Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
Study Results
Study Quality
Study Quality
1. Friedman LS. Chapter 16: Liver, Biliary Tract, & Pancreas Disorders. In: Papadakis MA, McPhee SJ, Rabow MW, eds. Current Medical Diagnosis & Treatment 2017. 56 ed. New York, NY: McGraw-Hill Education; 2017. Review/Other-Dx N/A No abstract available. No abstract available. 4
2. Reisman Y, Gips CH, Lavelle SM, Wilson JH. Clinical presentation of (subclinical) jaundice--the Euricterus project in The Netherlands. United Dutch Hospitals and Euricterus Project Management Group. Hepatogastroenterology. 1996;43(11):1190-1195. Observational-Dx 702 patients To obtain insight in disease distribution and clinical presentation of adult jaundiced patients in a Western country from a primary clinical database. Pancreatic or biliary carcinoma (20%), gallstone disease (13%) and alcoholic liver cirrhosis (10%) were the 3 most frequent diagnoses. Imaging (79%), clinical course (63%) and chemistry/serology (57%) were the most used ascertaining methods. Pancreatic or biliary carcinoma and gallstone disease were more common and age higher in general hospitals (p = 0.0001), and 'immunological' liver disease, non-alcoholic cirrhosis and hepatocellular carcinoma (HCC) more common in academic hospitals (p = 0.001). Patients aged 90 years or older (13%) had pancreatic or biliary carcinoma, liver metastases or heart failure and patients with age less than 20 (0.9%) had acute viral hepatitis, nonalcoholic active liver disease or HCC. Risk factors were more apparent (p < 0.02) in those aged less than 61 years. Feeling unwell (78%), dark urine (67%) and anorexia (57%) were the 3 most frequent symptoms; the 3 most frequent signs were liver enlarged (39%), looking ill (29%) and appearing wasted (23%). 4
3. Saini S. Imaging of the hepatobiliary tract. N Engl J Med. 1997;336(26):1889-1894. Review/Other-Dx N/A No abstract available. No abstract available. 4
4. Greig JD, Krukowski ZH, Matheson NA. Surgical morbidity and mortality in one hundred and twenty-nine patients with obstructive jaundice. Br J Surg. 1988;75(3):216-219. Observational-Tx 129 jaundice patients To observe the role of preoperative biliary drainage in routine surgical practice. The overall mortality was 4.7 per cent but increased to 9.1 per cent in patients with a serum bilirubin greater than 300 mumol/l. In all, 46.5 per cent of patients had a rise in postoperative creatinine but renal dysfunction occurred in only 4.7 per cent. Wound infection developed in 3.1 per cent of patients and appeared unrelated to infected bile; 3.9 per cent of patients were treated for postoperative septicaemic episodes 4
5. Hollands MJ, Little JM. Obstructive jaundice in chronic pancreatitis. HPB Surg. 1989;1(4):263-270. Observational-Dx 11 patients To study the role of obstructive jaundice in chronic pancreatitis. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause. Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from the onset of chronic pancreatitis. Jaundice was found to occur in the presence of more "destructive" disease, and jaundiced patients had a higher incidence of pancreatic calcification, diabetes and malabsorption at the time of presentation with jaundice. Obstructive jaundice caused by chronic pancreatitis was found to carry a good prognosis for jaundice, for pain and for life. Only one of the 11 patients died in hospital. 4
6. Kalser MH, Barkin J, MacIntyre JM. Pancreatic cancer. Assessment of prognosis by clinical presentation. Cancer. 1985;56(2):397-402. Observational-Dx 393 patients To analyze patients entered into pancreatic carcinoma treatment protocols of the Gastrointestinal Tumor Study Group as to significant differences in clinical presentation and factors influencing survival. Group I patients had the smallest lesions (median area, 9 cm2), located in head of the gland in 90% and painless jaundice was the most frequent clinical presentation (52%). In Group II, 83% were located in the head of the gland but the median area was much larger (36 cm2). Pain was present in 80% of cases, and jaundice in 62% with 48% having jaundice and pain. In Group III patients, lesions of body and tail were over four-fold as frequent as in Group I and almost three-fold greater than in Group II. The median area of the lesion was large (30 cm2). Pain was present in 85% and jaundice in only 31%. Median survival in Group I patients was longer than Group III (73 versus 10 weeks; P less than 0.001). 4
7. Herrine SK. Merck Manual. Professional Version. Jaundice.  Available at: Review/Other-Dx N/A To describe the mechanisms, etiology, diagnosis and treatment of jaundice. No results stated in abstract. 4
8. Bjornsson E, Ismael S, Nejdet S, Kilander A. Severe jaundice in Sweden in the new millennium: causes, investigations, treatment and prognosis. Scand J Gastroenterol. 2003; 38(1):86-94. Review/Other-Dx 173 patients To assess the causes of jaundice in Gothenburg, Sweden, to study the types of investigations applied in cholestatic and hepatocellular types of jaundice and treatment and to evaluate the prognosis of these patients up to a year from the diagnosis. The most common cause of jaundice was malignancy in 58 patients, liver metastases in 20, cholangiocarcinoma in 16, pancreatic cancer in 13, cancer of papilla Vateri in 2 and primary liver cancer in 7. Alcoholic liver disease was the second most common cause, found in 29 patients, followed by bile duct stones (28 patients). Only 3% had viral hepatitis. US and/or CT were performed in 95% of those with cholestasis and US had been performed in 75% of those with hepatocellular type and CT in almost 50%.32 patients were operated on, 27 patients were treated endoscopically and 17 patients required liver transplantation. Total mortality was 51% and in malignancy 82%. 4
9. Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut. 2001;48(3):409-413. Observational-Dx 121 patients; 69 consultant gastronenterologists & 67 local general practitioners To prospectively analyze clinically obvious jaundice (bilirubin >120 micromol/l) in South Wales to determine accuracy of diagnosis, referral pattern, treatment, and  outcome and to compare British gastroenterologists' and local general practitioners' perceptions of common causes of jaundice with our study findings. A total of 121 patients were identified of whom 95 were admitted to hospital because of jaundice, 22 developed jaundice while in hospital, and four remained in the community. Causes of jaundice were: malignancy 42, sepsis/shock 27, cirrhosis 25, gall stones 16, drugs 7, autoimmune hepatitis 2, and viral hepatitis 2. One in five was wrongly diagnosed, often as viral hepatitis. Although 30% were under surgical care only 4% required surgery. Overall mortality was high (31%) and greatest in sepsis/shock (51%). Gastroenterologists and GPs both perceived malignancy and gall stones to be the commonest causes of marked jaundice followed by viral hepatitis and cirrhosis; sepsis/shock was hardly mentioned. 3
10. Hung LN, Le Huong NT, Thuy An NT. Jaundice in Adult in-Patients at a Tertiary General Hospital. Journal of Biosciences and Medicines. 2015;03(02):1-11. Observational-Dx 416 jaundice patients To investigate the "new-onset jaundice" incidence, map of causes. approaching method. and risk factors for treatment failure in adult in-patients at a tertiary general hospital as Cho Ray Hospital, Ho Chi Minh City, Viet Nam. The incidence of “new-onset” jaundice in adult patients was 11 ± 5 person/day. The map of jaundice included 3 phases as pre-heaptic 13.7%, in-hepatic 58.2%, and post-hepatic 22.8%. Pancreatic and biliary tract diseases accounted 17.1%, then cirrhosis 16.3%, liver tumor 14.7%, hepatitis 8.9%, sepsis 8.9%, hematology diseases 7.9%, and cardiac diseases 7.5%. A guide for approaching causes of jaundice basing on 7 parameters as total bilirubin, D/T percentage, severity of ALT, AST/ALT ratio, severity of GGT, and bilirubin and urobilinogen in urine was established. The overall mortality was 7.5% (31/416), sepsis had highest death rate of 37.8% (14/37). Sepsis and AST/ALT ratio > 2 were the two independent risk factors of mortality. 3
11. Vuppalanchi R, Liangpunsakul S, Chalasani N. Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States? Am J Gastroenterol. 2007;102(3):558-562; quiz 693. Observational-Dx 732 adults To better understand the epidemiology of acute drug-induced liver injury. Sepsis or altered hemodynamic state resulting in presumed ischemic liver injury is the single most common cause of jaundice (22%). Acute liver disease as a result of nonalcoholic etiologies caused new-onset jaundice in 97 patients (13%), with acute viral hepatitis in 66 patients (9%) and DILI in 29 patients (4%). Most cases of DILI were as a result of acetaminophen toxicity with idiosyncratic DILI occurring in only five patients (0.7%). No mortality was observed at 6 wk in patients who developed idiosyncratic DILI. 4
12. Wolkoff AW. The Hyperbilirubinemias. In: Kasper DL, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine, 19e. 19 ed. New York, NY: McGraw-Hill Education; 2015. Review/Other-Dx N/A N/A N/A 4
13. Manning A, Frazee R, Abernathy S, et al. Protocol-Driven Management of Suspected Common Duct Stones. J Am Coll Surg. 2017;224(4):645-649. Observational-Dx 56 protocol patients; 56 non protocol patients To retrospectively compare protocol and pre-protocol patients by presence of pancreatitis, common duct risk factors, comorbidities, length of hospitalization and postoperative morbidity. There were 56 patients in each group, with a mean +/- SD age of 50.5 +/-20.88 years and 49.3+/- 20.92 years, respectively (p = NS). There were no significant differences between baseline and protocol patients with respect to individual and cumulative preoperative comorbidities, pancreatitis, elevation of liver function tests, bilirubin, common duct size, and postoperativemorbidity. There were fewer endoscopies (22 vs 35; p = 0.014), and shorter length of stay in protocol patients (2.8 days vs 3.8 days; p = 0.025). 3
14. Feld R, Kurtz AB, Zeman RK. Imaging the gallbladder: a historical perspective. AJR Am J Roentgenol. 1991;156(4):737-740. Review/Other-Dx N/A To provide a historical perspective of gall bladder imaging. No results stated in abstract. 4
15. Colli A, Fraquelli M, Andreoletti M, Marino B, Zuccoli E, Conte D. Severe liver fibrosis or cirrhosis: accuracy of US for detection--analysis of 300 cases. Radiology. 2003;227(1):89-94. Observational-Dx 300 asymptomatic patients To determine the accuracy of various ultrasonographic (US) signs for assessment of the degree of liver fibrosis, with histologic results as reference standard. In 107 (36%) patients with severe fibrosis (n = 34) or cirrhosis (n = 73), liver surface nodularity had the highest diagnostic accuracy, with specificity of 95% and positive and negative likelihood ratios 11.6 and 0.51, respectively. When liver surface nodularity was considered alone, posttest probability of severe fibrosis or cirrhosis increased from 35% to 86%. When caudate lobe hypertrophy and hepatic venous blood flow were also taken into account, posttest probability increased by only 2% (ie, to 88%). 2
16. Hartman PC, Oosterveld BJ, Thijssen JM, Rosenbusch GJ, van den Berg J. Detection and differentiation of diffuse liver disease by quantitative echography. A retrospective assessment. Invest Radiol. 1993;28(1):1-6. Observational-Dx 129 patients; 103 pathological findings To retrospectively investigate detectability of diffuse liver diseases by quantitative echography using scans of patients with known pathologic findings. Correct differentiation of these diseases ranged from 88% to 97%. Correlations between histologic grading and echographic parameters were poor. With only one exception, the differentiation between any two of the diseases could be made in 60% to 99% of cases. Different parameters better differentiated abnormal from normal scans than among diseases. 3
17. Layer G, Zuna I, Lorenz A, et al. Computerized ultrasound B-scan texture analysis of experimental diffuse parenchymal liver disease: correlation with histopathology and tissue composition. J Clin Ultrasound. 1991;19(4):193-201. Review/Other-Dx N/A To quantitatively describe ultrasound B-scan images of experimental diffuse liver images. Fatty livers, fatty fibrosis/cirrhosis, and cirrhosis without fatty infiltration of the liver were studied in female Wistar rats. Separation accuracies of more than 80% between the tissue classes "normal" vs "fatty infiltration," or "normal" vs "fatty cirrhosis," using only two statistical image parameters were found. A subclassification of the diffuse parenchymal liver disease was not possible. It is shown by multiple linear regression analysis that the image parameter "mean grey level" correlates better with total lipid content than with the amount of connective tissue. 4
18. Soresi M, Giannitrapani L, Cervello M, Licata A, Montalto G. Non invasive tools for the diagnosis of liver cirrhosis. World J Gastroenterol. 2014;20(48):18131-18150. Review/Other-Dx N/A To revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis. No results stated in abstract. 4
19. Vigano M, Visentin S, Aghemo A, Rumi MG, Ronchi G. US features of liver surface nodularity as a predictor of severe fibrosis in chronic hepatitis C. Radiology. 2005;234(2):641; author reply 641. Review/Other-Dx N/A No abstract available. No abstract available. 4
