Suk Kim MD, Abstract Co-Author: Nothing to Disclose

Nam kyung Lee MD, Presenter: Nothing to Disclose

Jun Woo Lee MD, Abstract Co-Author: Nothing to Disclose

Ki Seok Choo MD, Abstract Co-Author: Nothing to Disclose

Tae Yong Moon, Abstract Co-Author: Nothing to Disclose

Gwang Ha Kim, Abstract Co-Author: Nothing to Disclose

Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the CT findings in acute nonsuppurative and suppurative cholangitis in patients with extrahepatic bile duct stone and to determine if there are findings that assist in the differential diagnosis.

Fifty patients with stone in the extrahepatic bile duct on ERCP were enrolled in this study. CT was performed within 2 days before ERCP procedure. Findings at ERCP and CT were the standard of reference for patients with suppurative cholangitis (purulent discharge during ERCP procedure or hepatic abscess at CT, n = 15). Two radiologists who were unaware of the results of the ERCP retrospectively analyzed CT images. The following findings were evaluated: the degree of bulging papilla, stone in the ampulla of Vater, the presence of early inhomogeneous enhancement of the liver, the degree of bile duct dilatation, the degree of extrahepatic bile duct wall thickening, and hepatic abscess. Sensitivity and specificity for each of the individual findings were calculated. Statistical analyses were performed with Fisher exact test and Mann-Whitney tests.

Bulging of the papilla with abnormal enhancement of the papilla showed the highest specificity 81.8% with 76.5% sensitivity. The finding of presence of inhomogeneous enhancement of liver or stone in the ampulla of Vater had a high specificity of 94.1% or 87.9% respectively but a sensitivity of only 18.2% or 35.3% respectively. The combination of CT findings including bulging of the papilla with abnormal enhancement of the papilla, and early inhomogeneous enhancement of liver improved specificity (84.9% specificity and 70.6% sensitivity) for suppurative cholangitis. The other findings including the degree of bile duct dilatation and the degree of extrahepatic bile duct wall thickening were not significant findings for differentiation of suppurative cholangitis from nonsuppurative cholangitis.

A combination of CT findings is helpful in making the early diagnosis of suppurative changitis in patients with extrahepatic bile duct stone.

Kim, S, Lee, N, Lee, J, Choo, K, Moon, T, Kim, G, Discrimination of Suppurative Cholangitis from Nonsuppurative Cholangitis with CT: Preliminary Results.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4413265.html