J Korean Soc Radiol.  2011 Nov;65(5):495-503.

Comparative Study between Digital Tomosynthesis and Endoscopic Retrograde Cholangiopancreatography for the Evaluation of Common Bile Duct Stones: Focus on Detection and Stone Conspicuity

• Huh JM
• Beak SY
• Hwang Y
• Lee JK
• Kim Y
• Yi SY

Abstract

PURPOSE
To compare digital tomosynthesis with endoscopic retrograde cholangiopancreatography (ERCP) for the evaluation of common bile duct (CBD) stones as a complementary diagnostic tool.
MATERIALS AND METHODS
Ninety six consecutive patients clinically suspected of having CBD stones underwent ERCP and digital tomosynthesis over 22 months, from December, 2008 to May, 2010. Fourteen patients were excluded. Therefore 82 patients were included in this study. The images were retrospectively reviewed to compare the results with the final analysis based on the consensus of two abdominal radiologists. An evaluation of the presence of CBD stones was followed by a determination of the margins for the stones, scored with a five-point conspicuity scale.
RESULTS
Among the 82 patients, 54 collectively had 89 CBD stones and 28 had no stones. The sensitivity and specificity for the detection of CBD stones were 91.0% and 80.6% for ERCP, 92.1% and 93.5% for digital tomosynthesis, respectively. The average score was 3.29 for ERCP and 3.89 for digital tomosynthesis in 77 similar detected stones. Digital tomosynthesis demonstrated significantly better conspicuity than ERCP (p = 0.001).
CONCLUSION
Digital tomosynthesis is an effective and complementary diagnostic method for the evaluation of CBD stones.

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Choledocholithiasis
Common Bile Duct
Consensus
Humans
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Mimetic diagram of digital tomosynthesis. Digital tomosynthesis image acquired by continuous fluoroscopic exposure from top to bottom at a range of 40°, and with the target part as the center of the CBD. To focus the CBD, the target point is set at a depth of 120 mm from the skin with 70 mm buffer in all directions and continuous X-ray exposure for 2.5 seconds. Note.-CBD = common bile duct

• 

  Fig. 2 A 79-year-old man without a CBD stone. A. ERCP image obtained after injection of contrast material showing a CBD stone (arrow), which is considered to be a score of 5. B. Although the digital tomosynthesis image is slightly blurred, no definite stones are seen in the CBD. Note.-CBD = common bile duct, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 3 A 70-year-old man with one stone in the proximal CBD. A. On ERCP image, no definite CBD stone is visualized. B. Digital tomosynthesis image showing a proximal CBD stone (arrow) with a score of 3 because the upper margin of the CBD stone is obscured. Note.-CBD = common bile duct, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 4 A 66-year-old man with two proximal CBD stones. A. ERCP image obtained after injection of contrast material showing 2 CBD stones (arrows) which are considered to have a score of 2 (upper stone) and 3 (lower stone). B. Digital tomosynthesis image showing 2 CBD stones (arrows) more clearly compared with the visualization in (A), considered as score to have a 5 for both stones. Note.-CBD = common bile duct, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 5 A 74-year-old woman with a CBD stone. A. ERCP image clearly showing a CBD stone (arrow) with a score of 5. B. Digital tomosynthesis image showing the presence of a stone (arrow) in the proximal CBD with blurring of the margin, considered to have a score of 4. Note.-CBD = common bile duct, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 6 A 47-year-old woman with a CBD stone. CBD stone (arrow) clearly seen on both the ERCP image (A) and digital tomosynthesis image (B) with a score of 5. Note.-CBD = common bile duct, ERCP = endoscopic retrograde cholangiopancreatography

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