20. Pasanen PA, Partanen KP, Pikkarainen PH, Alhava EM, Janatuinen EK, Pirinen AE. A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis. Eur J Surg. 1993; 159(1):23-29. Observational-Dx 220 total patients. Patients with jaundice (n=187) or cholestasis without jaundice (n=33) Prospective study to assess accuracy of US, CT and ERCP in distinguishing between benign and malignant causes of jaundice and in determining cholestasis without jaundice. The benign nature of the extrahepatic obstruction was correctly defined by US, CT, and ERCP in 53%, 53%, and 90% of patients, respectively, and the corresponding figures for choledocholithiasis were 22%, 25%, and 79% (ERCP compared with each of the other techniques, P<0.0001). Intrahepatic benign diseases were diagnosed by US and CT in a third of cases. Malignant extrahepatic obstruction was correctly diagnosed in 57%, 80%, and 83%, respectively and the corresponding figures for pancreatic cancer were 60%, 97%, and 89% (US compared with CT, P<0.01, and with ERCP, P<0.05). Intrahepatic malignant lesions were diagnosed by US, CT, and ERCP in 100%, 77%, and 60% of patients, respectively. Results emphasize that the 3 imaging methods are complementary. 2
21. Laing FC, Jeffrey RB, Wing VW. Improved visualization of choledocholithiasis by sonography. AJR Am J Roentgenol. 1984;143(5):949-952. Review/Other-Dx 26 patients To retrospectively review 26 ultrasounds to study visualization of choledocholithiasis by sonography. No results stated in abstract. 4
22. Liu TH, Consorti ET, Kawashima A, et al. Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy. Ann Surg. 2001;234(1):33-40. Observational-Dx 440 patients To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC). Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%). 3
23. Mitchell SE, Clark RA. A comparison of computed tomography and sonography in choledocholithiasis. AJR Am J Roentgenol. 1984;142(4):729-733. Observational-Dx 54 patients To determine the comparative value of sonography and CT in the diagnosis of choledocholithiasis. Sonography correctly diagnosed nine of 49 patients with choledocholithiasis for a sensitivity rate of 18%. The accuracy rate for sonography was 19%; there were five false-positive examinations. CT correctly identified common duct stones in 26 of 30 patients for a sensitivity rate of 87%. The accuracy rate was 84%; there was one false positive. 3
24. Wermke W, Schulz HJ. [Sonographic diagnosis of bile duct calculi. Results of a prospective study of 222 cases of choledocholithiasis]. Ultraschall Med. 1987;8(3):116-120. Observational-Dx 490 patients To evaluate sonographic accuracy in the diagnosis of choledochal calculi 490 patients with cholestasis were examined prospectively with real-time scanner before ERCP or surgery. Ultrasound detected duct stones in 177 of 222 patients (sensibility 80%) and their absence in 242 of 268 (specificity 90%). Dilated extrahepatic bile ducts were demonstrated via ultrasound in 84% of cases with choledocholithiasis, dilated intrahepatic bile ducts in 57%. 4
25. Gurusamy KS, Giljaca V, Takwoingi Y, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015(2):CD011548. Meta-analysis 5 studies ; 523 participants To determine and compare the accuracy of ultrasound versus liver function tests for the diagnosis of common bile duct stones. Five studies including 523 participants reported the diagnostic accuracy of ultrasound. One studies (262 participants) compared the accuracy of ultrasound, serum bilirubin and serum alkaline phosphatase in the same participants. All the studies included people with symptoms. One study included only participants without previous cholecystectomy but this information was not available from the remaining studies. All the studies were of poor methodological quality. The sensitivities for ultrasound ranged from 0.32 to 1.00, and the specificities ranged from 0.77 to 0.97. The summary sensitivity was 0.73 (95% CI 0.44 to 0.90) and the specificity was 0.91 (95% CI 0.84 to 0.95). At the median pre-test probability of common bile duct stones of 0.408, the post-test probability (95% CI) associated with positive ultrasound tests was 0.85 (95% CI 0.75 to 0.91), and negative ultrasound tests was 0.17 (95% CI 0.08 to 0.33).The single study of liver function tests reported diagnostic accuracy at two cut-offs for bilirubin (greater than 22.23 mumol/L and greater than twice the normal limit) and two cut-offs for alkaline phosphatase (greater than 125 IU/L and greater than twice the normal limit). This study also assessed ultrasound and reported higher sensitivities for bilirubin and alkaline phosphatase at both cut-offs but the specificities of the markers were higher at only the greater than twice the normal limit cut-off. The sensitivity for ultrasound was 0.32 (95% CI 0.15 to 0.54), bilirubin (cut-off greater than 22.23 mumol/L) was 0.84 (95% CI 0.64 to 0.95), and alkaline phosphatase (cut-off greater than 125 IU/L) was 0.92 (95% CI 0.74 to 0.99). The specificity for ultrasound was 0.95 (95% CI 0.91 to 0.97), bilirubin (cut-off greater than 22.23 mumol/L) was 0.91 (95% CI 0.86 to 0.94), and alkaline phosphatase (cut-off greater than 125 IU/L) was 0.79 (95% CI 0.74 to 0.84). No study reported the diagnostic accuracy of a combination of bilirubin and alkaline phosphatase, or combinations with ultrasound. M
26. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008; 57(7):1004-1021. Review/Other-Dx N/A Guidelines on the diagnosis and treatment of patients with CBDS. It is recommended that wherever patients have symptoms, and investigation suggests ductal stones, extraction should be performed if possible. Trans-abdominal US is recommended as a preliminary investigation for CBDS and can help identify patients who have a high likelihood of ductal stones. However, clinicians should not consider it a sensitive test for this condition. Where patients with suspected CBDS have not been previously investigated initial assessment should be based on clinical features, liver function tests and US findings. EUS and MRI are both recommended as being highly effective at confirming the presence of CBDS. When selecting between the two modalities patient suitability, accessibility and local expertise are the most important considerations. 4
27. Bortoff GA, Chen MY, Ott DJ, Wolfman NT, Routh WD. Gallbladder stones: imaging and intervention. Radiographics. 2000; 20(3):751-766. Review/Other-Dx N/A Review of various imaging and intervention of gallbladder stones. US is the method of choice for detection of gallstones. The characteristic US findings of gallstones are a highly reflective echo from the anterior surface of the gallstone, mobility of the gallstone on repositioning the patient, and marked posterior acoustic shadowing. Oral cholecystography remains an excellent method of gallstone detection, but its role has been limited due to the advantages of US. The primary imaging modality in suspected acute calculous cholecystitis is usually US or cholescintigraphy. In certain clinical settings, interventional radiologic procedures have become an important alternative to surgery in the treatment of gallstones and their complications; techniques include percutaneous cholecystostomy and gallstone removal. 4
28. Pasanen P, Partanen K, Pikkarainen P, Alhava E, Pirinen A, Janatuinen E. Ultrasonography, CT, and ERCP in the diagnosis of choledochal stones. Acta Radiol. 1992;33(1):53-56. Observational-Dx 187 jaundice patients; 33 non jaundice patients To evaluate the sensitivity of ultrasonography (US), CT, and endoscopic retrograde cholangiopancreatography (ERCP) in the detection of choledochal stone disease. Altogether 83 patients had the final diagnosis of choledocholithiasis. In the jaundiced patients, the sensitivity of US, CT, and ERCP was 22.5%, 23.2%, and 80.6%, respectively. In cases of cholestasis without jaundice, the values were 20%, 37.5%, and 66.7%. In patients in whom all 3 imaging studies were done (n = 64), the differences between US and ERCP and between CT and ERCP were statistically significant (p less than 0.0001). In most false-negative ERCP studies (10/15), the clinical course of the disease strongly suggested a passed choledochal stone. 3
29. Ripolles T, Ramirez-Fuentes C, Martinez-Perez MJ, Delgado F, Blanc E, Lopez A. Tissue harmonic sonography in the diagnosis of common bile duct stones: a comparison with endoscopic retrograde cholangiography. J Clin Ultrasound. 2009; 37(9):501-506. Observational-Dx 107 patients To revisit the diagnostic accuracy of US in the detection of choledocholithiasis using modern equipment with tissue harmonic imaging and ERCP with sphincterotomy as the gold standard. US correctly detected stones in 65/76 patients (sensitivity of 86%). The specificity and the overall accuracy were 87% and 86%, respectively. The sensitivity of US was higher with dilated extrahepatic duct (44% in patients with common bile duct measuring <6 mm in diameter, 82% between 6 and 10 mm, and 100% with common bile duct >10 mm). The lateral approach with the patient in left lateral decubitus position of the patient was the most effective in 47% of the cases. US with tissue harmonic imaging is an accurate technique for the detection of choledocholithiasis that may be used as the first-choice technique to avoid unnecessary procedures in a high percentage of patients, especially those with dilated biliary tree. 2
30. Costi R, Sarli L, Caruso G, et al. Preoperative ultrasonographic assessment of the number and size of gallbladder stones: is it a useful predictor of asymptomatic choledochal lithiasis? J Ultrasound Med 2002;21:971-6. Observational-Dx 300 patients To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. Ultrasonographic classification of gallbladder stones was confirmed at surgery in 285 cases (95%). Asymptomatic common bile duct stones were diagnosed in 9.5% of patients with an ultrasonographic diagnosis of positive gallbladder stones and in only 2.3% of patients with a diagnosis of negative gallbladder stones (P < .05). 3
31. Yang MH, Chen TH, Wang SE, et al. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc 2008;22:1620-4. Observational-Dx 1002 patients To evaluate simple, noninvasive biochemical parameters as screening tests to predict the absence of common bile duct stones prior to laparoscopic cholecystectomy. Eighty-eight (8.8%) patients with gallstone disease who underwent laparoscopic cholecystectomy had concurrent common bile duct stones. Among all diagnostic tests, endoscopic retrograde cholangiopancreatography had the highest sensitivity (96.0%), specificity (99.1%), probability ratio (107.3), accuracy (98.0%), and positive predictive value (98.8%) in detecting common bile duct stones. At least one abnormal elevation among the five biochemical parameters had the highest sensitivity (87.5%). Total bilirubin had the highest specificity (87.5%), highest probability ratio (3.9), highest accuracy (84.1%), and highest positive predictive value (27.4%). All five biochemical predictors had high negative predictive values; gamma glutamyl transferase was highest (97.9%), while the lowest was total bilirubin (94.7%). Multivariate analysis showed only gamma glutamyl transferase, alkaline phosphatase, and total bilirubin to be independent predictors; gamma glutamyl transferase appeared to be the most powerful predictor (odds ratio 3.20). 3
32. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35. Review/Other-Dx N/A To assist gastroenterologists and primary care providers in the interpretation of normal and abnormal liver chemistries as well as an approach to prioritize and evaluate those who present with abnormal liver chemistries. No results stated in abstract. 4
33. Anderson SW, Lucey BC, Varghese JC, Soto JA. Accuracy of MDCT in the diagnosis of choledocholithiasis. AJR. 2006; 187(1):174-180. Observational-Dx 72 patients To evaluate the diagnostic performance of contrast-enhanced and unenhanced MDCT performed for various indications, in detecting choledocholithiasis. Unenhanced and contrast-enhanced MDCT images, interpreted in PACS workstations with axial images, are moderately sensitive and specific for showing choledocholithiasis. 2
34. Maurea S, Caleo O, Mollica C, et al. Comparative diagnostic evaluation with MR cholangiopancreatography, ultrasonography and CT in patients with pancreatobiliary disease. Radiol Med. 2009; 114(3):390-402. Observational-Dx 70 patients MRCP performed in all patients abdominal US: 55 patients (group 1) multislice CT: 37 patients (group 2) To directly compare the results of MRCP with those of US and multislice CT in the diagnosis of pancreaticobiliary diseases. Histology (n=27), biopsy (n=5), ERCP (n=28) and/or clinical-imaging follow-up (n=10) were considered standards of reference. Group 1 - the results of MRCP and US were concordant in the majority (92%) of cases; however, statistically significant discordance (P<0.01) was found in the evaluation of the extrahepatic ducts, with 9 cases (16%) of middle-distal CBDS being detected on MRCP only. Group 2- the results of MRCP and multislice CT were also concordant in most cases (87%). However, findings were significantly discordant when the intra- and extrahepatic ducts were analyzed, with 7 (19%) and 6 (16%) cases, respectively, of lithiasis being detected on MRCP only (P<0.01 for both). Study results confirm the diagnostic potential of MRCP in the study of the pancreaticobiliary duct system. In particular, the comparison between MRCP and US and multislice CT indicates the superiority of MRCP in evaluating bile ducts and detecting stones in the common bile duct. 3
