Utilizing CT to identify clinically significant biliary dilatation in symptomatic post-cholecystectomy patients: when should we be worried?

Purpose To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients. Methods In this IRB approved retrospecti...

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Bibliographic Details
Published in:Abdominal imaging 2022-12, Vol.47 (12), p.4126-4138
Main Authors: Uko, Imo I., Wood, Cecil, Nguyen, Edward, Huang, Annie, Catania, Roberta, Borhani, Amir A., Horowitz, Jeanne M., Gabriel, Helena, Keswani, Rajesh, Nikolaidis, Paul, Miller, Frank H., Kelahan, Linda C.
Format: Article
Language:English
Subjects:
Abdomen
Alkaline phosphatase
Bilirubin
Cholecystectomy
Computed tomography
Diameters
Dilatation
Dilatation, Pathologic
Gastroenterology
Hepatobiliary
Hepatology
Humans
Imaging
Intervention
Medical imaging
Medicine
Medicine & Public Health
Patients
Radiology
Retrospective Studies
Sensitivity
Thresholds
Tomography, X-Ray Computed
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Summary:Purpose To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients. Methods In this IRB approved retrospective study, two attending radiologists independently reviewed CT imaging for 118 post-cholecystectomy patients, who were subsequently evaluated with MRCP, ERCP, or EUS, prompted by findings on the CT and clinical status. Measurements of the common duct (CD) were obtained at the porta hepatis, distal duct, and point of maximal dilation on axial and coronal CT scans. Patients were grouped by whether they required intervention after follow-up imaging. Pertinent baseline lab values and patient demographics were reviewed. Results Of the 118 post-cholecystectomy patients, 38 patients (31%) required intervention, and 80 patients (69%) did not require intervention after follow-up imaging. For both readers, axial and coronal CD diameters were significantly higher in the ‘intervention required’ vs ‘no intervention’ groups at all locations ( p value  10 mm on CT and elevated bilirubin levels should undergo further clinical and imaging follow-up. Graphical abstract
ISSN:2366-0058
2366-004X
2366-0058
DOI:10.1007/s00261-022-03660-9