AJR:183, November 2004 1327 MDCT Cholangiography with Volume Rendering for the Assessment of Patients with Biliary Obstruction OBJECTIVE. We sought to evaluate the diagnostic utility of MDCT cholangiography with volume rendering in the evaluation of patients with suspected biliary tree obstruction. SUBJECTS AND METHODS. MDCT was performed in 34 patients who were thought to have biliary obstruction. Portal venous phase scanning was initiated 70 sec after the IV in- fusion of 150 mL of contrast agent, and no cholangiographic contrast agent was administered. Three-dimensional MDCT cholangiographic images were produced using volume rendering. ERCP was performed in 26 patients, and percutaneous transhepatic cholangiography (PTC) was performed in five patients; 17 patients underwent biopsy or surgery. The findings on MDCT cholangiography were compared with those of ERCP, PTC, biopsy, or surgery. RESULT S. The correct diagnosis was made on MDCT cholangiography for 14 (93%) of the 15 patients with a biliary stone and in 16 (94%) of the 17 patients with malignant biliary obstruc- tion. Microlithiasis in one patient could not be detected on MDCT cholangiography. One patient with polypoid adenocarcinoma and one patient with normal findings were incorrectly diagnosed with a biliary stone on the basis of MDCT cholangiography. In one of the two patients with a be- nign stricture, the stricture was incorrectly diagnosed as malignant. For the diagnosis of biliary stone, sensitivity and specificity of MDCT cholangiography were 93% and 89%, respectively. For the diagnosis of malignant obstruction, sensitivity and specificity were both 94%. The accu- racy of the technique for the diagnosis of the cause of biliary obstruction was 83.3%. CONCLUSION. MDCT cholangiography with volume rendering is a noninvasive and fast imaging technique with high sensitivity and specificity for the diagnosis of the cause of biliary tree obstruction. It is a promising diagnostic tool for the assessment of patients with bile duct obstructions. n patients with suspected biliary obstruction, accurate and early di- agnosis is crucial to selecting the appropriate therapeutic management. ERCP and percutaneous transhepatic cholangiogra- phy (PTC) are the gold standard techniques be- cause they allow both a direct visualization of biliary tree and therapeutic intervention. How- ever, they are invasive techniques and carry as- sociated risks that range in severity from minor to life-threatening [1]. Only 20–80% of the bile duct stones are visualized on sonography of the lower biliary tree because of frequent compro- mise due to reflection from overlying bowel gas [2]. CT cholangiography performed with oral or IV biliary contrast agents is not useful in patients whose bilirubin level is elevated be- cause the liver is unable to extract or excrete the contrast agent into the biliary system [2–4]. MR cholangiography is a noninvasive tech- nique, produces high contrast and high-resolu- tion images of the biliary tree, and also allows evaluation of the solid organs [5, 6], but con- traindications—including for patients with car- diac pacemakers, cerebral aneurysm clips, or claustrophobia and those who cannot endure the long examination—limit its use. Recently, MDCT has been introduced into clinical practice. It allows faster scanning, which decreases motion and breathing artifacts, as well as thinner collimation. MDCT collects volumetric data that lead to improved 3D as- sessment of vascular structures and the biliary tree. The display of volume-rendered data re- veals a biliary tree with higher attenuation than surrounding tissues. The resulting images are similar to conventional cholangiographic im- ages but are acquired without the use of biliary contrast agents [7]. The aim of this study was to evaluate the diagnostic utility of 3D MDCT Ali Ahmetoglu 1 Polat Kosucu 1 Sibel Kul 1 Hasan Dinç 1 Ahmet Sari 1 Mehmet Arslan 2 Etem Alhan 3 Halit Resit Gümele 1 Received January 26, 2004; accepted after revision April 20, 2004. 1 Department of Radiology, Karadeniz Technical University, Faculty of Medicine, Trabzon 61080, Turkey. Address correspondence to A. Ahmetoglu. 2 Department of Gastroenterology and Hepatology, Karadeniz Technical University, Faculty of Medicine, Trabzon 61080, Turkey. 3 Department of Surgery, Karadeniz Technical University, Faculty of Medicine, Trabzon 61080, Turkey. AJR 2004;183:1327–1332 0361–803X/04/1835–1327 © American Roentgen Ray Society I ˘ ˘ ¸ ¸ Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved