Values of Contrast-Enhanced Ultrasound in Classification and Diagnosis of Common Bile Duct and Superficial Organ Lesions under Compression Algorithm

This work aimed to investigate values of contrast-enhanced ultrasound (CEUS) under DEFLATE in the classification and diagnosis of the common bile duct and superficial lymphoid lesions. 88 patients with lower common bile duct lesions and 126 patients with superficial lymphoid lesions were selected as the subjects investigated and examined by CEUS under DEFLATE to compare characteristics and diagnostic efficiency of CEUS in different types of lesions. The time-intensity curve (TIC) was for quantitative analysis on CEUS results. The results showed that there were statistically significant differences in the comparison of time to peak (TTP), area under the curve (AUC), and gradient (Grad) of common bile duct walls in patients from the malignant group ( P < 0.05), while the comparison of three indicators of patients in the benign group was not statistically remarkable ( P > 0.05). In addition, there were statistically great differences in TTP, AUC, and Grad among patients in the benign and malignant groups ( P < 0.05). The sensitivity, specificity, accuracy, and positive/negative predictive value of CEUS + ultrasound (US) in the diagnosis of benign and malignant lymph nodes were 92.83%, 87.14%, 89.54%, 91.23%, and 86.43%, respectively. The values of maximal intensity (Imax) in the reactive hyperplasia group (group A), lymphoma group (group B), and metastatic lymph nodes group (group C) were compared, showing statistical differences ( P < 0.05). The TTP and AUC of group B were higher than those of groups A and C, respectively ( P < 0.05), and the base-to-peak ascending slope (KUP) and the absolute value of the semidescending slope (KDOWN) in group C increased hugely compared to group A ( P < 0.05). It indicated that CEUS examination under DEFLATE could be applied in the qualitative diagnosis of lower common bile duct lesions and superficial lymphoid lesions, which was worthy of clinical application.

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Value of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Papillary Thyroid Carcinoma Invasiveness

Frontiers in Oncology ◽

10.3389/fonc.2021.795302 ◽

2022 ◽

Vol 11 ◽

Author(s):

Lei Chen ◽

Luzeng Chen ◽

Zhenwei Liang ◽

Yuhong Shao ◽

Xiuming Sun ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Diagnostic Accuracy ◽

Preoperative Evaluation ◽

Contrast Enhanced Ultrasound ◽

Papillary Thyroid ◽

Contrast Enhanced ◽

Group A ◽

Group B

ObjectiveTo evaluate the diagnostic performance of preoperative contrast-enhanced ultrasound (CEUS) in the detection of extracapsular extension (ECE) and cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) and the added value of CEUS in the evaluation of PTC invasiveness to conventional ultrasound (US).Materials and MethodsA total of 62 patients were enrolled retrospectively, including 30 patients with invasive PTCs (Group A, ECE or LNM present) and 32 patients with non-invasive PTCs (Group B). All patients underwent US and CEUS examinations before surgery. US and CEUS features of PTCs and lymph nodes were compared between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US, CEUS, and the combination of the two in the detection of ECE and LNM of PTCs were calculated. Logistic regression was used to analyze relationships between variables.ResultsThe PTC size was larger in group A on both US and CEUS (P = 0.001, P = 0.003). More PTCs showed hyper-enhancement in group A (P = 0.013) than in group B. More PTCs had >25% contact between PTC and the thyroid capsule and discontinued capsule on US and CEUS (all P < 0.05) in group A than in group B. More absent hilum and calcification of lymph nodes were observed in group A (both P < 0.05) than in group B on US. More centripetal perfusion and enlarged lymph nodes were observed in group A (both P < 0.05) than in group B on CEUS. CEUS alone and US combined with CEUS manifested higher diagnostic accuracy (79.0%) than US alone (72.6%) in the detection of ECE. The combination of US and CEUS manifested the highest diagnostic accuracy (95.2%) than CEUS alone (90.3%) and US alone (82.2%) in the detection of LNM. Diagnoses of ECE and LNM by the combination of US and CEUS were independent risk factors for PTC invasiveness [odds ratio (OR) = 29.49 and 97.20, respectively; both P = 0.001].ConclusionCEUS or US combined with CEUS is recommended for the detection of PTC ECE, while the combination of US and CEUS is most recommended for LNM detection. CEUS plays an essential role in the preoperative evaluation of PTC invasiveness.

