Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT).
OBJECTIVE
Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the computed tomography (CT) findings between acute calculous suppurative and nonsuppurative cholangitis and to determine if there are findings that assist in the differential diagnosis.


METHODS
Fifteen patients with acute suppurative cholangitis were enrolled in this study. Findings at endoscopic retrograde cholangiopancreaticography (ERCP) were the standard of reference for suppurative cholangitis. To compare the findings of suppurative cholangitis with those of nonsuppurative cholangitis, 35 patients with nonsuppurative cholangitis were randomly selected. The following findings were evaluated: the presence of papillitis, the presence of stones in the ampulla, the presence of intrahepatic stones, the presence of early inhomogeneous enhancement of the liver, the degree of bile duct dilatation, the degree of bile duct wall thickening and presence of cholecystitis. Sensitivity and specificity for each of the individual findings were calculated. Statistical analyses were performed the Pearson chi(2) test, Fisher's exact test and the Mann-Whitney U test.


RESULTS
Papillitis showed the highest specificity 86% with 60% sensitivity. Marked inhomogeneous enhancement of the liver during the arterial phase showed 80% specificity with 60% sensitivity. In multivariate logistic analysis, papillitis and marked early inhomogeneous enhancement of the liver were the most significant predictors of acute suppurative cholangitis. The combination of these two CT findings improved specificity (97% specificity) for the diagnosis of suppurative cholangitis.


CONCLUSIONS
Papillitis and marked early inhomogeneous enhancement of the liver were found to be the most discriminative CT findings for the diagnosis of acute suppurative cholangitis and the differentiation between suppurative and nonsuppurative cholangitis.
Lee
Nam Kyung
NK
Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
Kim
Suk
S
Lee
Jun Woo
JW
Kim
Chang Won
CW
Kim
Gwang Ha
GH
Kang
Dae Hwan
DH
Jo
Hong Jae
HJ
D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013492:Suppuration / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*