Degree Of Bile Duct Dilatation Research Articles

Percutaneous transhepatic cholangial drainage combined with intra-tumoral iodine-125 seeds implantation and chemotherapy for locally progressive pancreatic head cancer with obstructive jaundice.

To investigate the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) combined with intra-tumoral iodine-125 (125I) particle implantation and chemotherapy in the treatment of locally advanced pancreatic head cancer (LAPHC) with obstructive jaundice. Twenty-one patients with LAPHC with obstructive jaundice were selected, and routine examination before surgery to determine location of obstruction and degree of bile duct dilatation was performed. All 21 patients underwent PTCD first, and usual examinations, including liver and kidney function, were re-examined after operation. When the liver function recovered significantly, patients were treated with seed implantation and systemic chemotherapy after surgery. Clinical efficacy and complications of 21 patients were observed, and changes in survival time and serum level of tumor markers were analyzed. After combined treatment, there were 3 cases of complete response (CR), 12 cases of partial response (PR), 3 cases of stable disease (SD), and 3 cases of progressive disease (PD) in 21 patients. The overall effective rate was 71.43%, and the local control rate was 85.71%. The pain relief was statistically significant one month after treatment, compared with that before treatment (VAS scores: 6.76 ±2.25 vs. 3.25 ±1.92, p < 0.001), and the rate of pain relief was 71.43% (15/21). In all patients, jaundice, abdominal pain, and abdominal distension improved to different degrees after surgery, and the skin pruritus disappeared. Bilirubin and transaminase improved to varying degrees 3 days, 1 week, and 4 weeks after treatment (p < 0.05). Cancer antigen 199 (CA-199), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA-125) after combination therapy, achieved statistically significant differences (t = 9.525, 10.378, 3.262, respectively, p < 0.05). The overall survival time of 21 patients was 11.6 months, ranging from 3.9 to 22.6 months. For LAPHC patients with obstructive jaundice, PTCD combined with particle implantation and chemotherapy is clinically effective in improving the quality of life and prolonging survival.

Total Fluoroscopy Time Reduction During Ultrasound- and Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage Procedure: Importance of Adjusting the Puncture Angle.

BackgroundThe purpose of this observational cohort study was to assess patient and operator-dependent factors which could have an impact on total fluoroscopy time during ultrasound and fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD).Material/MethodsBetween October 2016 and November 2020, 127 patients with malignant biliary obstruction underwent ultrasound- and fluoroscopy-guided PTBD with the right-sided intercostal approach. The initial bile duct puncture was ultrasound-guided in all patients, and the puncture angle was measured by ultrasound. Any subsequent steps of the procedure were performed under continuous fluoroscopy (15 fps). The patients were divided in 2 groups based on the puncture angle: ≤30° (group I) and >30° (group II). In a retrospective analysis, both groups were compared for inter- and intragroup variability, technical success, total fluoroscopy time, and complications.ResultsIn group II, the recorded total fluoroscopy time (232.20±140.94 s) was significantly longer than that in group I (83.44±52.61 s) (P<0.001). In both groups, total fluoroscopy time was significantly longer in cases with a lesser degree of bile duct dilatation, intrahepatic bile duct tortuosity, presence of liver metastases, and multiple intrahepatic bile duct strictures.ConclusionsThe initial bile duct puncture angle was identified as an operator-dependent factor with the possible impact on total fluoroscopy time. The puncture angle of less than 30° was positively correlated with overall procedure efficacy and total fluoroscopy time reduction.

Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts.