35. Pickuth D. Radiologic diagnosis of common bile duct stones. Abdom Imaging. 2000;25(6):618-621. Review/Other-Dx N/A To review noninvasive methods for imaging common bile duct stones. No results stated in abstract. 4
36. Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne H, Lee MJ. The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol. 1999;54(9):604-614. Observational-Dx 191 patients To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and ultrasound (US) in the diagnosis of choledocholithiasis in a large group of patients with bile duct stones confirmed at direct cholangiography. To compare bile duct stones confirmed at direct cholangiography. Compared with the final diagnosis, MRCP had a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. US had a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP diagnosed more stones and the stones were more proximally distributed within the bile duct at ERCP when compared with MRCP. 3
37. Tongdee T, Amornvittayachan O, Tongdee R. Accuracy of multidetector computed tomography cholangiography in evaluation of cause of biliary tract obstruction. J Med Assoc Thai. 2010; 93(5):566-573. Observational-Dx 50 patients Retrospective study to evaluate accuracy of MDCT cholangiography in evaluation of cause of biliary tract obstruction. Sensitivity, specificity, PPV, and NPV of MDCT cholangiography for detection of calculus, benign stricture, and malignancy were 91.7%-100%, except for sensitivity and PPV for detection of benign stricture, which were 66.7% and 66.7% respectively. MDCT cholangiography is a fast, noninvasive technique that offers high diagnostic accuracy in evaluation of cause of biliary tract obstruction. 3
38. Tseng CW, Chen CC, Chen TS, Chang FY, Lin HC, Lee SD. Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis? J Gastroenterol Hepatol. 2008; 23(10):1586-1589. Observational-Dx 266 patients; 163 choledocholithiasis patients divided into three groups To determine if CT with coronal reconstruction can aid in the diagnosis of choledocholithiasis. Group 1 - 92 undergoing CT using 5-mm thick sections with coronal reconstruction; Group 2- 32 undergoing CT using 5-mm thick sections without coronal reconstruction; and Group 3 - 39 undergoing CT using 7-mm thick sections without coronal reconstruction. Sensitivity and specificity of CT in diagnosing choledocholithiasis were 77.3% and 72.8%. There was no significant difference of CT diagnostic rate among the three groups (75.0%, 81.2% and 79.5%, respectively). The diameter of common bile duct, size of CBDS and white cell count showed significant differences between CT true-positive and false-negative cases in group 1 patients. The CT diagnostic rate was significantly lower in patients with choledocholithiasis of <5 mm than in patients with choledocholithiasis of =5 mm (56.5% vs 81.2%). The coronal reconstruction of CT imaging did not increase its diagnostic efficacy on choledocholithiasis. The stone size affects the diagnostic rate of abdominal CT for detecting choledocholithiasis. 2
39. Mathew RP, Moorkath A, Basti RS, Suresh HB. Value and Accuracy of Multidetector Computed Tomography in Obstructive Jaundice. Pol J Radiol. 2016;81:303-309. Observational-Dx 50 patients To find out the role of MDCT in the evaluation of obstructive jaundice with respect to the cause and level of the obstruction, and its accuracy. To identify the advantages of MDCT with respect to other imaging modalities. To correlate MDCT findings with histopathology/surgical findings/Endoscopic Retrograde CholangioPancreatography (ERCP) findings as applicable. Among the 50 people studied, males and females were equal in number, and the majority belonged to the 41-60 year age group. The major cause for obstructive jaundice was choledocholithiasis. MDCT with reformatting techniques was very accurate in picking a mass as the cause for biliary obstruction and was able to differentiate a benign mass from a malignant one with high accuracy. There was 100% correlation between the CT diagnosis and the final diagnosis regarding the level and type of obstruction. MDCT was able to determine the cause of obstruction with an accuracy of 96%. 3
40. Petrescu I, Bratu AM, Petrescu S, Popa BV, Cristian D, Burcos T. CT vs. MRCP in choledocholithiasis jaundice. J Med Life. 2015;8(2):226-231. Observational-Dx 63 patients To demonstrate the diagnostic accuracy of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting the obstacle in the common bile duct (CBD) and the possibility of establishing the lithiasic nature of the obstruction. A retrospective analysis was analyzed during an interval of 18 months that included jaundice patients admitted in the General Surgery Department of "Coltea" Clinical Hospital. They were examined by CT scanning and by MRCP, being suspected of choledocholithiasis. 63 patients were included in the study, 34 females and 29 males. 33 CT scans and 30 MRCP exams were performed. 4
41. Wyatt SH, Fishman EK. Biliary tract obstruction. The role of spiral CT in detection and definition of disease. Clin Imaging. 1997;21(1):27-34. Observational-Dx 42 patients To assess the efficacy of spiral computed tomography (CT) in determining the etiology of biliary tract obstruction. Spiral CT demonstrated the level of obstruction in all 30 patients in whom there was biliary tract dilatation. Thirty-two diagnoses were rendered in 30 patients, with specific obstructing lesions identified in 28 instances (88%). Twenty-five (78%) of 32 specific pathological diagnoses were correct. The positive predictive value for neoplasms in the pancreatic head was 100% (n = 17). Two patients with characteristic CT changes of sclerosing cholangitis were diagnosed as having superimposed cholangiocarcinoma, although the results of biopsies for neoplasm were negative. The sensitivity of spiral CT for detection of common duct calculi was 67% (n = 3). 3
42. Zeman RK. Cholelithiasis and cholecystitis. In: Gore RM, Levine MS, Laufer I, eds. Textbook of gastrointestinal radiology. Philadelphia: W.B. Saunders Co.; 1994:1636-74. Review/Other-Dx N/A Book chapter. N/A 4
43. Benarroch-Gampel J, Boyd CA, Sheffield KM, Townsend CM, Jr., Riall TS. Overuse of CT in patients with complicated gallstone disease. J Am Coll Surg 2011;213:524-30. Observational-Dx 562 patients To review data on CT use on gallstone disease patients. Five hundred and sixty-two consecutive patients presented emergently with complicated gallstone disease. Mean age was 45 years. Seventy-two percent of patients were female, 46% were white, and 41% were Hispanic. Seventy-two percent of patients had an ultrasound during the initial evaluation and 41% had a CT. Both studies were performed in 25% of patients (n = 141), 16% (n = 93) had CT only, and 47% (n = 259) had ultrasound only. CT was performed first in 67% of those who underwent both studies. Evening imaging (7 PM-7 AM, odds ratio [OR] = 4.44; 95% CI, 2.88-6.85), increased age (OR = 1.14 per 5-year increase; 95% CI, 1.07-1.21), leukocytosis (OR = 1.67; 95% CI, 1.10-2.53), and hyperamylasemia (OR = 2.02; 95% CI, 1.16-3.51) predicted use of CT. 3
44. Kudo M, Zheng RQ, Kim SR, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. Intervirology. 2008;51 Suppl 1:17-26. Observational-Dx 142 patients To evaluate the diagnostic accuracy of liver cirrhosis by imaging modalities, including CT, MRI and US, compared to results obtained from histopathological diagnoses of resected specimens. The differences in the five imaging parameters evaluated by CT, MRI and US between LC and CH were statistically significant (p < 0.001) except for the manifestations of portal hypertension on US. Irregular or nodular surface, blunt edge or morphological changes in the liver were selected as the best predictive signs for cirrhosis on US whereas liver parenchymal abnormalities, manifestations of portal hypertension and morphological changes in the liver were the best predictive signs on MRI and CT by multivariate analysis. The predictive diagnostic accuracy, sensitivity and specificity in discriminating LC from CH based on the best predictive signs were 71.9, 77.1 and 67.6% by CT; 67.9, 67.5 and 68.3% by MRI, and 66.0, 38.4 (lower than CT and MRI, p =0.001) and 88.8% (higher than CT and MRI, p =0.001)by US. According to the imaging impression scoring system, diagnostic accuracy, sensitivity and specificity were 67.0, 84.3 and 52.9% by CT; 70.3, 86.7 and 53.9% by MRI, and 64.0, 52.4 (lower than CT and MRI, p =0.0001) and 73.5% (higher than CT and MRI, p < 0.003) by US. ROC analysis showed that MRI and CT were slightly superior to US in the diagnosis of LC but no statistically significant difference was found between them. For the pathological diagnosis of P-LC, cirrhosis was diagnosed in 59.5, 46.7 and 41.7% of the P-LC cases by US, CT and MRI, respectively, with no significant difference among these methods. 3
45. Smith AD, Branch CR, Zand K, et al. Liver Surface Nodularity Quantification from Routine CT Images as a Biomarker for Detection and Evaluation of Cirrhosis.[Erratum appears in Radiology. 2017 Jun;283(3):923; PMID: 28514210]. Radiology. 280(3):771-81, 2016 09. Observational-Dx 24 healthy patients; 70 chronic liver disease patients To determine the accuracy, reproducibility, and intra- and interobserver agreement of a computer-based quantitative method to measure liver surface nodularity (LSN) from routine computed tomographic (CT) images as a biomarker for detection and evaluation of cirrhosis. Median LSN scores from nonenhanced thick-section CT images in cirrhotic livers (3.16; 56 livers) were significantly higher than in noncirrhotic livers (2.11; 38 livers; P < .001). LSN scores from the four CT imaging types (94 patients for each type) were very strongly correlated (range of Spearman r, 0.929-0.960). LSN scores from portal venous phase contrast-enhanced thick-section CT images had significantly higher accuracy (area under the receiver operating characteristic curve, 0.929) than splenic volume (area under the receiver operating characteristic curve, 0.835) or LLS-to-TLV ratio measurements (area under the receiver operating characteristic curve, 0.753) for differentiating cirrhotic from noncirrhotic livers (P = .038 and .003, respectively; n = 94). Intra- and interobserver agreements that used nonenhanced thick CT images were very good (intraclass correlation coefficient, 0.963 and 0.899, respectively). 3
46. Munir K, Bari V, Yaqoob J, Khan DB, Usman MU. The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice. J Pak Med Assoc. 2004;54(3):128-132. Observational-Dx 49 patients To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001. Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive (88%) and specific (96.8%) in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture. 3
47. Yoon JH, Lee SM, Kang HJ, et al. Clinical Feasibility of 3-Dimensional Magnetic Resonance Cholangiopancreatography Using Compressed Sensing: Comparison of Image Quality and Diagnostic Performance. Invest Radiol. 2017;52(10):612-619. Observational-Dx 84 patients To evaluate the clinical feasibility of fast 3-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) using compressed sensing (CS) in comparison with conventional navigator-triggered 3D-MRCP. Mean acquisition times of conventional MRCP, CS-MRCP, and BH-CS-MRCP were 7 minutes (419.7 seconds), 3 minutes 47 seconds (227.0 seconds), and 16 seconds, respectively (P < 0.0001, in all comparisons). In all patients, CS-MRCP showed better image sharpness (3.54 +/- 0.60 vs 3.37 +/- 0.75, P = 0.04) and visualization of the common bile duct (4.55 +/- 0.60 vs 4.39 +/- 0.78, P = 0.034) and pancreatic duct (3.47 +/- 1.22 vs 3.26 +/- 1.32, P = 0.025), but lower background suppression (3.00 +/- 0.54 vs 3.37 +/- 0.58, P < 0.001) than conventional MRCP. Overall image quality was not significantly different between the 2 examinations (3.51 +/- 0.95 vs 3.47 +/- 1.09, P = 0.75). The number of indeterminate MRCP examinations for the anatomic variation and disease of the bile duct significantly decreased on CS-MRCP, from 16.7%-22.6% to 9.5%-11.9% and 8.4%-15.6% to 3.6%-8.4% in all readers (P = 0.003-0.03). In the 28 patients who underwent BH-CS-MRCP, better image quality was demonstrated than with conventional MRCP and CS-MRCP (4.10 +/- 0.84 vs 3.44 +/- 1.21 vs 3.50 +/- 1.11, respectively, P = 0.002, 0.001). Sensitivities for detecting bile duct disease was 88.9% to 100% on both BH-CS-MRCP and conventional MRCP (P > 0.05), and for detecting pancreatic disease was 66.7% to 83.3% on BH-CS-MRCP and 50.0% to 72.2% on conventional MRCP (P = 0.002 in reader 1, 0.06-0.47 in readers 2-3). 3
48. Kang SK, Heacock L, Doshi AM, Ream JR, Sun J, Babb JS. Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients. Abdom Radiol (NY). 2017;42(6):1650-1658. Observational-Dx 123 scans To compare the performance of non-contrast MRI with half-Fourier acquisition single-shot turbo spin echo (HASTE) vs. contrast-enhanced MRI/3D-MRCP for assessment of suspected choledocholithiasis in hospitalized patients. There were 27 cases of choledocholithiasis, 31 cases of acute hepatitis, 37 cases of acute cholecystitis, and 3 clinically diagnosed cases of acute cholangitis. Both the abbreviated and full contrast-enhanced/MRCP image sets resulted in high accuracy for choledocholithiasis (91.1-94.3% vs. 91.9-92.7%). There was no difference in sensitivity or specificity for either reader for any diagnosis between image sets (p > 0.40). 1 reader showed improved confidence (p < 0.001) with inclusion of MRCP and contrast-enhanced images, but neither confidence nor MRCP quality scores were associated with diagnostic accuracy. Patient age and fever did not predict the need for contrast-enhanced images. 3
