The Comparıson Of Fındıngs Of Multı-Dedector Computed Tomography And Endoscopıc Cholangıopancreatography In Bıle Duct Pathologıes

Year 2013, Volume: 4 Issue: 14, 10 - 22, 03.03.2015

Fatma Öztürk , Tülin Öztürk Gülen Burakgazi Muammer Akyol İbrahim Bahçecioğlu Erkin Oğur

Abstract

Aim: To investigate diagnostic value of multidedector computed tomography (MDCT) using
multiplanar reformation (MPR) and minimum
intensity projection (MinIP) techniques with
comparison of MDCT findings and endoscopic
retrograde cholangiopancreatography (ERCP)
findings known as the “gold standart” in patients
with suspected biliary tract pathology.
Material and Methods: 30 patients with
considered biliary tract pathology according to
laboratory and clinical findings, and biliary tract
pathology identified after routine imagings were
underwent ERCP after MDCT included in this
study. Biliary tract measurments were made in
MPR and MinIP. When MDCT using with MPR
and MinIP techniques in the pathology detection
was compared wtih ERCP, the pozitive predictive
value, then negative predictive value, specifity and
sensivity were calculated.
Results: The pozitive predictive value, then
negative predictive value, specifity and sensivity
were found in the presence of patholgy detection as
96.15%, 25%, 50%, 89.28%, respectively. When
compared with ERCP, MDCT was 100%
compatible for the detection of obstruction level.
Conclusion: Multi-dedector computed tomography
with the development of MPR and MinIP
techniques is a noninvasive method to replace
diagnostic ERCP. In addition, MDCT offers
comrehensive informations about other intraabdominal organs and preoperative diagnosis and
staging of patients with pancreatobiliary tumors

Keywords

Multi-dedector computed tomography (MDCT), biliary tract pathology, ERCP, MPR, MinIP

SAFRA YOLLARI PATOLOJİLERİNDE ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİ VE ENDOSKOPİK KOLANJİOPANKREATOGRAFİ BULGULARININ KARŞILAŞTIRILMASI

Abstract

Amaç: Çalışmamızın amacı, safra yolu patolojisi
düşünülen olgularda Multiplanar reformasyon
(MPR) ve minimum intensite projeksiyon (MinIP)
tekniklerini kullanarak çok kesitli bigisayarlı
tomografi (ÇKBT) bulgularını altın standart olan
endoskopik retrograd kolanjiopankreatografi
(ERKP) ile karşılaştırarak ÇKBT’nin tanısal
değerini araştırmaktır.
Gereç ve Yöntemler: Çalışmaya laboratuar ve
klinik bulguları ile safra yolu patolojisi düşünülen
ve rutin çekimlerde safra yolu patolojisi tespit
edilen 30 olguya ÇKBT çekimi sonrası ERKP
yapıldı. MPR ve MinIP tekniklerinde safra
yolarının ölçümleri yapıldı. ÇKBT’nin, MPR ve
MinIP teknikleriyle birlikte patoloji tespitinde,
ERKP ile karşılaştırıldığında, pozitif kestirim
değeri, negatif kestirim değeri, özgüllük ve
duyarlılığı hesaplandı.
Bulgular Patoloji varlığı tespitindeki pozitif
kestirim değeri %96.15, negatif kestirim değeri
%25, özgüllüğü %50, duyarlılığı %89.28 olarak
tespit edildi. ÇKBT’nin obstrüksiyon seviyesini
tespiti ERKP ile karşılaştırıldığında %100 uyumlu
idi.

Sonuç: Çok kesitli bilgisayarlı tomografi, MPR ve
MinIP tekniklerin gelişimiyle pankreatobiliyer
sistemin değerlendirilmesinde tanısal ERKP’nin
yerini alabilecek noninvaziv bir yöntemdir. Ayrıca
diğer batın içi organların değerlendirilmesi ve
pankreatobiliyer tümörü bulunan hastaların,
preoperatif tanısı ve evrelemesinde geniş kapsamlı
bilgiler sunmaktadır.

