Gensuke Akaike MD, Presenter: Nothing to Disclose

Mitsutomi Ishiyama MD, Abstract Co-Author: Nothing to Disclose

Eisuke Shibata MD, Abstract Co-Author: Nothing to Disclose

Shoko Suzuki, Abstract Co-Author: Nothing to Disclose

Seiichiro Iida, Abstract Co-Author: Nothing to Disclose

Yukihisa Saida MD, Abstract Co-Author: Nothing to Disclose

Yoshiyuki Fujita, Abstract Co-Author: Nothing to Disclose

Shigekazu Funada, Abstract Co-Author: Nothing to Disclose

The purpose of this retrospective, cross-sectional study was to evaluate the utility of peribiliary edema and density of bile in the common bile duct (CBD) in diagnosing acute cholangitis.

Between January 2008 and March 2011, 131 patients with suspected acute cholangitis or choledocholithiasis underwent emergent endoscopic retrograde cholangiopancreatography (ERCP). Among these, 59 patients who underwent ERCP within 6 hours after CT imaging were included in this study (male:59%, mean age; 67.3 years). Two radiologists assessed CBD lumen density in Hounsfield units (HU) on plain CT. The mean density of the CBD was calculated at three different points in both the upper and lower CBD. The presence of peribiliary edema was also determined. A final diagnosis of acute cholangitis was confirmed if clinical information suggested cholangitis (fever, right upper quadrant pain, elevated WBC count and a cholestatic pattern of liver test abnormalities) and infected bile was obtained on ERCP. Based on this, patients were classified into a cholangitis group and non-cholangitis group (control) and CT results were subsequently compared. Chi-squared test and student t-test were used for statistical analyses.  

Of 59 patients, 44 (74.6%) were diagnosed with acute cholangitis. Peribiliary edema was found in 24 patients (52.2%) with cholangitis and in three (21.4%) controls. (p=0.043). Mean density in the lumen of the upper CBD of the cholangitis and control groups was 8.73 HU and 8.42 HU, respectively (p>0.1). Mean density in the lower CBD in each group was 11.0 HU and 13.7 HU, respectively (p>0.1).

It is difficult to identify infected bile based on CTdensity of the CBD lumen alone. In contrast, peribiliary edema was found significantly more often in those with cholangitis and is helpful finding to diagnose acute cholangitis.

Little has been published previously about CT findings of acute cholangitis. We found peribiliary edema is useful in diagnosing acute cholangitis.

Akaike, G, Ishiyama, M, Shibata, E, Suzuki, S, Iida, S, Saida, Y, Fujita, Y, Funada, S, CT Findings of Acute Cholangitis: Peribiliary Edema and Density of Bile in the Common Bile Duct.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015066.html