title: Diagnostic accuracy of transient hepatic attenuation differences on computed tomography scans for acute cholangitis in patients with malignant disease.
abstract: BACKGROUND
  Few reports have assessed the accuracy of transient hepatic attenuation differences (THAD) in the arterial phase of computed tomography (CT) in diagnosing acute cholangitis (AC). We examined the diagnostic accuracy of THAD in AC in patients with malignant disease.
  
  
  METHODS
  We retrospectively examined the records of 123 consecutive patients (73 men, 50 women; mean age, 69 [range, 43-91] years) who underwent dynamic CT 3 days before biliary drainage for malignant hepatobiliary disease between 2006 and 2011. We examined the diagnostic ability of THAD for AC and assessed the relationship between THAD and AC severity.
  
  
  RESULTS
  Acute cholangitis was present in 45% of patients. The sensitivity and specificity of THAD for AC were 93% and 39%, respectively. Diffuse, hemi-hepatic, and segmental THAD for AC were seen in 84%, 4%, and 9%, respectively. In all, 64% of patients were diagnosed with severe AC and 29% with mild AC, depending on the intensity of THAD, but the patterns and degree of intensity of THAD and AC severity were not related.
  
  
  CONCLUSIONS
  Although the pattern and the degree of intensity of THAD and AC severity were not related, THAD might be useful in diagnosing AC. Thus, THAD should be considered a diagnostic criterion for AC.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Sugishita
authors.forename: Ryota
authors.initials: R
authors.lastname: Higuchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Morita
authors.forename: Takehiro
authors.initials: T
authors.lastname: Ota
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT; Cholangitis; Diagnosis; Guideline; THAD