49. Sun N, Xu Q, Liu X, Liu W, Wang J. Comparison of preoperative evaluation of malignant low-level biliary obstruction using plain magnetic resonance and coronal liver acquisition with volume acceleration technique alone and in combination. Eur J Med Res. 2015;20:92. Observational-Dx 41 patients To evaluate the clinical value of plain magnetic resonance (MR) imaging (including magnetic resonance cholangiopancreatography, MRCP) and coronal liver acquisition with volume acceleration (LAVA) technique in the diagnosis and preoperative assessment of malignant low-level biliary obstruction. There were 14 pancreatic adenocarcinoma, 12 distal common bile duct carcinoma, 10 ampullary carcinoma, and 5 duodenal carcinoma cases. There was no significant difference in accuracy of the three groups' positioning diagnoses, 87.8, 90.2, and 92.7 %, respectively. The accuracy of the qualitative diagnoses was lower in group 1 at 78.0 %, but not significantly different in groups 2 and 3 at 92.7 and 95.1 %, respectively (P = 0.031, and 0.039, group 1 vs groups 2 and 3, respectively). Thirty-three patients underwent open surgery. There were 19 adjacent organ involvements, 9 vascular involvements, 13 lymph node metastases and 6 liver metastases. 22 patients were verified surgically and histologically for resectable lesions. Plain MR with coronal LAVA imaging showed 85.4 % accuracy, 90.9 % sensitivity, 78.9 % specificity, 83.3 % positive and 88.2 % negative predictive value for resectability. 3
50. Aube C, Delorme B, Yzet T, et al. MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study. AJR. 2005; 184(1):55-62. Observational-Dx 47 patients To prospectively compare diagnostic accuracy of MRCP and EUS for the diagnosis of CBDS in patients with a mild to moderate clinical suspicion of CBDS. The sensitivity and specificity of MRCP were, respectively, 90.5% and 87.5% for etiologic diagnosis and 87.5% and 96.6% for the detection of CBDS. The corresponding values for EUS were 86.4% and 91.3% for etiologic diagnosis and 93.8% and 96.6% for visualization of choledocholithiasis. 2
51. Choi JY, Lee JM, Lee JY, et al. Navigator-triggered isotropic three-dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: comparison with direct cholangiography. J Magn Reson Imaging. 2008; 27(1):94-101. Observational-Dx 23 patients To retrospectively compare the diagnostic accuracy of navigator-triggered isotropic 3D-MRCP using parallel imaging for malignant biliary obstruction with direct cholangiography. Patients with malignant biliary obstruction underwent MRCP and ERCP/PTC. 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in 3 patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction. 2
52. Park HS, Lee JM, Choi JY, et al. Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. AJR. 2008; 190(2):396-405. Observational-Dx 27 patients; 2 independent reviewers Retrospective study to compare the performance of MRI combined with MRCP with that of MDCT combined with direct cholangiography in the evaluation of the tumor extent and resectability of bile duct cancer with surgical and pathologic findings as the reference standard. For each reviewer, the overall accuracy rates for predicting involvement of the bilateral secondary biliary confluences and the intrapancreatic common bile duct were 90.7% and 87.0% for MRI with MRCP and 85.1% and 87.0% for MDCT with direct cholangiography. The differences were not statistically significant for either image set for either reviewer (P>0.05). In the assessment of vascular involvement, lymph node metastasis, and tumor resectability, the readers’ diagnostic performance using MRI with MRCP was similar to that with MDCT with direct cholangiography (P>0.05). In the diagnosis of bile duct cancer with a noninvasive procedure, the information regarding tumor extent and resectability obtained with contrast-enhanced MRI combined with MRCP is comparable with that obtained with MDCT with direct cholangiography. 2
53. Hekimoglu K, Ustundag Y, Dusak A, et al. MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis. 2008; 9(3):162-169. Observational-Dx 269 total patients To compare the diagnostic potential of one of the new MR sequences in MRCP procedure and ERCP with review of current literatures. Patients were prospectively enrolled in this study. The study participants were classified into four main groups; normal into group I, stone disease into group II, tumor into group III and others into group IV. Group I consisted of 228 patients who had a normal pancreaticobiliary tree on both the MRCP and ERCP examinations. In group II there were 18 patients, for whom the MRCP had a 88.9% sensitivity and a 100% specificity for diagnosing biliary stone disease. It’s PPV, NPV and accuracy rates were 100%, 99.2% and 99.2%, respectively. The MRCP had 100% sensitivity and a 100% specificity for 20 patients in group III. It also had 100% PPV, 100% NPV, and 100% total accuracy rates in this group. In three patients in group IV, the MRCP had a 100% sensitivity and specificity, respectively. Its PPV, NPV and accuracy were 100%, 100% and 100%, respectively. MRCP is used with increasing frequency as a noninvasive alternative to ERCP and the diagnostic results of MRCP with a heavily T2-weighted MR sequence and ERCP are comparable with high accuracy in various hepatobiliary pathologies. 1
54. Chen FM, Ni JM, Zhang ZY, Zhang L, Li B, Jiang CJ. Presurgical Evaluation of Pancreatic Cancer: A Comprehensive Imaging Comparison of CT Versus MRI. AJR Am J Roentgenol. 2016;206(3):526-535. Observational-Dx 38 patients To compare comprehensive CT and MRI in the presurgical evaluation of pancreatic cancer. The rate of detection of tumors was higher with MRI than with CT but not significantly so (reviewer 1, p = 1.000; reviewer 2, p = 0.500). In the evaluation of vessel involvement, nodal status, and resectability, although CT had higher ROC AUC values than did MRI (reviewer 1, 0.913 vs 0.858, 0.613 vs 0.503, and 0.866 vs 0.774; reviewer 2, 0.879 vs 0.849, 0.640 vs 0.583, and 0.830 vs 0.815), the differences were not statistically significant (p = 0.189 vs 0.494, 0.328 vs 0.244, and 0.193 vs 0.813 for reviewers 1 and 2). In the evaluation of tumor extension and organ metastases in the 38 patients, correct diagnosis of one of two liver metastases was achieved with both image sets, one case of omental and one case of peritoneal seeding were underestimated, and one case of stomach invasion was overestimated. 3
55. Joo I, Lee JM. Imaging bile duct tumors: pathologic concepts, classification, and early tumor detection. Abdom Imaging. 2013;38(6):1334-1350. Review/Other-Dx N/A To review the classification system of the bile duct tumors with their radiologic and pathologic findings as well as role of imaging in the early detection of bile duct tumors. No results stated in abstract. 4
56. Tirkes T, Menias CO, Sandrasegaran K. MR imaging techniques for pancreas. Radiol Clin North Am. 2012;50(3):379-393. Review/Other-Dx N/A To highlight the advantages and disadvantages of state-of-the-art and emerging pulse sequences and their application to imaging pancreatic diseases. No results stated in abstract. 4
57. Kolodziejczyk E, Jurkiewicz E, Pertkiewicz J, et al. MRCP Versus ERCP in the Evaluation of Chronic Pancreatitis in Children: Which Is the Better Choice? Pancreas. 2016;45(8):1115-1119. Observational-Dx 48 children To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in the detection of chronic pancreatitis (CP)-specific changes in the pediatric population. Diagnostic ERCP pancreatograms were obtained in 41 (85.4%) of 48 patients and diagnostic MRCP images in all 48 children. The sensitivity and positive predictive value of MRCP were 77.1% and 90%, respectively, and its specificity and negative predictive value amounted to 50% and 27.3%, respectively. The patients with consistent results of MRCP and ERCP (ie, true-positive and true-negative cases) and individuals with incompatible results of the tests (ie, false-positive and false-negative cases) differed in terms of their median age at MRCP (14.17 vs 10.33 years) and median CP stage according to the Cambridge Scale (4 vs 2). 4
58. Scaffidi MG, Luigiano C, Consolo P, et al. Magnetic resonance cholangio-pancreatography versus endoscopic retrograde cholangio-pancreatography in the diagnosis of common bile duct stones: a prospective comparative study. Minerva medica. 2009; 100(5):341-348. Observational-Dx 140 patient To prospectively evaluate sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP in diagnosis of choledocholithiasis using ERCP/endoscopic sphincterotomy as gold standard. 120/140 patients completed the study. MRCP diagnosed lithiasis of CBDS in 84. ERCP confirmed the lithiasis in 73/84 patients who were submitted to endoscopic sphincterotomy. Eleven were negative after endoscopic sphincterotomy. ERCP documented stones in 10 patients among the 36 negative at MRCP; stones were detected only in 4 patients after endoscopic sphincterotomy. In 26/36 patients negative at MRCP, ERCP confirmed this response: only 12/26 patients underwent endoscopic sphincterotomy. The sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP were: 88%, 72%, 83%, 87%, and 72%, respectively. As the MRCP diagnostic yield is still limited with small stones, the question of which patient is the best candidate to ERCP/endoscopic sphincterotomy is still unsolved. 3
59. Kondo S, Isayama H, Akahane M, et al. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography. Eur J Radiol. 2005; 54(2):271-275. Observational-Dx 28 patients Prospective study to compare the diagnostic ability of EUS, MRCP, and helical CT cholangiography in patients with suspected CBDS. Each patient underwent EUS, MRCP, and helical CT cholangiography prior to ERCP, the result of which served as the diagnostic gold standard. CBDS were detected in 24 (86%) of 28 patients by ERCP/EUS. The sensitivity of EUS, MRCP, and helical CT cholangiography was 100%, 88%, and 88%, respectively. False negative cases for MRCP and helical CT cholangiography had a CBDS <5 mm in diameter. No serious complications occurred while one patient complained of itching in the eyelids after the infusion of contrast agent on helical CT cholangiography. When examination can be scheduled, MRCP or helical CT cholangiography will be the first choice because they were less invasive than EUS. MRCP and helical CT cholangiography had similar detectability but the former may be preferable considering the possibility of allergic reaction in the latter. When MRCP is negative, EUS is recommended to check for small CBDS. 2
60. Reid J, Dolan R, Patel M, Fleming R, Young D, Hair A. Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP. Surgeon. 2017;15(3):119-122. Observational-Dx 1812 patients To ascertain if direct measurement of the size of common bile duct stones (CBD) on magnetic resonance cholangio-pancreatography (MRCP) can be used to predict the likelihood of a positive endoscopic retrograde cholangio-pancreatography (ERCP) result. 221 patients (75%) had stones demonstrated on ERCP. A receiver operating curve (ROC) was plotted correlating stone size with the likelihood of a positive ERCP result, and demonstrates that using a cut off of >4 mm as an indication for ERCP gives the mathematical best-fit correlation with a sensitivity of 83% (95% CI 78-88) and specificity of 66% (95% CI 53-77). 3
61. Oto A, Ernst R, Ghulmiyyah L, Hughes D, Saade G, Chaljub G. The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease. Br J Radiol. 2009;82(976):279-285. Observational-Dx 18 pregnant patients To determine the usefulness of MR cholangiopancreatography (MRCP) in the evaluation of pregnant patients with acute pancreaticobiliary disease and its additional value over ultrasound 15 patients were also evaluated with ultrasound. Biliary dilatation was detected in eight patients by ultrasound, but the cause of biliary dilatation could not be determined by ultrasound in seven patients. MRCP demonstrated the aetiology in four of these patients (choledocholithiasis (n51), Mirizzi syndrome (n51), choledochal cyst (n51) and intrahepatic biliary stones (n51)) and excluded obstructive pathology in the other four patients. MRCP was unremarkable in the seven patients who had no biliary dilatation on ultrasound. Three patients underwent only MRCP; two had choledocholithiasis and one cholelithiasis and pancreatitis. Choledocholithiasis diagnosed with MRCP (n53) was confirmed by endoscopic retrograde cholangiopancreatography. Mirizzi syndrome (n51) and a choledochal cyst (n51) were confirmed by surgery. The patients with normal MRCP (n512) and one patient with intrahepatic stones improved with medical treatment.MRCP appears to be a valuable and safe technique for the evaluation of pregnant patients with acute pancreaticobiliary disease. 4
