Application of CT Image Scanning Technology Based on Iris Algorithm in Clinical Diagnosis of Patients with Hepatobiliary Stones

Objective: To investigate the value of multi-slice spiral CT in the diagnosis of extrahepatic bile duct stones using Iris algorithm. Methods: 66 cases of extrahepatic bile duct stones underwent plain and enhanced multiline spiral CT. Observe the density, size, location and number of stones during the plain scan. According to the venous phase enhanced scan, the extrahepatic bile duct wall ≥2 mm was used as the thickening criterion to evaluate the stone density, size, number, and composition ratio of the site and its relationship with tube wall thickening. Results: A total of 57 cases of stones of different densities were found on CT. Nine cases of stones of equal density were not identified. Among the 56 cases with thickened wall, 87.50% (49/56) were concentric and 12.50% (7/56) were eccentric. The wall thickening occurred 62.50% (35/56) below the stone; 17.86% (10/56) was located on the level or above the stone, and 8.93% (5/56) was above the stone. 6 cases (6/56) (10.71%) showed extensive tube wall thickening, all caused by multiple stones. Conclusion: In the study of extrahepatic bile duct stones using the Iris algorithm, it was found that most concentric circular tube wall thickening occurred on or below the stone level. When plain CT scan does not show clear bile duct stones, and this phenomenon appears in the portal vein phase of enhanced scan, the possibility of stones should be considered.

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Comparison between endoscopic sphincterotomy and endoscopic papillary balloon dilation in treatment of extrahepatic bile duct stones

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2014.00860 ◽

2014 ◽

Vol 35 (8) ◽

pp. 860

Author(s):

Guan-zhong HU ◽

Zhen-dong JIN ◽

Feng LIU ◽

Min-min ZHANG ◽

Dong WANG ◽

...

Keyword(s):

Bile Duct ◽

Endoscopic Sphincterotomy ◽

Extrahepatic Bile Duct ◽

Balloon Dilation ◽

Bile Duct Stones ◽

Endoscopic Papillary Balloon Dilation

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Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

Korean Journal of Radiology ◽

10.3348/kjr.2005.6.4.235 ◽

2005 ◽

Vol 6 (4) ◽

pp. 235 ◽

Cited By ~ 21

Author(s):

Yong Sung Park ◽

Ji Hyung Kim ◽

Young Woo Choi ◽

Tae Hee Lee ◽

Cheol Mog Hwang ◽

...

Keyword(s):

Bile Duct ◽

Extrahepatic Bile Duct ◽

Percutaneous Treatment ◽

Bile Duct Stones ◽

Occlusion Balloon

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The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography

Diagnostics ◽

10.3390/diagnostics10121005 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1005

Author(s):

Atsushi Kanno ◽

Eriko Ikeda ◽

Kozue Ando ◽

Hiroki Nagai ◽

Tetsuro Miwata ◽

...

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Ultrasonography ◽

Autoimmune Pancreatitis ◽

Wall Thickening ◽

Endoscopic Retrograde ◽

Intraductal Ultrasonography ◽

Bile Duct Wall ◽

Duct Wall

Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.

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Intraductal Papillary Neoplasm of the Bile Duct With Invasive Adenocarcinoma Complicating IgG4-related Sclerosing Cholangitis: Report of a Case

International Surgery ◽

10.9738/intsurg-d-15-00023.1 ◽

2017 ◽

Vol 102 (1-2) ◽

pp. 70-76

Author(s):

Ryo Ashida ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

Keiko Sasaki ◽

...

Keyword(s):

Bile Duct ◽

Sclerosing Cholangitis ◽

Invasive Carcinoma ◽

Extrahepatic Bile Duct ◽

Inflammatory Cells ◽

Wall Thickening ◽

Multidetector Row Computed Tomography ◽

Intraductal Papillary Neoplasm ◽

Serum Igg4 ◽

Papillary Neoplasm

Although there have been many previous studies of IgG4-related SC focusing on the differential diagnosis from cholangiocarcinoma, only a few patients with cholangiocarcinoma against a background of IgG4-related SC have been reported. We herein present a case of intraductal papillary neoplasm of the bile duct (IPNB) associated with invasive carcinoma complicating IgG4-related sclerosing cholangitis. A 71-year-old female with icterus was admitted to a local hospital, where stricture of the extrahepatic bile duct were detected, and subsequently referred to our hospital for possible surgery. Abdominal multidetector-row computed tomography demonstrated marked wall thickening along the entire extrahepatic bile duct. The left lateral superior bile duct (B2) and left lateral inferior duct (B3) were individually obstructed, and percutaneous transhepatic biliary drainage catheters were placed in B2 and B3 separately. The patient was diagnosed to have diffusely spread cholangiocarcinoma and underwent right hepatic trisectionectomy with caudate lobectomy and pancreatoduodenectomy. A histological examination revealed intraductal papillary tumors composed of fibrovascular stalks covered by neoplastic epithelium. Carcinomatous invasion of the papillary tumors was observed in the fibromuscular layer, and there was abundant infiltration of inflammatory cells with fibrosis outside of the cancerous tissue. The inflammatory cells were primarily composed of plasma cells, a majority of which were positive for IgG4 (>30 cells/high-power field); the postoperative serum IgG4 level was 890 mg/dL. Therefore, a diagnosis of coexisting IPNB associated with invasive carcinoma and IgG4-related sclerosing cholangitis was made. To the best of our knowledge, this is the first report of IPNB complicating IgG4-related sclerosing cholangitis.

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