This study sought to evaluate the role of diffusion-weighted imaging (DWI) in differentiation between obstructed and unobstructed bile ducts in patients undergoing magnetic resonance imaging (MRI). Eighty-four patients, 40 males and 44 females (mean age: 56.4 ± 15.1years), undergoing MRI with DWI (0-50-500-700) were evaluated and divided into two groups: 58 with abnormal laboratory tests (obstructed group) and 26 with normal laboratory values (unobstructed group). Laboratory tests were total bilirubin, alkaline phosphatase, and gamma-glutamyltransferase. Median ADC values were calculated and correlated with laboratory tests and degree of bile-duct dilatation (absent, moderate, or severe). The persistence of signal on DWI (b500 and b700) in the biliary tract was evaluated. Bilirubin values were tested for correlation with bile-duct ADC values and persistence of b700 signal. For statistical analysis, Student t test, chi-square test and Wilcoxon-Mann-Whitney test were used. ADC maps were plotted for three levels of the biliary tree, and a receiver operating characteristic (ROC) curve was calculated. In the obstructed group, 15 patients had severe dilatation, 24 had moderate dilatation, and 19 had no appreciable dilatation; 38 patients had persistent signal on b700 images. In the unobstructed group, 23 patients had no dilatation and 3 had moderate dilatation; 4 patients had persistent signal on b700 images. Correlation was found between degree of bile-duct dilatation, bilirubin levels, persistence of b700 signal, and ADC map values. The calculated ADC map cutoff value (353 10-6 mm2/s) was able to differentiate the obstructed and unobstructed groups with 92.3% sensitivity, 81% specificity, and 91.9% accuracy. DWI is able to distinguish patients with obstructed versus unobstructed bile ducts, regardless of the degree of dilatation, correlating with clinical and laboratory findings.

Adequacy of ultrasound reports in patients presenting with obstructive jaundice at a tertiary hospital radiology department

Background: Patients with obstructive jaundice require a stepwise approach to investigation and management. Ultrasound (US) is the initial screening modality of choice and has been shown to be accurate in demonstrating the presence of dilated bile ducts, as well as the level and cause of obstruction. For adequate radiological communication to the clinician, degree of bile duct dilatation, level of obstruction, appearance of the transition zone and cause of obstruction must be reported. However, without a structured reporting method, much of this information may be omitted.Objectives: The aim of the study was to investigate the adequacy of US findings in patients with obstructive jaundice, as documented, without standardised reporting.Methods: A retrospective chart review of 130 US reports of adult patients presenting at Grey’s Hospital US Department with a clinical assessment of obstructive jaundice was conducted. Data for the period January to December 2013, were analysed. US reports of patients with dilated bile ducts were assessed for report adequacy by looking at four important clinical factors, that is, the degree of bile duct dilatation, the level of obstruction, the appearance of the transition zone and the cause of the obstruction.Results: A report adequacy score was assessed in 79 patients with dilated bile ducts; however, two reports were excluded because of obscuration by gas. There was a high level of report inadequacy (38%) without the use of a structured reporting template. The level of obstruction was the most common component missing from the reports (25%), followed by the appearance of the transition zone (18%) and cause of obstruction (12%).Conclusion: We propose the use of an US report template for obstructive jaundice patients in order to ensure comprehensive reporting. Structured radiological reporting will improve the method of communication between clinicians and radiologists, thus improving the quality of patient care.

Evaluation of 40 patients with periampullary carcinoma using double contrast-enhanced ultrasonography (DCUS)

Objective To analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma. Key words: Ultrasonography ; Microbubbles ; Contrast ; Periamupullay carcinoma; Diagnosis

Degree of bile-duct dilatation in liver-transplanted patients with biliary stricture: a magnetic resonance cholangiography-based study

This study assessed whether the degree of bile-duct dilatation in liver-transplanted patients is correlated with the time from intervention and the type of underlying biliary stricture. Fifty-seven 3D magnetic resonance cholangiograms (MRCs) performed on 42 liver-transplanted patients were retrospectively evaluated. Diameter was measured at the level of the extrahepatic bile duct (EBD), right hepatic duct (RHD), left hepatic duct (LHD), anterior and posterior right hepatic ducts (aRHD, pRHD) and left lateral and medial ducts (LLD, LMD). Data were stratified according to the type of biliary stricture (all types, anastomotic, ischaemic-like, mixed) and compared, on a per-examination basis: (a) between two groups based on time from transplantation using a 1-year threshold (nonlongitudinal analysis); (b) among 26 repeated examinations on 11 patients (longitudinal analysis); (c) among different stricture groups. The biliary tree was slightly dilated within 1 year from transplantation (2.9±1.3 to 6.1±3.2 mm). In general, nonlongitudinal analysis showed minimally larger duct size after 1 year (mean +1.4±0.5 mm) despite significant differences at most sites of measurement considering all types of strictures (p<0.01; Mann-Whitney U test). Longitudinal analysis showed diameter increase over time, although without statistically significant differences (p>0.01; Kruskal-Wallis test). No significant difference in bile-duct size was observed when comparing types of stricture (p>0.01; Kruskal-Wallis test). Biliary dilatation after liver transplantation is mild and develops slowly regardless of the underlying type of stricture, possibly in relation to graft properties. MRC has a potential role as first-line imaging modality for a reliable assessment of biliary dilatation and the presence of a stricture.