62. Kim TU, Kim S, Lee JW, et al. Ampulla of Vater: comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy. Eur J Radiol. 2008; 66(1):48-64. Review/Other-Dx N/A To review the normal anatomy of the ampulla of Vater, describe the role of MR in the detection and characterization of the lesion in or around the ampulla of Vater, and correlate them with ERCP. ERCP is the most accurate tool for diagnosing neoplastic and non-neoplastic conditions in or around the ampulla of Vater. However, ERCP involves inherent morbidity because of its invasiveness. MRCP can provide global information on the pancreaticobiliary tree non-invasively in patients with suspected or known pancreaticobiliary disease. Additional conventional MRI might provide valuable information in distinguishing between neoplastic and non-neoplastic conditions. The dynamic 3D-gadobutrol-enhanced sequence might assist in depicting and characterizing the abnormal papilla. MRI in conjunction with MRCP may be helpful for making an accurate assessment of the ampulla of Vater as well as for distinguishing between neoplastic and non-neoplastic conditions. 4
63. Masselli G, Manfredi R, Vecchioli A, Gualdi G. MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol 2008; 18(10):2213-2221. Observational-Dx 15 patients; 2 reviewers Retrospective study to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma and consequently to determine the capability of MRI/MRCP for staging cholangiocarcinoma. Overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (P<0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the cases. The number of overall correctly assessed patients with regard to resectability was 11 true positive, 1 false positive and 3 true negative. The combination of MRI/MRCP is a reliable diagnostic method for staging hilar cholangiocarcinomas. Delayed periductal enhancement is accurate in the evaluation of neoplastic perineural spread, and it can improve diagnostic accuracy to identify resectable and unresectable tumors. 2
64. Expert Panel on Gastrointestinal Imaging:, Horowitz JM, Kamel IR, et al. ACR Appropriateness Criteria Chronic Liver Disease. J. Am. Coll. Radiol.. 14(11S):S391-S405, 2017 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic liver disease. No results stated in abstract. 4
65. Carr-Locke DL. Overview of the role of ERCP in the management of diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2002;56(6 Suppl):S157-160. Review/Other-Dx N/A To discuss the role of ERCP in clinical practice. No results stated in abstract. 4
66. Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR. 2003; 181(3):819-827. Review/Other-Dx N/A To describe the gross appearance of intrahepatic and extrahepatic cholangiocarcinomas, correlate the pathologic and imaging findings, consider the mode of spread of these tumors, and discuss the clinical significance of the various growth patterns of cholangiocarcinoma. Morphologic classification of cholangiocarcinoma is useful for understanding the biological behavior of this tumor as well as for planning and choosing the appropriate treatment and for predicting prognosis. 4
67. Lomanto D, Pavone P, Laghi A, et al. Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases. Am J Surg. 1997;174(1):33-38. Observational-Dx 136 patients To assess the feasibility of MRCP versus ERCP in the diagnosis of biliary tract and pancreatic diseases. In choledocholithiasis, MRCP showed 91.6% sensitivity, 100% specificity, and overall diagnostic accuracy 96.8%. Of 48 patients with stenotic lesions, 16 were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In the patients submitted to biliary-enteric anastomosis, MCRP was able to detect the dilatation of the intrahepatic ducts, the stenosis, and associated stones in all 8 positive cases. In the remaining 7 patients with mild signs of cholangitis, MCRP showed irregular aspects of the biliary tree in the main ducts. In the 11 patients with chronic pancreatitis, MCRP was able to depict the dilated Wirsung duct and the stenotic tract, although the fine details of the secondary ducts were not evaluated due to the low spatial resolution as compared with conventional films. 3
68. Baron TH, Petersen BT, Mergener K, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol. 2006;101(4):892-897. Review/Other-Dx 21 surveys; 16855 patients To provide health-care providers, patients, and physicians with an exhaustive assessment of prospective studies on rates of complications and fatalities associated with endoscopic retrograde cholangiopancreatography (ERCP). In 21 selected surveys, involving 16,855 patients, ERCP-attributable complications totaled 1,154 (6.85%, CI 6.46-7.24%), with 55 fatalities (0.33%, CI 0.24-0.42%). Mild-to-moderate events occurred in 872 patients (5.17%, CI 4.83-5.51%), and severe events in 282 (1.67%, CI 1.47-1.87%). Pancreatitis occurred in 585 subjects (3.47%, CI 3.19-3.75%), infections in 242 (1.44%, CI 1.26-1.62%), bleeding in 226 (1.34%, CI 1.16-1.52%), and perforations in 101 (0.60%, CI 0.48-0.72%). Cardiovascular and/or analgesia-related complications amounted to 173 (1.33%, CI 1.13-1.53%), with 9 fatalities (0.07%, CI 0.02-0.12%). As compared with old reports, morbidity rates increased significantly in most recent studies: 6.27%versus 7.51% (P(c)= 0.029). 4
69. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781-1788. Meta-analysis 12 studies; 16855 patients To provide health-care providers, patients, and physicians with an exhaustive assessment of prospective studies on rates of complications and fatalities associated with endoscopic retrograde cholangiopancreatography (ERCP). In 21 selected surveys, involving 16,855 patients, ERCP-attributable complications totaled 1,154 (6.85%, CI 6.46-7.24%), with 55 fatalities (0.33%, CI 0.24-0.42%). Mild-to-moderate events occurred in 872 patients (5.17%, CI 4.83-5.51%), and severe events in 282 (1.67%, CI 1.47-1.87%). Pancreatitis occurred in 585 subjects (3.47%, CI 3.19-3.75%), infections in 242 (1.44%, CI 1.26-1.62%), bleeding in 226 (1.34%, CI 1.16-1.52%), and perforations in 101 (0.60%, CI 0.48-0.72%). Cardiovascular and/or analgesia-related complications amounted to 173 (1.33%, CI 1.13-1.53%), with 9 fatalities (0.07%, CI 0.02-0.12%). As compared with old reports, morbidity rates increased significantly in most recent studies: 6.27%versus 7.51% (P(c)= 0.029). Good
70. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48(1):1-10. Observational-Dx 2769 patients To prospectively study complications of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). One hundred eleven major complications (4.0%) were recorded: moderate-severe pancreatitis 36 (1.3%), cholangitis 24 (0.87%), hemorrhage 21 (0.76%), duodenal perforation 16 (0.58%), others 14 (0.51%). Among 942 diagnostic ERCPs there were 13 major complications (1.38%) and 2 deaths (0.21%), whereas among 1827 therapeutic ERCPs there were 98 major complications (5.4%) and 9 deaths (0.49%). The difference in the incidence of complications between diagnostic and therapeutic ERCPs was statistically significant (p < 0.0001). Small center and precut were recognized as independent risk factors for overall major complications of therapeutic ERCP, whereas the following risk factors were identified in relation to specific complications: (1) pancreatitis: age less than 70 years, pancreatic duct opacification, and nondilated common bile duct; (2) cholangitis: small center, jaundice; (3) hemorrhage: small center; and (4) retroperitoneal duodenal perforation: precut, intramural injection of contrast medium, and Billroth II gastrectomy. 3
71. Aronson N, Flamm CR, Mark D, et al. Endoscopic retrograde cholangiopancreatography. Evid Rep Technol Assess (Summ). 2002; (50):1-8. Review/Other-Dx 149 studies To systematically review the evidence on the diagnostic and therapeutic effectiveness of ERCP. Four clinical conditions were addressed: (1) CBDS; (2) pancreaticobiliary malignancy; (3) pancreatitis; and (4) abdominal pain of possible pancreaticobiliary origin. Also, the evidence on determinants of complications of ERCP and on the prediction of CBDS were reviewed. Qualitative assessment of the available evidence suggests that: MRCP and EUS provide similar diagnostic performance as ERCP for detecting CBDS or malignant pancreaticobiliary obstruction. Sensitivity of nonsurgical tissue sampling techniques for detecting malignancy is similar or higher for brush cytology vs bile aspiration cytology, similar for FNA cytology vs brush cytology, and similar or higher for forceps biopsy vs brush cytology. Rigorous studies are needed to reliably quantify the relative performance of diagnostic ERCP compared to alternatives. Comparative studies of alternative diagnostic and treatment strategies for CBDS are urgently needed. Interventions intended to reduce complications of ERCP should incorporate prospectively defined studies to evaluate results. 4
72. Costamagna G, Familiari P, Marchese M, Tringali A. Endoscopic biliopancreatic investigations and therapy. Best Pract Res Clin Gastroenterol. 2008; 22(5):865-881. Review/Other-Dx N/A A review on endoscopic biliopancreatic interventions. Endoscopic biliopancreatic interventions should be performed only by ERCP-dedicated endoscopists. ERCP training can help in improving overall ERCP performance. 4
73. Caddy GR, Tham TC. Gallstone disease: Symptoms, diagnosis and endoscopic management of common bile duct stones. Best Pract Res Clin Gastroenterol. 2006; 20(6):1085-1101. Review/Other-Dx N/A To review clinical presentation, investigation and current management of bile duct stones. Transabdominal US is a sensitive test in detecting bile duct dilatation but the sensitivity is reduced in its ability to detect choledocholithiasis. A NIH consensus statement found that ERCP, MRCP and EUS were comparable in their sensitivities, specificities and accuracy rates for detection of choledocholithiasis. 4
74. Gopinathan PM, Pichan G, Sharma VM. Role of dehydration in heat stress-induced variations in mental performance. Arch Environ Health 1988;43:15-7. Observational-Dx N/A To describe the role of dehydration in heat stress-induced variations in mental performances. No results stated in abstract. 4
75. Lauri A, Horton RC, Davidson BR, Burroughs AK, Dooley JS. Endoscopic extraction of bile duct stones: management related to stone size. Gut 1993;34:1718-21. Observational-Dx 100 patients To assess the importance of stone size to the success of endoscopic spincterotomy. Of the remaining 88 patients endoscopic sphincterotomy was successful in 75 (85%). Of the 75 patients having endoscopic sphincterotomy stone clearance was successful in 44 (59%). There were no deaths and only four complications, which rapidly resolved on conservative treatment (two acute pancreatitis, two bleeding). The number of CBD stones present was similar in those patients with successful endoscopic sphincterotomy and duct clearance (median 1, range 1-10, n = 44) as in those in whom it failed (median 2, range 1-6, n = 31). In contrast there was a highly significant difference when stone size was analysed (successful clearance median stone size 10 mm, range 3-27 mm; unsuccessful: median 18 mm, range 10-42, p<0.001). Stones less than 10 mm in diameter (n=21) were all removed successfully whereas in patients with stones over 15 mm (n=25) only three were removed endoscopically (12%). All patients with evidence of residual stones had additional treatment. Of these 31 patients, 10 had surgery, 11 had insertion of an endoprosthesis, and 10 had dissolution treatment with methyl-tert-butyl ether through a nasobiliary catheter. 4
76. Chen WX, Xie QG, Zhang WF, et al. Multiple imaging techniques in the diagnosis of ampullary carcinoma. Hepatobiliary Pancreat Dis Int. 2008; 7(6):649-653. Observational-Dx 41 patients (all patients examined by US, and 39 of them received enhanced CT, 29 MRCP, and 25 ERCP) Retrospective study to evaluate the efficacy of abdominal US, enhanced CT, MRCP and ERCP in detecting ampullary carcinoma. Accuracy of US, CT, MRCP and ERCP were compared in the diagnosis of ampullary carcinoma. The accurate rate for detection of ampullary carcinoma with US was 26.83%. The accuracy of CT and ERCP in detection of ampullary tumors was 84.62% and 100%, respectively, which were significantly higher than that of US (P<0.05). The accuracy of MRCP in detection of ampullary tumors was similar to that of US in spite of visualization of obstruction and dilatation of the pancreaticobiliary duct with MRCP. Because of the obscure and late onset of symptoms, ampullary carcinoma is difficult to diagnose early. Multiple imaging techniques should be carried out appropriately in order to early diagnose the disease and improve the prognosis. 3
77. Krishna NB, LaBundy JL, Saripalli S, Safdar R, Agarwal B. Diagnostic value of EUS-FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Pancreas. 2009; 38(6):625-630. Observational-Dx 213 patients Retrospective analysis of a prospective database. To evaluate the performance characteristics of EUS-FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Focal pancreatic lesion was identified in 173 patients by EUS. The final diagnosis included adenocarcinoma (n=89), neuroendocrine tumor (n=14), mucinous cystadenocarcinoma (n=1), solid pseudopapillary tumor (n=2), metastases (n=4), benign cyst (n=19), pseudocyst (n=9), abscess (n=4), chronic pancreatitis (n=32), and normal pancreas (n=39). EUS-FNA had an accuracy of 97.6% for diagnosing malignant neoplasm, with 96.6% sensitivity, 99.0% specificity, 96.2% NPV, and 99.1% PPV. EUS-FNA is highly accurate for diagnosing malignancy in patients with a focal pancreatic lesion on CT scan/MRI but without obstructive jaundice. EUS-FNA can potentially be used as a definitive diagnostic test in the management of these patients. 3
