Clinical evaluation of 3D-CT cholangiography for preoperative examination in laparoscopic cholecystectomy

Abstract

Three-dimensional-computed tomography (3D-CT) cholangiography is a 3D shaded surface display image of the biliary tract obtained by using helical CT after intravenous cholangiography or cholangiography per percutaneous transhepatic cholangio-drainage tube. We investigated whether 3D-CT cholangiography could provide a useful image, for preoperative examination in laparoscopic cholecystectomy. Sixty-five patients with biliary diseases were examined by 3D-CT cholangiography. Helical scanning was performed on a Proceed Accell (GE Medical Systems, Waukesha, WI, USA). Three-dimensional images were created using an independent workstation. A clear image of the common bile duct was obtained for all patients (100%) by 3D-CT cholangiography. The gallbladder was well visualized in 54 (93%) and the cystic duct was shown to be opacified in 55 (95%) of the 58 patients with a gallbladder. Thirty-one patients were diagnosed as having gallstones by 3D-CT cholangiography (sensitivity. 72.1%; specificity, 100%; accuracy, 79.3%), while 43 were diagnosed as having cholecystolithiasis by ultrasonography. The advantages of 3D-CT cholangiography were a low level of invasiveness, easily obtained images compared to those obtained with endoscopic retrograde cholangiography (ERC), good opacification, and provision of a three-dimensional understanding of the biliary system, especially of the cystic duct. When combined with ultrasonography and routine liver function tests, 3D-CT cholangiography was considered very useful for obtaining information before laparoscopic cholecystectomy. It allowed the omission of ERC in many patients who were considered to have no common bile duct stone, by employment of 3D-CT cholangiography.

Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy

“…Accessory hepatic ducts are reported to be better identified if three-dimensional construction of the bile duct is performed after helical CT following DIC, as compared with the use of either ERC or MRC [4,7,10,13,15]. However, MRC is the most useful method when a contrast medium cannot be used, choledocholithiasis is suspected, a cystic duct is occluded, or both the bile duct and the pancreatic duct image need to be obtained at the same time due to an abnormal confluence of the bile duct and pancreatic duct [5,28].…”

Efficacy of Cholangiography Under Helical Computed Tomography for Laparoscopic Cholecystectomy

“…4 On the other hand, helical CT cholangiography clearly shows the biliary tract structures in a three-dimensional shaded surface display image obtained after intravenous cholangiography. 5,6 However, while the preoperative advantages of helical CT cholangiography, including its noninvasive nature, ease of application, and accuracy in identifying and evaluating the CBD and cystic duct, have been established, 4-6 the operative advantages of this tool have not yet been clearly confirmed. Therefore, we prospectively evaluated the efficacy of helical CT cholangiography for LC.…”

Evolution of Virtual CT Laparoscopy for Preoperative Imaging in Laparoscopic Cholecystectomy.

“…CT is most frequently used in the initial evaluation of the biliary tract. CT cholangiography is a useful tool in the radiological work-up of patients with jaundice and suspected biliary diseases; its use enables physicians to make a number of useful decisions [16][17][18][19][20] . Acute cholecystitis due to gallstones is usually treated by laparoscopic cholecystectomy.…”

“…There are many reports on the usefulness of 3D-CT cholangiography, and these reports describe whether the separated lesion of the intra-hepatic bile duct is depicted in the technique [16,17]. However, under laparoscopic surgery physicians need to understand the flow of the outer-hepatic bile duct, common bile duct, and cystic duct rather than the intra-hepatic bile duct.…”