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

Yıl 2024, Cilt: 15 Sayı: 1, 56 - 62, 28.03.2024
https://doi.org/10.18663/tjcl.1396832

Öz

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.

Proje Numarası

yok

Kaynakça

  • Sousa M, Fernandes S, Proença L, et al. Diagnostic yield of endoscopic ultrasonography for dilation of common bile duct of indeterminate cause. Rev Esp Enferm Dig. 2019;111(10):757-9.
  • Holm AN, Gerke H. What should be done with a dilated bile duct? Current gastroenterology reports. 2010;12(2):150-6.
  • Hekimoglu K, Ustundag Y, Dusak A, et al. MRCP vs ERCP in the evaluation of biliary pathologies: review of current literature. Journal of digestive diseases. 2008;9(3):162-9.
  • Godfrey EM, Rushbrook SM, Carrol NR. Endoscopic ultrasound: a review of current diagnostic and therapeutic applications. Postgraduate medical journal. 2010;86(1016):346-53.
  • Rana SS, Bhasin DK, Sharma V, Rao C, Gupta R, Singh K. Role of endoscopic ultrasound in evaluation of unexplained common bile duct dilatation on magnetic resonance cholangiopancreatography. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology. 2013;26(1):66.
  • Oppong KW, Mitra V, Scott J, et al. Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct. Scandinavian journal of gastroenterology. 2014;49(4):473-80.
  • De Angelis C, Marietti M, Bruno M, Pellicano R, Rizzetto M. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World journal of gastrointestinal endoscopy. 2015;7(8):799.
  • Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean journal of radiology. 2009;10(1):71-80.
  • Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014;34(3):565-86.
  • Scheiman JM, Carlos RC, Barnett JL, et al. Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. The American journal of gastroenterology. 2001;96(10):2900-4.
  • Rösch T, Meining A, Frühmorgen S, et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointestinal endoscopy. 2002;55(7):870-6.
  • Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World Journal of Gastroenterology: WJG. 2014;20(30):10495.
  • Rösch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointestinal endoscopy. 2004;60(3):390-6.
  • Moon JH, Cho YD, Cha SW, et al. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Official journal of the American College of Gastroenterology| ACG. 2005;100(5):1051-7.
  • Calvo MM, Bujanda L, Calderón A, et al., editors. Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis. Mayo Clinic Proceedings; 2002: Elsevier.
  • Mesihović R, Mehmedović A. Better non-invasive endoscopic procedure: endoscopic ultrasound or magnetic resonance cholangiopancreatography? Medicinski Glasnik. 2019;16(1).
  • CeperoValdà M, Vara SM. Valor de la ecoendoscopÃa en el diagnóstico de las lesiones del tracto gastrointestinal. Investigaciones Medicoquirúrgicas. 2019;10(2).
  • Moparty B, Bhutani MS. Endoscopic ultrasonograpy for choledocholithiasis and biliary malignancy. Current Treatment Options in Gastroenterology. 2005;8(2):135-42.
  • Anwer M, Asghar MS, Rahman S, et al. Diagnostic accuracy of endoscopic ultrasonography versus the gold standard endoscopic retrograde cholangiopancreatography in detecting common bile duct stones. Cureus. 2020;12(12).
  • Szalacha-Tarała E, Ramotowski R, Guz W, Samojedny A, Dziurzyńska-Białek E, Jadczak P. Diagnostics of biliary dilatation by means of magnetic resonance cholangiopancreatography. Polish Journal of Radiology. 2014;79:315.
  • Gouveia C, Loureiro R, Ferreira R, et al. Performance of the choledocholithiasis diagnostic score in patients with acute cholecystitis. GE-Portuguese Journal of Gastroenterology. 2018;25(1):24-9.
  • Schroeder T, Hartman M, Heller M, Klepchick P, Ilkhanipour K. Duodenal diverticula: potential complications and common imaging pitfalls. Clinical radiology. 2014;69(10):1072-6.
  • Balci NC, Noone T, Akün E, Akinci A, Klör HU. Juxtapapillary diverticulum: findings on MRI. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2003;17(4):487-92.
  • Nikolaidis P, Hammond NA, Day K, et al. Imaging features of benign and malignant ampullary and periampullary lesions. Radiographics. 2014;34(3):624-41.