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Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

BMC Gastroenterology ◽

10.1186/s12876-020-01523-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ahmad Hormati ◽

Mohammad Reza Ghadir ◽

Seyed Saeed Sarkeshikian ◽

Faezeh Alemi ◽

Majid Moghaddam ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Ursodeoxycholic Acid ◽

The Elderly ◽

Success Rates ◽

Biliary Stones ◽

Cbd Stones ◽

Group A ◽

Bile Duct Stenting ◽

Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

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Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

The American Surgeon ◽

10.1177/0003134820947396 ◽

2020 ◽

pp. 000313482094739

Author(s):

Wan Zhen ◽

Wang Xu-Zhen ◽

Fu Nan-Tao ◽

Li Yong ◽

Xiao Wei-Dong ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Common Bile Duct Exploration ◽

Biliary Surgery ◽

Tube Drainage ◽

T Tube ◽

Significant Difference ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

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Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

The American Surgeon ◽

10.1177/000313481408000227 ◽

2014 ◽

Vol 80 (2) ◽

pp. 178-181 ◽

Cited By ~ 23

Author(s):

Hong-Wei Zhang ◽

Ya-Jin Chen ◽

Chang-Hao Wu ◽

Wen-Da Li

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hospital Stay ◽

Primary Closure ◽

Bile Leakage ◽

Common Bile Duct Exploration ◽

Tube Drainage ◽

T Tube ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

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K-Means Clustering Algorithm-Based Detection of Carotid Atherosclerotic Plaque Using Contrast-Enhanced Ultrasound Images

Scientific Programming ◽

10.1155/2021/2223344 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ruitao Zhou ◽

Ruijie Zhou ◽

Zhibo Zhu

Keyword(s):

Atherosclerotic Plaque ◽

Clustering Algorithm ◽

Detection Method ◽

Control Group ◽

Carotid Atherosclerotic Plaque ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Group A ◽

Group B ◽

Sensitivity Specificity

The aim of this study was to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) based on the K-means clustering (KMC) algorithm for the vulnerability of carotid atherosclerotic plaque (CAA). In this study, 90 patients with CAA were enrolled into a control group (group A) and an experimental group (group B). The angiography method and KMC-based ultrasound detection were applied to diagnose the CAA patients from the two groups, respectively. The results showed that the sensitivity, specificity, and positive predictive value of patients from group B (92.3%, 90.1%, and 94.8%) for diagnosing CAA were obviously higher than those of patients from group A (81.4%, 88.6%, and 75.3%) ( P < 0.05 ). The detection rate of patients from group B (83%, 85%) was dramatically higher than that of patients from group A (65%, 71%) in terms of artery bifurcation and CAA ( P < 0.05 ). Besides, patients from group B were more satisfied with their diagnostic method than group A ( P < 0.05 ). In conclusion, the ultrasound detection method based on KMC had high sensitivity, specificity, and accuracy in the detection of CAA. In addition, ultrasound detection was better than angiography in the diagnosis of plaque in different parts, and it was worthwhile to apply the ultrasound detection method based on KMC in clinical practice.

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Detection of Common Bile Duct Stones in Mild Acute Biliary Pancreatitis Using Magnetic Resonance Cholangiopancreatography

Surgery Research and Practice ◽

10.1155/2018/5216089 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

David Aranovich ◽

Veacheslav Zilbermints ◽

Natalia Goldberg ◽

Oleg Kaminsky

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Cbd Stones ◽

Significant Difference ◽

Group A ◽

Group B

Background. All patients with mild acute biliary pancreatitis should undergo early cholecystectomy. Whether routine common bile duct (CBD) imaging should be employed before the surgical procedure in these patients is a matter of current controversy. The aim of this study was to investigate the rate of detection of CBD stones using magnetic resonance cholangiopancreatography (MRCP) at different time intervals from admission. Methods. From January 1, 2011, through December 31, 2016, 72 patients with acute biliary pancreatitis underwent MRCP. Fifty-six (n=56) of them with mild biliary pancreatitis met the study criteria. The patients were divided into two groups. Group A did not have stones in the CBD (n=45), and Group B had stones in the CBD (n=11). The time from admission to MRCP was divided into several periods (day 1 through day 180), and the presence of the CBD stones on MRCP was weighted against remoteness from admission. Liver chemistry profiles were compared between the groups on admission and before the MRCP. Results. The cumulative rate of choledocholithiasis was 19.7% (Group B, n=11). Forty-five patients (Group A, n=45, 80.3%) did not have gallstones in the CBD. Eight patients with choledocholithiasis (8/56, 14.2%) were detected during the first 10 days from admission out of 27 patients. In patients who underwent MRCP between days 11 and 20, choledocholithiasis was found in two patients (2/56, 3.5%) and in one patient between days 21 and 30 (1/56, 1.8%). No stones were found in patients who underwent MRCP beyond 30 days from admission. Liver chemistry profiles did not show a significant difference in both groups. CBD dilatation was observed at presentation in 11 patients (n=11/56), 6 in Group A (6/45, 13.3%) and 5 in Group B (5/11, 45.5%) (p=0.016). Conclusions. Routine CBD evaluation should be encouraged after mild acute biliary pancreatitis. Early performance of MRCP gives high yield in selecting the patients for endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. A liver chemistry profile either on admission or before MRCP cannot predict the presence of CBD stones.

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Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000800007 ◽

2011 ◽

Vol 26 (suppl 2) ◽

pp. 31-37

Author(s):

Edmilson Rodrigo Daneze ◽

Guilherme Azevedo Terra ◽

Júverson Alves Terra Júnior ◽

Aline Gomes de Campos ◽

Alex Augusto da Silva ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Obstructive Jaundice ◽

Biliary Obstruction ◽

Clinical Signs ◽

Common Bile Duct Ligation ◽

Duct Ligation ◽

Group A ◽

The Common ◽

Group B

PURPOSE: To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS: Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS: The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION: Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.

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Common Bile Duct Exploration in an Elderly Asian Population

International Surgery ◽

10.9738/intsurg-d-13-00168.1 ◽

2015 ◽

Vol 100 (2) ◽

pp. 261-267 ◽

Cited By ~ 12

Author(s):

Vishal G. Shelat ◽

Vincent J. M. Chia ◽

JeeKeem Low

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Elderly Patients ◽

Laparoscopic Approach ◽

Asian Population ◽

Laparoscopic Group ◽

The Elderly ◽

Common Bile Duct Exploration ◽

Group A ◽

Group B

Common bile duct exploration (CBDE) is an accepted treatment for choledocholithiasis. This procedure is not well studied in the elderly population. Here we evaluate the results of CBDE in elderly patients (>70 years) and compare the open (group A) with the laparoscopic group (group B). A retrospective review was performed of elderly patients with proven common bile duct (CBD) stones who underwent CBDE from January 2005 to December 2009. There were 55 patients in group A and 33 patients in group B. Mean age was 77.6 years (70–91 years). Both groups had similar demographics, liver function tests, and stone size—12 mm (range, 5–28 mm). Patients who had empyema (n = 9), acute cholecystitis (n = 15), and those who had had emergency surgery (n = 28) were more likely to be in group A (P < 0.05). The mean length of stay for group A was 11.7 ± 7.3 days; for group B, 5.2 ± 6.3 days; the complication rate was higher in group A (group A, 38.2%; group B, 8.5%; P = 0.072). The overall complication and mortality rate was 29.5% and 3.4%, respectively. CBDE can be performed safely in the elderly with accepted morbidity and mortality. The laparoscopic approach is feasible and safe in elective setting even in the elderly.

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Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211058381 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110583

Author(s):

Songming Ding ◽

Shanjie Dong ◽

Hengkai Zhu ◽

Weilin Wu ◽

Yiting Hu ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Clinical Laboratory ◽

Demographic Data ◽

Gamma Glutamyl Transpeptidase ◽

Stone Size ◽

Cbd Stones ◽

Spontaneous Passage ◽

Group A ◽

Group B

Objective Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. Methods Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. Results Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. Conclusions CBD stones less than 0.33 cm in size may be self-expelled through the papilla.

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Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal ◽

10.18203/2349-2902.isj20195381 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4244 ◽

Cited By ~ 1

Author(s):

Ahmed Abdel Kahaar Aldardeer ◽

Alaa A. Redwaan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Single Stage ◽

Complication Rates ◽

Bile Duct Stones ◽

Two Stage ◽

Endoscopic Retrograde ◽

Cbd Stones ◽

Group A ◽

Group B

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability.

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