Retrospective analysis of unexplained common bile duct dilatation with magnetic resonance cholangiopancreatography

Abstract

Aim: In our study, we aimed to obtain guiding clues and information to create a diagnostic algorithm by retrospectively investigating the laboratory, imaging and histological data of patients in whom dilatation in the Common Bile Duct (CBD) was observed with Magnetic Resonance Cholangiopancreatography (MRCP), but whose cause could not be determined. Material and Methods: Demographic data, clinical findings, laboratory results, MRCP findings, Endoultrasonography(EUS) findings, Endoscopic Retrograde Cholangiopancreatography (ERCP) findings, cytopathological results and follow-up data were collected from 137 patients who underwent MRCP due to CBD dilatation but whose etiology could not be determined with certainty. In MRCP, the axial T2-weighted images were measured by a single radiologist at the widest level in the common hepatic duct and proximal to the choledochal duct and compared with EUS. Results: The mean age of the study population was 62.1±14.1 years. Thirty-nine patients (28.5%) were female. The mean diameter of the CBD on MRCP was 11.8±3.1 mm, while the mean diameter on EUS was 10.5±4.0 mm, and a statistically significant difference was detected (p<0.001). 59/137 (43%) patients who could not be diagnosed definitively by MRCP were followed up without further investigation based on laboratory and clinical findings. The mean follow-up period was 17.6 (6-43) months. The diagnosis was confirmed in 78 (57%) patients with CBD dilatation with further investigation. Benign stenosis was diagnosed in 18.3% of the patients, thrown choledochal stone in 10.2%, choledochal cyst in 9.5%, and stone-sludge in the CBD in 8.8%. Statistical analysis of 60 patients who underwent EUS and received a definite diagnosis showed that the diagnostic sensitivity of EUS was 58.3% in patients who could not be diagnosed by MRCP. Conclusion: In patients with CBD dilatation whose cause cannot be explained by MRCP, if accompanied by symptoms and/or abnormal liver tests, and in the presence of additional findings such as acute cholecystitis and acute pancreatitis, especially to rule out choledocholithiasis, EUS should be performed first . Then, if necessary, further examination should be performed with ERCP.

Keywords

• Common bile duct dilatation
• MRCP
• EUS
• ERCP
• Diagnostic algorithm

Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi

Abstract

Amaç:Çalışmamızda Manyetik Rezonans Kolanjiopankreatografi (MRKP) ile Ana Safra Kanalında (ASK) dilatasyon izlenen, ama nedeni saptanamayan hastaların laboratuvar, görüntüleme ve histolojik verileri retrospektif olarak incelendi, tanısal algoritma oluşturmak için yol gösterici ipuçları ve bilgiler elde edilmesi amaçlandı. Gereç ve Yöntemler:ASK dilatasyonu nedeniyle MRKP yapılan ancak etiyolojisi kesin olarak belirlenemeyen 137 hastanın demografik verileri, klinik bulguları, laboratuvar sonuçları, MRKP, Endoultrasonografi (EUS) ve Endoskopik retrograd kolanjiopankreatografi (ERKP) bulguları, sitopatolojik sonuçlar ve takip verileri toplandı. MRKP'de aksiyel T2 ağırlıklı görüntülerde tek bir radyolog tarafından ortak hepatik kanaldaki en geniş seviyede ve koledok proksimalinde ölçümler yapılarak EUS ile karşılaştırıldı. Bulgular: Çalışma popülasyonunun yaş ortalaması 62.1±14.1 yıldı.Hastaların %28,5’i kadındı.MRKP'de ASK'nin ortalama çapı 11,8±3,1 mm iken, EUS'de ortalama çap 10,5±4,0 mm idi ve istatistiksel olarak anlamlı farklık vardı (p<0,001).MRKP ile kesin tanı konulamayan 59 (%43) hasta laboratuvar ve klinik bulgular dahilinde ileri inceleme yapılmadan takibe alındı. Takibe alınan hastaların ortalama takip süresi 17.6 (6-43) ay idi. MRKP’de ASK dilatasyonu olan 78(%57) hastada tanı kesinleştirildi. Hastaların % 18.3’ü benign darlık, % 10.2’si atılmış koledok taşı, % 9.5’i koledok kisti, % 8,8’i ASK’da taş-çamur tanısı aldı.Kesin tanı alan ve EUS yapılan 60 hastada, MRKP'de tanı konulamayan hastalarda EUS'nin tanıdaki duyarlılığının %58,3 olarak saptandı. Sonuç: MRKP ile nedeni açıklanamayan ASK dilatasyonlarında, semptomları ve/veya anormal karaciğer testleri olan hastalarda pozitif bulgu olasılığı yüksek olduğundan, kesin tanı konulana kadar özellikle koledokolityazis düşünülen durumlarda, akut kolesistit, akut pankreatit gibi ek bulgular varlığında öncelikle EUS ve ardından gerekli görülürse ERKP ile ileri inceleme yapılmalıdır.

Keywords

• Ana safra kanalı dilatasyonu
• MRKP
• EUS
• ERKP
• tanısal algoritma

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