The Diameter of Common Bile Duct Does not Predict the Cause of Extrahepatic Cholestasis

Extrahepatic cholestasis is usually caused by either a bile duct stone or a stricture. In early phase in primary care, when novel imaging studies such as magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography (ERCP) are seldom available, the differential diagnosis between benign and malignant causes is clinically challenging. The aim of the present study was to analyze the value of the degree of common bile duct dilatation in differential diagnosis of extrahepatic cholestasis. In all, 212 consecutive patients in whom a bile duct stricture (n=103) or a stone (n=109) had been found in ERCP were included in the study population. The maximum diameter of the common bile duct was measured from ERCP images. Plasma bilirubin concentration was measured before ERCP. The median (range) values for the common bile duct diameter for the patients with a stricture and those with a stone were 16 (5 to 33 mm) and 15 mm (6 to 29 mm), respectively (P=0.0038). In receiver operating characteristic analysis, the difference was barely significant when compared with random value (P=0.0399). Area under curve for bile duct diameter was 0.615. In conclusion, the degree of bile duct dilatation does not aid in differential diagnosis between benign and malignant causes of extrahepatic cholestasis.

Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT)

Purpose Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the computed tomography (CT) findings between acute calculous suppurative and nonsuppurative cholangitis and to determine if there are findings that assist in the differential diagnosis. Materials and methods Fifteen patients with acute suppurative cholangitis were enrolled in this study. Findings at endoscopic retrograde cholangiopancreaticography (ERCP) were the standard of reference for suppurative cholangitis. To compare the findings of suppurative cholangitis with those of nonsuppurative cholangitis, 35 patients with nonsuppurative cholangitis were randomly selected. The following findings were evaluated: the presence of papillitis, the presence of stones in the ampulla, the presence of intrahepatic stones, the presence of early inhomogeneous enhancement of the liver, the degree of bile duct dilatation, the degree of bile duct wall thickening and presence of cholecystitis. Sensitivity and specificity for each of the individual findings were calculated. Statistical analyses were performed the Pearson χ 2 test, Fisher's exact test and the Mann–Whitney U test. Results Papillitis showed the highest specificity 86% with 60% sensitivity. Marked inhomogeneous enhancement of the liver during the arterial phase showed 80% specificity with 60% sensitivity. In multivariate logistic analysis, papillitis and marked early inhomogeneous enhancement of the liver were the most significant predictors of acute suppurative cholangitis. The combination of these two CT findings improved specificity (97% specificity) for the diagnosis of suppurative cholangitis. Conclusion Papillitis and marked early inhomogeneous enhancement of the liver were found to be the most discriminative CT findings for the diagnosis of acute suppurative cholangitis and the differentiation between suppurative and nonsuppurative cholangitis.

Bile Duct Dilatation after Subtotal Gastrectomy in Stomach Cancer: Comparison with Gastroduodenostmy (BillothI) and Gastro Jejunosto my (Billoth II)

