicated in table 1 Ultrasound demonstrated dilatation of the common bile duct or intrahepatic biliary radicals in 16 of 18 patients; all were ultimately shown to have obstructive jaundice by percutaneous transhepatic cholangiography (fig. 1). In patients with nondilated ducts, ultrasound was accurate in nine of ii patients. In a twelfth, the ultrasound study was nondiagnostic because of excessive amounts of gas. The intrahepatic biliary radicals were the most accurate marker of obstructive jaundice, since their ultrasound status correlated with the ultimate diagnosis in 89% of cases. The common bile duct was convincingly identified .
Received October 8, 1976; accepted Presented at the annual meeting of I
Department
requests
to
H.
Am J Roentgenol
of Radioiogy, L. Neiman.
129 :979-982,
McGaw
TABLE Diagnostic
1977
Accuracy
Dilated Ducts
.
Ultrasound Percutaneous transhepatic cholangiography Operative cholangiography #{149} Two false
t Two false Two
979
1
in Recognizing Ducts
Technique
after revision August 12, 1977. the American Roentgen Ray Society, Washington, Medical Center of Northwestern University, 303
December
is
Dilated Nondilated Ducts
16/18*
9/12t
18/18 0
5/7j 5/5
negative.
positive failures.
and one failure.
D.C., September 1976. East Chicago Avenue, Chicago,
illinois
6061
1
.
Address
reprint
Downloaded from www.ajronline.org by 117.56.227.157 on 10/08/15 from IP address 117.56.227.157. Copyright ARRS. For personal use only; all rights reserved
980
NEIMAN
The
etiology
nosed
by
creatic
bed
of
the
obstruction
ultrasound. was
obstruction
not
was
is not
In those obscured
by gas,
suggested
is less ( 9.76, P < Walls et al. [7] in their =
cases
in 73%
aseasily
where the
Chiba needle percutaneous transhepatic raphy has proved to be a highly accurate
safe less,
means of studying the biliary percutaneous cholangiography
and
ultrasound
native, =
4.89,
p
cholangiography. not available giography
offers
although