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

Yıl 2024, Cilt: 15 Sayı: 1, 56 - 62, 28.03.2024
https://doi.org/10.18663/tjcl.1396832

Öz

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.

Etik Beyan

Çalışmamız hastanemiz Etik Kurulu tarafından onaylandı (Tarih: 13.10.2021, Karar: E2-21-912). Araştırma Helsinki Deklarasyonuna uygun olarak yürütülmüştür.

Destekleyen Kurum

YOK

Proje Numarası

yok

Teşekkür

YOK

Kaynakça

  • Sousa M, Fernandes S, Proença L, et al. Diagnostic yield of endoscopic ultrasonography for dilation of common bile duct of indeterminate cause. Rev Esp Enferm Dig. 2019;111(10):757-9.
  • Holm AN, Gerke H. What should be done with a dilated bile duct? Current gastroenterology reports. 2010;12(2):150-6.
  • Hekimoglu K, Ustundag Y, Dusak A, et al. MRCP vs ERCP in the evaluation of biliary pathologies: review of current literature. Journal of digestive diseases. 2008;9(3):162-9.
  • Godfrey EM, Rushbrook SM, Carrol NR. Endoscopic ultrasound: a review of current diagnostic and therapeutic applications. Postgraduate medical journal. 2010;86(1016):346-53.
  • Rana SS, Bhasin DK, Sharma V, Rao C, Gupta R, Singh K. Role of endoscopic ultrasound in evaluation of unexplained common bile duct dilatation on magnetic resonance cholangiopancreatography. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology. 2013;26(1):66.
  • Oppong KW, Mitra V, Scott J, et al. Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct. Scandinavian journal of gastroenterology. 2014;49(4):473-80.
  • De Angelis C, Marietti M, Bruno M, Pellicano R, Rizzetto M. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World journal of gastrointestinal endoscopy. 2015;7(8):799.
  • Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean journal of radiology. 2009;10(1):71-80.
  • Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014;34(3):565-86.
  • Scheiman JM, Carlos RC, Barnett JL, et al. Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. The American journal of gastroenterology. 2001;96(10):2900-4.
  • Rösch T, Meining A, Frühmorgen S, et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointestinal endoscopy. 2002;55(7):870-6.
  • Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World Journal of Gastroenterology: WJG. 2014;20(30):10495.
  • Rösch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointestinal endoscopy. 2004;60(3):390-6.
  • Moon JH, Cho YD, Cha SW, et al. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Official journal of the American College of Gastroenterology| ACG. 2005;100(5):1051-7.
  • Calvo MM, Bujanda L, Calderón A, et al., editors. Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis. Mayo Clinic Proceedings; 2002: Elsevier.
  • Mesihović R, Mehmedović A. Better non-invasive endoscopic procedure: endoscopic ultrasound or magnetic resonance cholangiopancreatography? Medicinski Glasnik. 2019;16(1).
  • CeperoValdà M, Vara SM. Valor de la ecoendoscopÃa en el diagnóstico de las lesiones del tracto gastrointestinal. Investigaciones Medicoquirúrgicas. 2019;10(2).
  • Moparty B, Bhutani MS. Endoscopic ultrasonograpy for choledocholithiasis and biliary malignancy. Current Treatment Options in Gastroenterology. 2005;8(2):135-42.
  • Anwer M, Asghar MS, Rahman S, et al. Diagnostic accuracy of endoscopic ultrasonography versus the gold standard endoscopic retrograde cholangiopancreatography in detecting common bile duct stones. Cureus. 2020;12(12).
  • Szalacha-Tarała E, Ramotowski R, Guz W, Samojedny A, Dziurzyńska-Białek E, Jadczak P. Diagnostics of biliary dilatation by means of magnetic resonance cholangiopancreatography. Polish Journal of Radiology. 2014;79:315.
  • Gouveia C, Loureiro R, Ferreira R, et al. Performance of the choledocholithiasis diagnostic score in patients with acute cholecystitis. GE-Portuguese Journal of Gastroenterology. 2018;25(1):24-9.
  • Schroeder T, Hartman M, Heller M, Klepchick P, Ilkhanipour K. Duodenal diverticula: potential complications and common imaging pitfalls. Clinical radiology. 2014;69(10):1072-6.
  • Balci NC, Noone T, Akün E, Akinci A, Klör HU. Juxtapapillary diverticulum: findings on MRI. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2003;17(4):487-92.
  • Nikolaidis P, Hammond NA, Day K, et al. Imaging features of benign and malignant ampullary and periampullary lesions. Radiographics. 2014;34(3):624-41.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Radyoloji ve Organ Görüntüleme
Bölüm Araştırma Makalesi
Yazarlar