78. Krishna NB, Mehra M, Reddy AV, Agarwal B. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc 2009; 70(1):70-79. Observational-Dx 624 patients; EUS evidence of chronic pancreatitis was present in 147 patients Retrospective analysis of prospective database to determine the clinical value of EUS-FNA for pancreatobiliary malignancy diagnosis based on clinical presentation and presence of chronic pancreatitis. Pancreatobiliary malignancy diagnosis was diagnosed in 73.9% of patients with obstructive jaundice and biliary stricture or pancreatic mass, in 49.6% of patients with pancreatic mass, and in 7.0% of patients with an enlarged head of pancreas or dilated pancreatic duct +/- common bile duct. The prevalence of pancreatobiliary malignancy diagnosis was lower in all 3 presentations with associated chronic pancreatitis. Both chronic pancreatitis and presentation with obstructive jaundice lowered performance characteristics of EUS-FNA, but chronic pancreatitis did so only in the subset of patients with obstructive jaundice. All except 1 false-negative diagnoses were due to cytologic misinterpretation. Among patients with suspected pancreatobiliary malignancy diagnosis, the accuracy of EUS-FNA is significantly lower only in a subset of patients with obstructive jaundice with underlying chronic pancreatitis, largely as a result of difficulty in cytologic interpretation. 3
79. Ross WA, Wasan SM, Evans DB, et al. Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc. 2008; 68(3):461-466. Observational-Dx 114 patients Retrospective single-center study to determine the feasibility and outcomes of combining EUS-FNA and a therapeutic ERCP into a single session. EUS-FNA had a sensitivity, specificity, PPV, NPV, and overall accuracy of 84.6%, 100%, 100%, 62.9%, and 87.8%, respectively. During an ERCP, endoscopic sphincterotomies were performed in 51 patients, and biliary stents were placed in 96 patients. 12 patients (10.5%) had a complication, with 6 having postprocedural pancreatitis. Combined EUS-FNA and therapeutic ERCP is technically feasible, with a complication rate no higher than the component procedures, while efficiently providing tissue diagnosis and biliary drainage. 3
80. Sharaiha RZ, Kumta NA, Desai AP, et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc. 2016. Observational-Tx 60 patients To compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center. A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009). 2
81. Kamata K, Kitano M, Omoto S, et al. New endoscopic ultrasonography techniques for pancreaticobiliary diseases. Ultrasonography. 2016;35(3):169-179. Review/Other-Dx N/A To review new endoscopic ultrasonography techniques for pancreaticobiliary diseases. No results stated in abstract. 4
82. Polkowski M, Larghi A, Weynand B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012;44(2):190-206. Review/Other-Dx N/A To express the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. No results stated in abstract. 4
83. Eloubeidi MA, Chen VK, Eltoum IA, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003;98(12):2663-2668. Observational-Dx 158 patients To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with suspected pancreatic cancer, and to assess immediate, acute, and 30-day complications related to EUS-FNA. A total of 158 patients (mean age 62.3 yr) underwent EUS-FNA during the study period. The mean tumor size was 32 x 26 mm. The median number of passes was three (range one to 10). Of these patients, 44% had at least one failed attempt at tissue diagnosis before EUS-FNA. The sensitivity, specificity, PPV, NPV, and accuracy of EUS-FNA in solid pancreatic masses were 84.3%, 97%, 99%, 64%, and 84%, respectively. Immediate self-limited complications occurred in 10 of the 158 EUS-FNAs (6.3%). Of 90 patients contacted at 24-72 h, 78 patients (87%) responded. Of the 90 patients, 20 (22%) reported at least one symptom, all of which were minor except in three cases (one self-limited acute pancreatitis and two emergency room visits, one of which led to admission). In all, 83 patients were contacted at 30 days, and 82% responded. No additional or continued complications were reported. 3
84. Banafea O, Mghanga FP, Zhao J, Zhao R, Zhu L. Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies. BMC Gastroenterol. 2016;16:108. Meta-analysis 20 studies; 2761 patients To pool the existing literature and assess the overall performance of EUS-FNA in the diagnosis of solid pancreatic lesions. : Twenty studies involving a total of 2,761 patients were included in the study. The pooled sensitivity and specificity of EUS-FNA in the diagnosis of solid pancreatic lesions were 90.8 % [95 % confidence interval (CI), 89.4-92 %] and 96.5 % (95 % CI, 94.8-97.7 %), respectively. The positive and negative likelihood ratios were 14.8 (95 % CI, 8.0-27.3) and 0.12 (95 % CI, 0.09-0.16), respectively. The overall diagnostic accuracy was 91.0 %. Good
85. Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45(5):387-393. Observational-Dx 44 patients To determine the safety, accuracy, and clinical utility of EUS-guided FNA in both the diagnosis and staging of pancreatic cancer. CT detected only 15 of 61 (25%) focal lesions seen by EUS, Adequate specimens were obtained by EUS-guided FNA in 44 of 47 (94%) pancreatic lesions and 14 of 14 (100%) associated lymph nodes (overall adequacy was 95%). Of the 46 lesions in which specimens were adequate and a final diagnosis was available (32 malignant, 14 benign), EUS-guided FNA had a sensitivity of 92%, specificity of 100%, and diagnostic accuracy of 95% for pancreatic lesions and 83%, 100%, and 88% for lymph nodes, respectively. Six percent of pancreatic cases had inadequate specimens and, if included, lowered the sensitivity to 83%, specificity to 80%, and diagnostic accuracy to 88% for pancreatic lesions. In 3 patients with enlarged celiac nodes on EUS, EUS-guided FNA was able to make a tissue diagnosis of metastasis, which changed the preoperative staging and precluded surgery. EUS in combination with EUS-guided FNA precluded surgery in 12 of 44 (27%) and may have precluded surgery in an additional 6 of 44 (14%). EUS-guided FNA avoided the need for further diagnostic tests, thus expediting therapy in a total of 25 (57%) patients and influenced clinical decisions in 30 of 44 (68%) patients. The estimated cost savings based on surgeries avoided was approximately $3300 per patient. There was only one complication (2%), a post-FNA fever. 3
86. Maple JT, Ben-Menachem T, Anderson MA, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010; 71(1):1-9. Review/Other-Dx N/A Guideline document on the role of endoscopy in patients with suspected choledocholithiasis. No results stated. 4
87. Winger J, Michelfelder A. Diagnostic approach to the patient with jaundice. Prim Care 2011;38:469-82; viii. Review/Other-Dx N/A To describe the diagnosis of a patient with jaundice. No results stated in abstract. 4
88. European Association for the Study of the L. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol 2009;51:237-67. Review/Other-Dx N/A To define the use of diagnostic, therapeutic and preventive modalities, including non-invasive and invasive procedures, in themanagement of patients with cholestatic liver diseases. No results stated in abstract. 4
89. Fargo MV, Grogan SP, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2017;95(3):164-168. Review/Other-Dx N/A To discuss the evaluation and diagnosis of jaundice in adults. No results stated in abstract. 4
90. Molvar C, Glaenzer B. Choledocholithiasis: Evaluation, Treatment, and Outcomes. Semin Intervent Radiol. 2016;33(4):268-276. Review/Other-Dx N/A To discuss the evaluation, treatment and potential outcomes of choledocholithiasis. No results stated in abstract. 4
91. Bao PQ, Johnson JC, Lindsey EH, et al. Endoscopic ultrasound and computed tomography predictors of pancreatic cancer resectability. J Gastrointest Surg. 2008;12(1):10-16; discussion 16. Observational-Dx 76 patients To investigate the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to predict a margin negative (R0) resection and the need for venous resection in patients undergoing pancreaticoduodenectomy (PD). Forty-seven (62%) underwent potentially curative PD. The R0 resection rate was 70%. There were 16 unresectable patients because of locally advanced disease. Venous involvement>180 degrees and arterial involvement>90 degrees by CT had 100% positive predictive value for failure to achieve R0 resection (p<.01). If patients with prestudy biliary stents were excluded, EUS venous abutment or invasion also predicted R0 failure (p=.02). Combined but not individual EUS and CT findings were predictive of need for vein resection. 3
92. Tamm EP, Balachandran A, Bhosale PR, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50(3):407-428. Review/Other-Dx N/A To review recent surgical advances and general treatment approaches that have led to a change in the understanding of resectable disease and staging, the current criteria for staging, current classifications of resectable disease, imaging techniques, imaging, and imaging criteria for staging. Because of the evolution of treatment strategies staging criteria for pancreatic cancer now emphasize arterial involvement for determining unresectable disease. Preoperative therapy may improve the likelihood of margin negative resections of borderline resectable tumors. Cross-sectional imaging is crucial for correctly staging patients. Magnetic resonance (MR) imaging and computed tomography (CT) are probably comparable, with MR imaging probably offering an advantage for identifying liver metastases. Positron emission tomography/CT and endoscopic ultrasound may be helpful for problem solving. Clear and concise reporting of imaging findings is important. Several national organizations are developing templates to standardize the reporting of imaging findings. 4
93. Vukobrat-Bijedic Z, Husic-Selimovic A, Bijedic N, et al. Sensitivity of EUS and ERCP Endoscopic Procedures in the Detection of Pancreatic Cancer During Preoperative Staging Correlated with CT and CT Angiography Imaging Methods. Acta Inform Med. 2014;22(3):160-163. Observational-Dx 49 patients To give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA. Testing of differences was carried out using Fisher's exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2-1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75-1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27-3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2-1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA. 3
94. Ito T, Sugiura T, Okamura Y, et al. The diagnostic advantage of EOB-MR imaging over CT in the detection of liver metastasis in patients with potentially resectable pancreatic cancer. Pancreatology. 2017;17(3):451-456. Observational-Dx 257 patients To evaluate the diagnostic value of EOB-MR imaging in the detection of liver metastasis among patients with pancreatic cancer that was determined to be resectable by MDCTand ultrasonography. Thirty-seven PLs were noted in 17 patients: 31 PLs were true LMs, and six were benign lesions (3 hemangiomas and 3 abscesses). Nine LMs were newly detected during surgery and were not detected by preoperative EOB-MR imaging. The diagnostic ability of EOB-MR imaging was as follows: sensitivity, 77.5%; specificity, 94.7%; positive predictive value, 83.8%; negative predictive value, 92.3%; and accuracy, 90.2%. A multivariate analysis revealed that the presence of PL on EOB-MR imaging was the only independent risk factor for intraoperative liver metastasis (P < 0.001). 3
95. Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic Resonance Imaging of Liver Metastasis. Semin Ultrasound CT MR. 2016;37(6):533-548. Review/Other-Dx N/A To describe magnetic resonance imaging of liver metastasis. No results stated in abstract. 4
96. Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology. 2010;257(3):674-684. Meta-analysis 39 studies; 3,391 patients To obtain diagnostic performance values of computed tomography (CT), magnetic resonance (MR) imaging, fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and FDG PET/CT in the detection of colorectal liver metastases in patients who have not previously undergone therapy. Thirty-nine articles (3391 patients) were included. Variation existed in study design characteristics, patient descriptions, imaging features, and reference tests. The sensitivity estimates of CT, MR imaging, and FDG PET on a per-lesion basis were 74.4%, 80.3%, and 81.4%, respectively. On a per-patient basis, the sensitivities of CT, MR imaging, and FDG PET were 83.6%, 88.2%, and 94.1%, respectively. The per-patient sensitivity of CT was lower than that of FDG PET (P = .025). Specificity estimates were comparable. For lesions smaller than 10 mm, the sensitivity estimates for MR imaging were higher than those for CT. No differences were seen for lesions measuring at least 10 mm. The sensitivity of MR imaging increased significantly after January 2004. The use of liver-specific contrast material and multisection CT scanners did not provide improved results. Data about FDG PET/CT were too limited for comparisons with other modalities. M