Purpose : To evaluate the incidence and degree of bile duct dilatation after partial gastrectomy due togastric cancer and to determine any differences between gastroduodenostomy (Billoth I) and gastrojejunostomy(Billoth II). Materials and Methods : We retrospectively analyzed the follow up abdominal CT findings in 113patients who had undergone partial gastrectomy without truncal vagotomy or cholecystectomy. In all cases,preoperative abdminal CT findings showed no evidence of bile duct dilatation. Among 113 patients, 41 underwentBilloth I surgery, and 72 underwent Billoth II. No case showed clinical or radiological evidence of obstructivecauses of bile duct dilatation. Among these patients, we decided the criteria for dilatation when this was noted.The grade was either mild (3 -4 mm), moderate (5 -8mm), or severe (over 9mm), as measured at the centralintra-hepatic duct. Extra-hepatic duct dilatation was graded as mild (6 -8mm), moderate (9 -12mm) or severe (over13 mm). We analyzed serum bilrirubin and alkaline phosphatase levels. Results : When the central intrahepatic ductwas measured, 78 of 113 patients(69 %) showed bile duct dilata-tion; 24 of 41 cases(58.5 %) were in the billoth Igroup and 54 of 72 (75 %) were the in Billoth II group. After measurement of the extra hepatic duct, 22 of41cases(53.6%) in the Billoth I group and 54 of 72 (75 %) in the Billoth II group were found to be dilated. Theresults showed a slightly increased incidence of bile duct dilatation in the Billoth, II group but this was notstatistically significant(p>0.05). In the laboratory, total, direct, and indirect bilirubin, as well as alkalinephosphatase levels, were measured. Higher levels were found in Billoth II than in Billoth I but all findings werewithin normal limits. Conclusion : Mild dilatation of the bile duct after partial gastrectomy was a not uncommonfinding, and there was no significant difference of incidence or degree of dilatation according to the procedureperformed. If a patient has no clinical symptoms, it appears that clinical it appears that clinical evaluationdoes not require fur-ther study.

MR cholangiography in the examination of patients with biliary-enteric anastomoses.

The aim of our study was to determine the role of MR cholangiography in the noninvasive examination of patients with biliary-enteric anastomoses. Twenty-four patients (nine men and 15 women; mean age, 68.9 years old) with biliary-enteric anastomoses underwent MR cholangiography. We used a fat-suppressed three-dimensional turbo spin-echo sequence (3000/700 [TR/TE]; echo train length, 128) with no breath-hold, optimized with a 0.5-T magnet. Imaging studies were performed because of scheduled follow-up (five patients), persistent jaundice (six patients), cholangitis and abnormal liver function (eight patients), and a combination of transient jaundice, epigastric pain, and abnormal liver function (five patients). Image quality was graded from optimal to good in 21 (88%) of 24 cases and poor in three (13%) of 24 cases. The degree of bile duct dilatation was correctly assessed, with complete agreement between the two observers in all cases. MR cholangiography correctly showed bile duct irregularities in six of the eight patients with cholangitis (kappa = .59), anastomotic strictures in all 19 patients with strictures (kappa = .86), and 3- to 15-mm stones in nine of 10 patients (kappa = .95). A slight overestimation of the strictures occurred in four of the 19 cases with strictures. MR cholangiography is a reliable imaging technique for the examination of patients with biliary-enteric anastomoses.

Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.

We studied cholangiograms in 129 patients with primary sclerosing cholangitis (PSC) to determine if there was a correlation between any of the findings and the prognosis of the disease. The grade, length, and extent of strictures, the degree of bile duct dilatation, and the distribution of lesions were evaluated. Survival curves were generated to test the association of these radiologic signs with subsequent survival. High-grade intrahepatic duct strictures (greater than 75% narrowing) were associated with a 19% decrease in 3-year survival (p = .05) compared with lower-grade strictures. Diffuse intrahepatic strictures (involving greater than 25% of the ducts) were associated with a 16% decrease in 3-year survival (p = .012) compared with localized strictures. Statistically insignificant (p greater than .05) but measurable decreases in survival were observed with high-grade extrahepatic duct strictures, diffuse involvement of the extrahepatic ducts, long confluent strictures anywhere in the biliary tree, and marked dilatation of the intrahepatic ducts. In general, intrahepatic duct disease was found to have greater prognostic significance than extrahepatic duct disease. High-grade strictures and diffuse strictures of the intrahepatic ducts were found to be indicators of a poor prognosis in PSC and were more predictive of a poor prognosis than was extrahepatic duct disease.