title: Double-Duct Sign in the Clinical Context.
abstract: OBJECTIVE
  Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infrequently encountered finding in cross-sectional radiological imaging of the pancreatobiliary system. This sign is commonly deemed to signify on ominous pathology and suggests the presence of pancreatic or biliary malignancy.
  
  
  METHODS
  We aim to correlate double-duct sign discovered on magnetic resonance cholangiopancreatogram (MRCP) in the clinical context. We retrospectively analyzed MRCP database over a period of 4 years, January 2010 to December 2013. Follow-up information was available for a median of 27 months (range, 12-42 months)
  
  
  RESULTS
  The commonest cause of double-duct sign was choledocholithiasis followed closely by pancreatobiliary malignancy. Patients with jaundice in the context of double-duct sign had a higher incidence of malignancy (48%). None of the anicteric patients were found to have malignancy (P = 0.002).
  
  
  CONCLUSIONS
  In patients with MRCP evidence of double-duct sign, the absence of jaundice makes a malignant etiology unlikely. Conversely, in jaundiced patients, a malignant cause is much more likely. Figures from larger series are needed to support this conclusion.
authors.affiliation: From the *Gastroenterology, James Cook University Hospital, Middlesborough, United Kingdom; and †Gastroenterology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
authors.forename: Rohit
authors.initials: R
authors.lastname: Sinha
authors.forename: Terri
authors.initials: T
authors.lastname: Gardner
authors.forename: Krishnaveni
authors.initials: K
authors.lastname: Padala
authors.forename: John Richard
authors.initials: JR
authors.lastname: Greenaway
authors.forename: Diamond
authors.initials: D
authors.lastname: Joy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D003135:Common Bile Duct / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D004108:Dilatation, Pathologic; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007565:Jaundice / Q000097:blood / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology*; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001663:Bilirubin