97. Rosch T, Meining A, Fruhmorgen S, et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc. 2002;55(7):870-876. Observational-Dx 50 jaundice patients To evaluate magnetic resonance cholangiopancreatography (MRCP) as a new procedure in comparison with the established methods of diagnosis including ERCP or percutaneous transhepatic cholangiography (PTC), CT, and EUS. Seven patients ultimately proved to have jaundice caused by parenchymal liver disease and 43 had a biliary stricture (17 benign, 26 malignant). Forty patients underwent all 4 imaging tests. There were 10 patients in whom patient-specific problems precluded some procedures but who were included in an intention-to-diagnose analysis. The sensitivity and specificity for diagnosis of malignancy in the 50 patients were as follows: 85% / 75% for ERCP/PTC, 85% / 71% for MRCP, 77% / 63% for CT, and 79% / 62% for EUS, with similar values in the 40 patients who underwent all 4 imaging methods. The combination of MRCP and EUS improved specificity. 2
98. Lee DH, Lee JM, Kim KW, et al. MR imaging findings of early bile duct cancer. J Magn Reson Imaging. 2008; 28(6):1466-1475. Observational-Dx 17 patients; 2 reviewers To retrospectively evaluate the MRI features of early bile duct cancer and to correlate them with the clinicopathologic findings. In all patients, MRI demonstrated single or multiple intraluminal bile duct masses showing a sharply defined outer margin. The most common enhancement pattern of the biliary lesions showed heterogeneous amorphous enhancement or heterogeneous enhancement with central, dot-like structures or vascular structures (76.5%, 13/17 patients). The difference of signal to noise ratio between bile duct and tumor was greatest in the equilibrium phase (P<0.05). MRCP combined with dynamic contrast-enhanced MRI can be useful for detecting early bile duct cancers. Common MRI findings of early bile duct cancer include one or more inhomogeneously enhancing intraductal masses with clear outer margins and preservation of the bile duct wall. 3
99. Ryoo I, Lee JM, Chung YE, et al. Gadobutrol-enhanced, three-dimensional, dynamic MR imaging with MR cholangiography for the preoperative evaluation of bile duct cancer. Invest Radiol. 2010; 45(4):217-224. Observational-Dx 60 patients; 2 reviewers To retrospectively evaluate the diagnostic performance of 1.0-M gadobutrol-enhanced, 3D, dynamic MRI with 3D-MR cholangiography in the preoperative evaluation of bile duct cancer staging and resectability. Surgical and pathology findings were used as the reference standards. The AUC of the 2 reviewers was 0.95 and 0.93, respectively, for evaluation of the involvement of both secondary biliary confluences and 0.85 and 0.84, respectively, for assessment of the intrapancreatic duct. For determining the tumor resectability, the overall accuracy was 0.93 and 0.88, respectively, whereas for assessment of the vascular involvement, the AUC values were 0.92 for reviewer 1 and 0.70 for reviewer 2 for the portal vein evaluation, and 0.99 for reviewer 1 and 0.76 for reviewer 2 for the hepatic artery evaluation. In the assessment of lymph node metastasis, the overall accuracy was approximately 0.77 for each reviewer. One-molar, gadobutrol-enhanced, dynamic imaging, using a 3D-gadobutrol-enhanced technique with isotropic 3D-MR cholangiography showed excellent diagnostic capability for assessing the longitudinal extent and tumor resectability of bile duct cancer, although it generally underestimated the tumor involvement of vessels and lymph nodes. 2
100. Yu SA, Zhang C, Zhang JM, et al. Preoperative assessment of hilar cholangiocarcinoma: combination of cholangiography and CT angiography. Hepatobiliary Pancreat Dis Int. 2010; 9(2):186-191. Review/Other-Dx 13 total patients: 9 PTC, 1 ERCP, 3 MRCP To evaluate the clinical value of cholangiography combined with spiral 3D-CT angiography for a preoperative assessment of hilar cholangiocarcinoma. The data from 5/13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classification and the T-staging system were consistent with those of surgical exploration in 12/13 patients. 7/8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were confirmed intraoperatively and underwent palliative procedures. Cholangiography combined with multi-slice spiral 3D-CT angiography can satisfactorily delineate the local invasion of hilar cholangiocarcinoma and accurately evaluate the resectability. This approach, therefore, contributes to the planning of safe operation. 4
101. Di Cesare E, Puglielli E, Michelini O, et al. Malignant obstructive jaundice: comparison of MRCP and ERCP in the evaluation of distal lesions. Radiol Med. 2003;105(5-6):445-453. Observational-Dx 21 patients To compare the diagnostic accuracy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of malignant stenosis of the distal common bile duct. CPRM correctly identified the presence and site of the distal biliary stenosis in 21/21 (100%) cases, as well as allowing evaluation of the upper abdomen by associating it with conventional MRI. ERCP, instead, allowed detection of the presence and site of biliary stenosis in 20/21 (95%) cases. 3
102. Adam V, Bhat M, Martel M, et al. Comparison Costs of ERCP and MRCP in Patients with Suspected Biliary Obstruction Based on a Randomized Trial. Value Health. 2015;18(6):767-773. Review/Other-Dx 257 patients To complete a cost analysis based on a medical effectiveness randomized trial comparing an ERCP-first approach with an MRCP-first approach in patients with suspected bile duct obstruction. Total per-patient direct costs were Can$3547 for ERCP-first patients and Can$4013 for MRCP-first patients. Corresponding indirect costs were Can$732 and Can$694, respectively. Causes for differences in direct costs included a more frequent second procedure and a greater mean number of hospital days over the year in patients of the MRCP-first group. In contrast, it is the ERCP-first patients whose indirect costs were greater, principally due to more time away from activities of daily living. Choosing an ERCP-first strategy rather than an MRCP-first strategy saved on average Can$428 per patient over the 12-month follow-up duration; however, there existed a large amount of overlap when varying total cost estimates across a sensitivity analysis range based on observed resources utilization. 4
103. Meagher S, Yusoff I, Kennedy W, Martel M, Adam V, Barkun A. The roles of magnetic resonance and endoscopic retrograde cholangiopancreatography (MRCP and ERCP) in the diagnosis of patients with suspected sclerosing cholangitis: a cost-effectiveness analysis. Endoscopy. 2007;39(3):222-228. Observational-Dx N/A To determine the most cost-effective strategy for imaging techniques for diagnosing sclerosing cholangitis. The average cost-effectiveness ratios were $414 for MRCP_ERCP, $1101 for ERCP_MRCP and $1123 for ERCP_ERCP, per correct diagnosis. The ERCP_MRCP strategy was dominated (more expensive and less effective) by MRCP_ERCP, while ERCP_ERCP was more effective and more costly than MRCP_ERCP, at $289,292 per additional correct diagnosis. Sensitivity and threshold analyses confirmed the robustness of these findings. 4
104. Liu L, Xu HX, Wang WQ, et al. Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden. Oncotarget. 2016;7(5):5943-5956. Observational-Dx 905 patients To evaluate the potential of serum tumor markers to predict the incidence and intensity of pancreatic cancer metastasis as well as patient survival. Serum CA125 levels were the most strongly associated with pancreatic cancer metastasis and were higher in patients with metastatic disease than those without. CA125 levels increased with increasing metastasis to lymph nodes and distant organs, especially the liver. High baseline CA125 levels predicted early distant metastasis after pancreatectomy and were associated with the presence of occult metastasis before surgery. An optimal CA125 cut-off value of 18.4 U/mL was identified; patients with baseline CA125 levels of 18.4 U/mL or higher had poor surgical outcomes. In addition, high serum CA125 levels coincided with the expression of a metastasis-associated gene signature and with alterations in "driver" gene expression involved in pancreatic cancer metastasis. 3
105. Wernecke K, Rummeny E, Bongartz G, et al. Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging. AJR Am J Roentgenol. 1991;157(4):731-739. Observational-Dx 75 patients To evaluate the sensitivity of sonography, CT, and MR imaging in the detection of hepatic masses in carcinoma patients. Sixty-five (68%) of 95 focal hepatic masses were detected by CT, 60 lesions (63%) by MR, and 50 lesions (53%) by sonography. Although lesions 1-2 cm were shown almost equally well by CT and MR (74% and 77%, respectively), the detection rate of smaller lesions (less than 1.0 cm) decreased more drastically with MR (31%) than with CT (49%). Sonography had a sensitivity of only 20% with the smaller lesions. All imaging techniques had a sensitivity of 100% for focal hepatic masses larger than 2.0 cm. Our results show that CT has a higher overall sensitivity (68%) than MR and sonography for the detection of focal hepatic masses. When the results of the three procedures are combined, the overall sensitivity is 77%. 2
106. Bang BW, Jeong S, Lee DH, Kim CH, Cho SG, Jeon YS. Curved planar reformatted images of MDCT for differentiation of biliary stent occlusion in patients with malignant biliary obstruction. AJR. 2010; 194(6):1509-1514. Observational-Dx 173 patients To prospectively evaluate the usefulness of MDCT using a curved planar reformation technique for the noninvasive assessment of the causes of biliary stent occlusion in patients with malignant biliary obstruction. The differences in attenuation value inside the biliary stent between the contrast-enhanced and unenhanced phases of CT in the tissue growth group was 27.7 +/- 21.7 HU and 4.2 +/- 10.6 HU in the stent-clogging group (P=0.002). The sensitivity and specificity of MDCT for the diagnosis of tissue growth were 86.7% and 85.7%, respectively. The overall accuracy of curved planar reformation images of MDCT for diagnosing the causes of stent occlusion was 86.2%. Curved planar reformation MDCT is a useful noninvasive technique that is relatively accurate for diagnosing the cause of biliary stent occlusion and is helpful for planning the therapeutic management of such patients. 2
107. Choi YH, Lee JM, Lee JY, et al. Biliary malignancy: value of arterial, pancreatic, and hepatic phase imaging with multidetector-row computed tomography. J Comput Assist Tomogr. 2008; 32(3):362-368. Observational-Dx 42 patients; 2 independent observers Retrospective study to assess the diagnostic value of arterial, pancreatic, and hepatic phase imaging with MDCT of a bile duct malignancy. The degree of tumor conspicuity was higher in the pancreatic and hepatic phases than in the arterial phase (P<0.01); however, there was no statistical difference in tumor conspicuity between the pancreatic and hepatic phases (P>0.05). The mean tumor attenuation was greater in the hepatic phase at 114.2 +/- 24.6 HU vs 72.9 +/- 18.3 HU in the arterial phase (P<0.001). The images obtained in the hepatic phases were significantly superior to those obtained in the arterial phase for predicting the tumor involvement into the secondary biliary confluence (P<0.05). In predicting for the vascular involvement by the tumors, there was no significant difference among the 3 enhancement phases (P>0.05). Routine acquisition of arterial phase images is not necessary for successful detection and evaluation of the extent of hilar or extrahepatic bile duct carcinoma. 2
108. Furukawa H, Ikuma H, Asakura-Yokoe K, Uesaka K. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology. Eur Radiol. 2008; 18(12):2841-2847. Observational-Dx 72 patients To evaluate the value of positron emission tomography with FDG-PET as a preoperative diagnostic investigation in patients with biliary carcinoma. Patients underwent preoperative MDCT and FDG-PET. Both diagnoses were compared with subsequent histopathology and follow-up results. In 64 lesions with biliary carcinoma, 57 (89%) revealed an intense focal accumulation on FDG-PET and were interpreted as malignant. On the other hand, 8 benign lesions did not show any specific accumulation. Detection rate of FDG-PET in the nodular type of the tumor (96% or 27/28) was superior to that of the infiltrating type (74% or 17/23) (P=0.037). For the evaluation of lymph node metastasis, the overall accuracy was 69% (35/51) in both FDG-PET and MDCT: FDG-PET had a lower sensitivity (33% vs 57%) and a higher specificity (97% vs 79%) than MDCT, although the values were not significantly different. FDG-PET revealed all 6 lesions of distant metastases in 6 patients including two lesions missed by MDCT. FDG-PET has high detectability of biliary malignancies. Like MDCT, FDG-PET offers only modest accuracy for regional lymph node staging, but it may reveal distant metastases missed by MDCT. 3
