Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis |
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Authors: | Robert N Gibson Janette M Vincent Tony Speer Neil A Collier Keith Noack |
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Institution: | (1) Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Mebourne, Victoria, 3050, Australia;(2) Department of Gastroenterology, Royal Melbourne Hospital, Mebourne, Victoria, 3050, Australia;(3) Department of Surgery, Royal Melbourne Hospital, Mebourne, Victoria, 3050, Australia |
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Abstract: | To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were 5 mm and eight were 4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats. |
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Keywords: | Computed tomography Bile ducts Intravenous cholangiography Choledocholithiasis |
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