Keywords

Çok kesitli bilgisayarlı tomografi (ÇKBT), safra yolu patolojileri, ERKP, MPR, MinIP

References

• Einstein MD, Lapin AS, Ralls PW, Halls JM. The insensivity of sonography in the detection
• of choledocholithiasis. Am J Roentgenol 1984; 142: 725-8.
• Baron RL, Tublin ME, Peterson MS. Imaging the spectrum of biliary tract disease. RadiolClin
• North Am 2002; 40: 1325-54.
• Pavone P, Laghi A, Catalano C, Panebianco V, Fabiano S, Passariello R. MRI of the biliary
• and pancreatic ducts. EurRadiol 1999; 9: 1513-22.
• Roskams T, Desmet V. Embryology of extra-and intrahepatic bile ducts, the ductal plate. The
• Anatomical Record 2008; 291: 628-35.
• Tuncel E. Klinik Radyoloji. Genişletilmiş 2. Baskı, Bursa: Güneş ve Nobel Kitabevleri, 2008;
• -513.
• Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz O, Pham C, Meakins JL,
• Goresky CA.. Useful predictors of bile ductstones in patients under going laparoscopic
• cholecystectomy. McGill Gallstone Treatment Group AnnSurg 1994; 220: 32-9.
• Kim HC, Park SJ, Park SI, Park SH, Kim HJ, Shin HC, Bae WK, Kim IY, Lee HK. Multislice
• CT cholangiography using thin-slab minimum intensity projection and multiplanar
• reformation in the evaluation of patients with suspected biliary obstruction: preliminary
• experience. Clin Imaging 2005; 29: 46-54.
• Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree:
• diagnosis with MR Cholangiopancreatography. Radiology 1996; 199: 521-7.
• Turner MA, Fulcher AS. The cystic duct: normal anatomy and disease processes.
• Radiographics 2001; 21: 3-22.
• Caoili EM, Paulson EK, Heyneman LE, Branch MS, Eubanks WS, Nelson RC. Helical CT
• cholangiography with three-dimensional volum erendering using an oral biliary contrast
• agent: feasibility of a noveltechnique. Am J Roentgenol 2000; 174: 487-92.
• Itoh S, Fukushima H, Takada A, Suzuki K, Satake H, Ishigaki T. Assessment of anomalous
• pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in
• MDCT. Am J Roentgenol 2006; 187: 668-75.
• Khalid A, Slivka A. Pancreas divisum. Curr Treat Options Gastroenterol 2001; 4: 389-99.
• Goldberg HI. Helicalcholangiography: complementary or substitute study for endoscopic
• retrograde cholangiography? Radiology 1994; 192: 615-6.
• Kim HC, Yang DM, Jin W, Ryu CW, Ryu JK, Park SI, Park SJ, Shin HC, Kim
• IY.Multiplanar reformations and minimum intensity projections using multi-detector row CT
• for assessing anomalies and disorders of the pancreaticobiliary tree. World J Gastroenterol
• ; 13: 4177-84.
• Zandrino F, Benzi L, Ferretti ML, Ferrando R, Reggiani G, Musante F. Multislice CT
• cholangiography without biliary contrast agent: technique and initial clinical results in the
• assessment of patients with biliary obstruction. EurRadiol 2002; 12: 1155-61.
• Baron RL, Rohrmann CA Jr, Lee SP, Shuman WP, Teefey SA. CT evaluation of gallstones in
• vitro: correlation with chemical analysis. Am J Roentgenol 1988; 151: 1123-28.
• Anderson SW, Lucey BC, Varghese JC, Soto JA. Accuracy of MDCT in thediagnosis of
• choledocholithiasis. Am J Roentgenol 2006; 187: 174-80.
• Erden A. MR kolanjiopankreatografi. Erden İ (editor). Gövde Manyetik Rezonans. 1. Baskı,
• Ankara: Tuna Matbacılık, 2005: 29-38.
• Halefoglu AM. Magnetic resonance cholangiopancreatography: a useful tool in the evaluation
• of pancreatic and biliary disorders. World J Gastroenterol 2007; 13: 2529-34.
• Fulcher AS, Turner MA. MR pancreatography: a useful tool for evaluating pancreatic
• disorders. Radiographics 1999; 19: 5-24.
• Plumley TF, Rohrmann CA, Freeny PC, Silverstein FE, Ball TJ. Doubleductsign: reassessed
• significance in ERCP. Am J Roentgenol 1982; 138: 31-5.
• Chen HW, Pan AZ, Zhen ZJ, Su SY, Wang JH, Yu SC, Lau WY. Preoperative evaluation of
• resectability of klatskin tumor with 16-MDCT angiography and cholangiography. Am J
• Roentgenol 2006; 186: 1580-6.
• Macari M, Lazarus D, Israel G, Megibow A. Duodenal diverticul amimicking cystic
• neoplasms of the pancreas: CT and MR imaging findings in seven patients. Am J Roentgenol
• ; 180: 195-9.
• Zech CJ, Schoenberg SO, Reiser M, Helmberger T. Cross-sectional imaging of biliary
• tumors: current clinical status and future developments. EurRadiol 2004; 14: 1174-87.