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Comparison of CT Duodeno-Cholangiopancreatography to ERCP for Assessing Biliary Obstruction

Kielar, Ania MD*; Toa, Hardy MD, FRCPC*; Sekar, Arni MD, FRCPC; Mimeault, Richard MD, FRCSC; Jaffey, James MSc, (Biostatistic; System Science)§

Journal of Computer Assisted Tomography: September-October 2005 - Volume 29 - Issue 5 - p 596-601
doi: 10.1097/01.rct.0000168364.98309.62
Abdominal Imaging: Original Article
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The authors have developed a CT protocol, CT duodeno-cholangiopancreatography (CDCP), which is performed during a single contrast-enhanced phase, proceeding cranially, allowing enhancement of the pancreas during its parenchymal phase followed by enhancement of the liver during its portal-venous phase. This retrospective pilot study evaluates CDCP compared with endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic tool for assessing the cause and level of biliary obstruction. Forty-one patients with jaundice underwent CDCP and ERCP between October 2002 and May 2004. Pathologic confirmation was obtained in 31 of the 41 (76%) patients. The sensitivity, specificity, and kappa values of CDCP and ERCP compared with pathology were calculated for tumors and stones. Pathology-proven cases included 7 cases of stones, 23 tumors, and 1 other cause of obstruction. The overall level of agreement of diagnoses between CDCP and pathology was 29 of 31 (93.5%); that between CDCP and ERCP was 36 of 41 (88%). Comparing CDCP to pathology for tumors, the sensitivity was 100%, the specificity was 89%, and the kappa was 0.92 (95% CI 0.76-1.0). For stone detection, CDCP had a sensitivity of 86%, a specificity of 100%, and a kappa value of 0.90 (95% CI 0.72-1.0). For level of obstruction of the common bile duct, comparing CDCP to ERCP, observations agreed in 31 of the 36 (86%) cases; for the pancreatic duct, observations agreed in 24 of the 25 (96%) cases. CDCP is a noninvasive diagnostic tool that can be used to assess the cause and level of obstruction. A blinded prospective study would be valuable to further assess the merits of CDCP.

From the *Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ottawa, ON; †Department of Gastroenterology, University of Ottawa, Ottawa Hospital, Ottawa, ON; ‡Department of General Surgery, University of Ottawa, Ottawa Hospital, Ottawa, ON and §Ottawa Health Research Institute, Ottawa, Canada.

Received for publication December 22, 2004; accepted April 20, 2005.

Winner of Canadian Congress Gold Award for a scientific presentation by a resident at 2004 ISR Conference, Montreal, PQ, Canada.

Reprints: Ania Kielar, c/o Guiliana Granieri, Ottawa Hospital-Diagnostic Imaging Department, Ottawa ON K1Y 4E9, Canada (e-mail: arke4@rogers.com).

© 2005 Lippincott Williams & Wilkins, Inc.