Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis

Abstract

To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were <or=5 mm and eight were <or=4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats.

Assessment of the optimal temporal window for intravenous CT cholangiography

“…Since we studied peripheral ducts, it is not possible to comment on the adequacy of first-and second-order branch opacification. It should be noted, however, that in a study by Gibson et al 55 out of 65 patients (61 patients with normal bilirubin levels) undergoing CT cholangiography with meglumine iotroxate demonstrated good opacification of at least third-order intrahepatic branches [14]. Although the present study used iodipamide meglumine rather than meglumine iotroxate, by assessing very peripheral ducts, the study may have underestimated the ability of CT cholangiography to produce good opacification of intrahepatic ducts.…”

“…In recent years, several studies on CT cholangiography with IV cholangiographic contrast agent have shown promising results in the evaluation of obstructive biliary disease and of the biliary tract in potential living liver donors [9,[12][13][14][15]. Besides pathomorphological information, CT cholangiography with the use of an IV contrast agent can also provide additional information on biliary kinetics [8].…”

“…With this technique the biliary system is opacified with either an intravenous (IV) or an oral cholangiographic contrast agent [8][9][10][11]. In the past 5 years, IV cholangiographic contrast agents (e.g., iodipamide meglumine, meglumine iotroxate) have been shown to be preferable to oral agents for CT cholangiography owing to their superior ability to opacify the biliary tree [9,[12][13][14][15][16]. Though numerous studies investigated the bile iodine concentration in animals and the biliary opacification in patients on serial radiographs after the administration of IV cholangiographic contrast agent in the 1970s and 1980s [17][18][19][20][21][22], to the best of our knowledge, to date, there have been no reports in the scientific literature on the optimal temporal window of CT cholangiography with IV cholangiographic contrast agents.…”

Minimum intensity projections of the biliary system using 16-channel multidetector computed tomography in patients with biliary obstruction: comparison with MRCP

“…These methods are dedicated for visualization of the biliary tract and represent highly sophisticated diagnostic tools. Computed tomography (CT) to date had not gained broad acceptance as a dedicated imaging modality for the biliary system, even though the use of oral or intravenous contrast agents with biliary excretion is possible [8][9][10][11][12][13][14][15]. Thus, the assessment of bile ducts in various diagnoses, like pancreatic cancer, chronic pancreatitis, cholangiocarcinoma, biliary concrements, and many more, commonly occurring in CT imaging as the first-or second-line diagnostic tool, often requires additional investigation with dedicated examinations using the aforementioned modalities.…”

Challenging clinical paradigms of common bile duct diameter

“…Further studies are needed to explore the predictive value of the bile duct diameter in other clinical scenarios and the role of duct diameter as a continuous age-related variable in a clinical algorithm to triage patients to conservative management, ERCP, or minimally invasive imaging with EUS, MRCP, or CT cholangiography. 12,13 DISCLOSURE…”