Comparison of CT duodeno-cholangiopancreatography to ERCP for assessing biliary obstruction.
The authors have developed a CT protocol, CT duodeno-cholangiopancreatography (CDCP), which is performed during a single contrast-enhanced phase, proceeding cranially, allowing enhancement of the pancreas during its parenchymal phase followed by enhancement of the liver during its portal-venous phase. This retrospective pilot study evaluates CDCP compared with endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic tool for assessing the cause and level of biliary obstruction. Forty-one patients with jaundice underwent CDCP and ERCP between October 2002 and May 2004. Pathologic confirmation was obtained in 31 of the 41 (76%) patients. The sensitivity, specificity, and kappa values of CDCP and ERCP compared with pathology were calculated for tumors and stones. Pathology-proven cases included 7 cases of stones, 23 tumors, and 1 other cause of obstruction. The overall level of agreement of diagnoses between CDCP and pathology was 29 of 31 (93.5%); that between CDCP and ERCP was 36 of 41 (88%). Comparing CDCP to pathology for tumors, the sensitivity was 100%, the specificity was 89%, and the kappa was 0.92 (95% CI 0.76-1.0). For stone detection, CDCP had a sensitivity of 86%, a specificity of 100%, and a kappa value of 0.90 (95% CI 0.72-1.0). For level of obstruction of the common bile duct, comparing CDCP to ERCP, observations agreed in 31 of the 36 (86%) cases; for the pancreatic duct, observations agreed in 24 of the 25 (96%) cases. CDCP is a noninvasive diagnostic tool that can be used to assess the cause and level of obstruction. A blinded prospective study would be valuable to further assess the merits of CDCP.
Kielar
Ania
A
Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ottawa, ON, Canada. arke4@rogers.com
Toa
Hardy
H
Sekar
Arni
A
Mimeault
Richard
R
Jaffey
James
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003287:Contrast Media; D004386:Duodenum / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D003287:Contrast Media