Esin Ölçücüoğlu 0000-0002-7883-6524

Muhammed Said Beşler 0000-0001-8316-7129

Muhammet Batuhan Gökhan 0000-0002-3579-7887

Derya Arı 0000-0001-8024-781X

Ömer Öztürk 0000-0002-4545-7149

Sabite Kacar 0000-0002-3257-3546

Meral Akdoğan Kayhan 0000-0003-4624-2542

Sarper Ökten 0000-0002-4721-6357

Proje Numarası yok
Yayımlanma Tarihi 28 Mart 2024
Gönderilme Tarihi 27 Kasım 2023
Kabul Tarihi 5 Ocak 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 15 Sayı: 1

Kaynak Göster

APA Ölçücüoğlu, E., Beşler, M. S., Gökhan, M. B., Arı, D., vd. (2024). Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi. Turkish Journal of Clinics and Laboratory, 15(1), 56-62. https://doi.org/10.18663/tjcl.1396832
AMA Ölçücüoğlu E, Beşler MS, Gökhan MB, Arı D, Öztürk Ö, Kacar S, Akdoğan Kayhan M, Ökten S. Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi. TJCL. Mart 2024;15(1):56-62. doi:10.18663/tjcl.1396832
Chicago Ölçücüoğlu, Esin, Muhammed Said Beşler, Muhammet Batuhan Gökhan, Derya Arı, Ömer Öztürk, Sabite Kacar, Meral Akdoğan Kayhan, ve Sarper Ökten. “Manyetik Rezonans Kolanjiopankreatografi Ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi”. Turkish Journal of Clinics and Laboratory 15, sy. 1 (Mart 2024): 56-62. https://doi.org/10.18663/tjcl.1396832.
EndNote Ölçücüoğlu E, Beşler MS, Gökhan MB, Arı D, Öztürk Ö, Kacar S, Akdoğan Kayhan M, Ökten S (01 Mart 2024) Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi. Turkish Journal of Clinics and Laboratory 15 1 56–62.
IEEE E. Ölçücüoğlu, M. S. Beşler, M. B. Gökhan, D. Arı, Ö. Öztürk, S. Kacar, M. Akdoğan Kayhan, ve S. Ökten, “Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi”, TJCL, c. 15, sy. 1, ss. 56–62, 2024, doi: 10.18663/tjcl.1396832.
ISNAD Ölçücüoğlu, Esin vd. “Manyetik Rezonans Kolanjiopankreatografi Ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi”. Turkish Journal of Clinics and Laboratory 15/1 (Mart 2024), 56-62. https://doi.org/10.18663/tjcl.1396832.
JAMA Ölçücüoğlu E, Beşler MS, Gökhan MB, Arı D, Öztürk Ö, Kacar S, Akdoğan Kayhan M, Ökten S. Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi. TJCL. 2024;15:56–62.
MLA Ölçücüoğlu, Esin vd. “Manyetik Rezonans Kolanjiopankreatografi Ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi”. Turkish Journal of Clinics and Laboratory, c. 15, sy. 1, 2024, ss. 56-62, doi:10.18663/tjcl.1396832.
Vancouver Ölçücüoğlu E, Beşler MS, Gökhan MB, Arı D, Öztürk Ö, Kacar S, Akdoğan Kayhan M, Ökten S. Manyetik Rezonans Kolanjiopankreatografi ile Nedeni Açıklanamayan Ana Safra Kanalı Dilatasyonunun Retrospektif Analizi. TJCL. 2024;15(1):56-62.


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