Radiological Evaluation of Obstructive Jaundice: Comparison of USG, CT and Endoscopic Retrograde Cholangiography

Senthil Kumaaran, A K (2010) Radiological Evaluation of Obstructive Jaundice: Comparison of USG, CT and Endoscopic Retrograde Cholangiography. Masters thesis, Kilpauk Medical College, Chennai.


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AIM OF THE STUDY: To compare the accuracy of ultrasound and CT scan in evaluation of level and cause of biliary obstruction with Endoscopic retrograde cholangiography. MATERIALS AND METHODS: Ninety patients with suspected biliary obstruction underwent Ultrasound followed by CT scan of the upper abdomen and Direct Cholangiogram (ERC) in the Department of Radiology Kilpauk Medical College & Hospital and Department of Digestive Health & Diseases, Kilpauk Medical College. The level of biliary obstruction was grouped as hilar, suprapancreatic and intrapancreatic. Similarly the cause was grouped as malignant or benign. Confirmed diagnosis was obtained by USG-guided FNAC or ERC-biopsy or preoperatively by other imaging modality. RESULTS: 34 male and 56 female patients in the age of 26 to 86 years were examined. Accuracy of USG in identifying the correct level of obstruction was 89%, 91% and 87% for hilar, suprapancreatic and intrapancreatic respectively. Similarly CT accuracy was 82% for the hilar, 87% for the suprapancreatic and 80% for the intrapancreatic level. 66 patients had malignant and remaining 24 had benign obstruction. The most common cause of malignancy was cholangiocarcinoma (26.6%) followed by ampullary (24.5%), gallbladder carcinoma (13.3%) and carcinoma of pancreatic head (8.8%). The most common benign obstruction was choledocholithiasis (17.7%) followed by postoperative stricture 4 (4%) and choledochal cyst (4.4%). Accuracy of identifying malignancy was 91%, 89% and 87% for the USG, CT and ERC respectively. Similarly USG, CT and DC had accuracy of 84%, 84% and 87% for identification of benign cause. These findings were statistically significant (p value = < 0.05 at 95% confidence interval). CONCLUSION: This study showed almost similar accuracy of USG, CT and ERC in identification of level and cause of the biliary obstruction. However considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of patients with obstructive jaundice. If it is combined with other imaging modality like CT or DC (ERC) the sensitivity and accuracy increases further. Because of the hazards of the invasive procedures like PTC and ERC, their use should be reserved for those who require therapeutic interventions.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Radiological Evaluation, Obstructive Jaundice, Comparison of Ultrasonography, Computer Tomography, Endoscopic Retrograde Cholangiography.
Subjects: MEDICAL > Gastroenterology
Depositing User: Subramani R
Date Deposited: 07 Mar 2020 06:48
Last Modified: 07 Mar 2020 06:48

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