109. Seo H, Lee JM, Kim IH, et al. Evaluation of the gross type and longitudinal extent of extrahepatic cholangiocarcinomas on contrast-enhanced multidetector row computed tomography. J Comput Assist Tomogr. 2009; 33(3):376-382. Observational-Dx 56 patients; 2 reviewers Retrospective study to determine the accuracy of contrast-enhanced MDCT in classifying the morphological subtype and revealing the longitudinal extent of extrahepatic cholangiocarcinomas. Image analysis results were compared with the pathological findings. The accuracy of MDCT for morphological classification was 78.6% (44/56). The differences between the radiological and pathological measurements of the longitudinal extent of the tumors ranged from 0 to 53.5 mm, with a mean of 5.89 mm (11.42 mm). There was moderate correlation between the 2 measurements of the longitudinal extent of the tumors (P<0.05, gamma = 0.4455). In 35 patients, MDCT measurements did not differ significantly from the pathological measurements (62.5%).In 18 patients; CT underestimated the longitudinal extent of the tumor by more than 6 mm (32.1%). In the 39 patients with multiplanar reconstruction images, the correlation between the CT and the pathological measurements of the longitudinal extent was better in the combined interpretation of the axial and coronal images (P<0.05, gamma = 0.4153) than that in the interpretation of only the axial images (P>0.05, gamma = 0.2652). Results demonstrate that MDCT can correctly classify the morphological subtype of extrahepatic cholangiocarcinoma. Nevertheless, CT has a strong tendency to underestimate the longitudinal tumor extent compared with the pathological results. 2
110. Ni Q, Wang H, Zhang Y, et al. MDCT assessment of resectability in hilar cholangiocarcinoma. Abdom Radiol (NY). 2017;42(3):851-860. Observational-Dx 77 patients To investigate the value of multidetector computed tomography (MDCT) assessment of resectability in hilar cholangiocarcinoma, and to identify the factors associated with unresectability and accurate evaluation of resectability. The sensitivity, specificity, and overall accuracy of MDCT assessment were 83.3 %, 75.9 %, and 80.5 %, respectively. The main causes of inaccuracy were incorrect evaluation of N2 lymph node metastasis (4/15) and distant metastasis (4/15). Bismuth type IV tumor, main or bilateral hepatic artery involvement, and main or bilateral portal vein involvement were highly associated with unresectability (P < 0.001). Patients without biliary drainage had higher accuracy of MDCT evaluation of resectability compared to those with biliary drainage (P < 0.001). 3
111. Pietryga JA, Morgan DE. Imaging preoperatively for pancreatic adenocarcinoma. J Gastrointest Oncol. 2015;6(4):343-357. Review/Other-Dx N/A To review imaging for the diagnosis of pancreatic adenocarcinoma. No results stated in abstract. 4
112. Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RB, Jr. MDCT in Pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol. 2004;182(2):419-425. Observational-Dx 25 patients To determine the negative predictive value of MDCT with curved planar reformations for detecting vascular invasion and predicting overall resectability in patients with pancreatic adenocarcinoma. On MDCT, 23 (92%) of 25 patients were deemed to have resectable pancreatic adenocarcinoma. The tumors in the remaining two (8%) were considered not resectable because of the presence of vascular invasion (which was confirmed in only one patient at surgery). Of those 23 patients deemed to be candidates for curative resection on the basis of MDCT results, 20 were found to have resectable adenocarcinoma at time of surgery, yielding a negative predictive value for MDCT of 87% (20/23 patients) for overall resectability. In the other three patients, adenocarcinoma was deemed to be unresectable because of small metastases to the liver (two patients) or to the peritoneum (one patient) discovered at surgery. For detection of vascular invasion, MDCT yielded a negative predictive value of 100% (108/108 vessels) with no false-negative findings and an accuracy of 99% (109/110 vessels) with 108 true-negative findings, one true-positive finding, and one false-positive finding. 4
113. Choi JY, Kim MJ, Lee JM, et al. Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR. 2008; 191(5):1448-1457. Review/Other-Dx N/A To review the roles of US, MDCT, MRI, and direct cholangiography in the evaluation of hilar cholangiocarcinoma. Hilar cholangiocarcinoma is a primary malignant tumor typically located at the confluence of the right and left ducts within the porta hepatis. Staging of hilar cholangiocarcinoma with various imaging techniques is crucial for management, and a comprehensive approach is needed for accurate preoperative assessment. 4
114. Qayyum A, Tamm EP, Kamel IR, et al. ACR Appropriateness Criteria(R) Staging of Pancreatic Ductal Adenocarcinoma. J Am Coll Radiol. 2017;14(11S):S560-S569. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging of pancreatic ductal adencarcinoma. No results stated in abstract. 4
115. Raijman I. Biliary and pancreatic stents. Gastrointest Endosc Clin N Am. 2003; 13(4):561-592, vii-viii. Review/Other-Dx N/A To review the most recent available data concerning biliary and pancreatic stents and discuss possible future developments. Use of biliary and pancreatic stents has increased significantly during the last 2 decades because of improvements in available endoscopes and endoscopic accessories, as well as better techniques. The number of endoscopists who can successfully complete these demanding procedures has also increased, as have the indications for stent therapy in biliary and pancreatic diseases. Review does not attempt to cover all data reported in biliopancreatic stent therapy. 4
116. Malak M, Masuda D, Ogura T, et al. Yield of endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography for solid pancreatic neoplasms. Scand J Gastroenterol. 2016;51(3):360-367. Observational-Dx 234 patients To retrospectively compare EUS-FNA and ERCP tissue sampling and ability of cytopathological diagnosis in solid pancreatic neoplasms and to determine usefulness and adverse events of combining both procedures. Sensitivity, specificity and accuracy were 98.9%, 93.3% and 98.1% for group A, and 72.1%, 60% and 71.4% for group B. Those for group C were all 100%. Sensitivity for malignancy in the pancreas head was 100% for group A and 82.4% for group B, and in the pancreas body and tail, 97.6% for group A and 57.1% for group B. EUS-FNA was more sensitive than ERCP cytology in diagnosing malignant pancreatic neoplasms 21-30 mm in size (p = 0.0068), 31-40 mm (p = 0.028) and >/= 41 mm (p < 0.0001). Sensitivity for pancreatic malignancy with group C was 100% regardless of mass location or size. Adverse events were 1.9%, 6.6% and 2.6% following EUS-FNA, ERCP and combined procedures, respectively. 3
117. Maranki J, Hernandez AJ, Arslan B, et al. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy. 2009; 41(6):532-538. Observational-Dx 49 patients had EUS-guided cholangiography: 35 had biliary obstruction due to malignancy and 14 had a benign etiology A report on 5 years of experience in patients who underwent interventional EUS-guided cholangiography after failed ERCP. Overall success rate of interventional EUS-guided cholangiography was 84% (41/49), with an overall complication rate of 16%. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83%. In all, 14 patients underwent an extrahepatic approach. In 8/14 (57%), stent placement across the major papilla was achieved. A transenteric stent was placed in 4 patients. Biliary decompression was achieved in 12/14 cases (86%). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29/40 cases (73%), and the extrahepatic approach was successful in seven of nine cases (78%). There were no procedure-related deaths. Interventional EUS-guided cholangiography offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed. 3
118. Sai JK, Suyama M, Kubokawa Y, Watanabe S, Maehara T. Early detection of extrahepatic bile-duct carcinomas in the nonicteric stage by using MRCP followed by EUS. Gastrointest Endosc. 2009; 70(1):29-36. Observational-Dx 142 patients had MRCP; 2 reviewers Prospective single study to examine the usefulness of MRCP followed by EUS in the early diagnosis of extrahepatic bile-duct carcinoma in the nonicteric stage. 26/142 patients underwent EUS. Ten patients (5 with stricture, 4 with filling defect, and 1 with no stricture or filling defect) had extrahepatic bile-duct carcinoma, including 5 patients with an incidentally diagnosed T1 stage tumor. Sensitivity and specificity of MRCP followed by EUS were 90% and 98%, respectively. MRCP followed by EUS was highly sensitive and specific for the early diagnosis of extrahepatic bile-duct carcinoma in the nonicteric stage, including T1 stage tumors. Filling defects, as well as stenosis in the bile duct, are important MRCP findings of T1 stage carcinoma. 3
119. Gress TM. Molecular diagnosis of pancreatobiliary malignancies in brush cytologies of biliary strictures. Gut. 2004;53(12):1727-1729. Review/Other-Dx N/A No abstract available. No abstract available. 4
120. Saifuku Y, Yamagata M, Koike T, et al. Endoscopic ultrasonography can diagnose distal biliary strictures without a mass on computed tomography. World J Gastroenterol. 2010; 16(2):237-244. Observational-Dx 34 patients Retrospective study to assess the diagnostic ability of EUS for evaluating causes of distal biliary strictures shown on ERCP or MRCP, even without identifiable mass on CT. 17 patients (50%) were finally diagnosed with benign conditions, including 6 “normal” subjects, while 17 patients (50%) were diagnosed with malignant disease. In terms of diagnostic ability, EUS showed 94.1% sensitivity, 82.3% specificity, 84.2% PPV, 93.3% NPV and 88.2% accuracy for identifying malignant and benign strictures. EUS was more sensitive than routine cytology (94.1% vs 62.5%, P=0.039). NPV was also better for EUS than for routine cytology (93.3% vs 57.5%, P=0.035). In addition, EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9 (94.1% vs 53%, P=0.017). On EUS, biliary stricture that was finally diagnosed as malignant showed as a hypoechoic, irregular mass, with obstruction of the biliary duct and invasion to surrounding tissues. EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT. Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer. 3
121. Burak KW, Angulo P, Lindor KD. Is there a role for liver biopsy in primary sclerosing cholangitis? Am J Gastroenterol. 2003;98(5):1155-1158. Observational-Dx 139 patients To examine how often routine liver biopsies provide important information in patients with PSC. A total of 30 patients did not have a liver biopsy, whereas 29 patients had a biopsy before cholangiography. In 79 patients the liver biopsy was performed after the diagnosis of PSC was established by cholangiography (median time from cholangiography to liver biopsy, 21 days). In 78 of 79 patients (98.7%) the liver biopsy revealed no atypical findings and did not affect clinical management. In one patient the liver biopsy revealed findings of an overlap syndrome with autoimmune hepatitis, and the patient was treated with corticosteroids and azathioprine. This patient had biochemical features consistent with autoimmune hepatitis. One patient developed a bile leak after liver biopsy, requiring hospitalization (complication rate 0.9%). 3
122. Olsson R, Hagerstrand I, Broome U, et al. Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis. J Clin Pathol. 1995;48(10):933-935. Observational-Dx 112 biopsy specimens; 44 patients To study sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis (PSC). Quantitative sampling variability was confined mainly to just one grade or stage, although 11% (six of 56) of the biopsy specimen pairs differed by more than one stage (7% (one of 15) in pairs > 2 cm in length). Qualitative sampling variabilities were between 18 and 71%. Advanced disease (stages 3 or 4) was missed in 40% (two of five) of the biopsy specimens while cirrhosis was missed in 37%. 4
123. Steele IL, Levy C, Lindor KD. Primary sclerosing cholangitis--approach to diagnosis. MedGenMed. 2007;9(2):20. Review/Other-Dx N/A To use case scenarios to illustrate the diagnostic process in primary sclerosing cholangitis(PSC) and review the current understanding of how clinical presentation, laboratory tests, endoscopy, radiology, and histology facilitate the diagnosis of PSC. No results stated in abstract. 4
124. Zhang X, Gao X, Liu BJ, et al. Effective staging of fibrosis by the selected texture features of liver: Which one is better, CT or MR imaging? Comput Med Imaging Graph. 2015;46 Pt 2:227-236. Observational-Dx 367 patients To investigate different types of datasets acquired from CT and MR images to select the optimal parameters and features for the proper classification of fibrosis. According to the accuracy rate (AR) calculated from each combination, the optimal number of texture features to classify liver fibrosis degree ranges from 4 to 7, no matter which modality was utilized. The overall performance calculated by the average sum of maximum AR value of all 15 features is 66.83% in CT images, while 68.14%, and 71.98% in MR images, respectively; among the 15 texture features, mean gray value and entropy are the most commonly used features in all 3 imaging datasets. The correlation feature has the lowest AR value and was removed as an effective feature in all datasets. AR value tends to increase with the injection of contrast agency, and both CT and MR images reach the highest AR performance during the equilibrium phase. 3
125. Elsayes KM, Oliveira EP, Narra VR, et al. MR and MRCP in the evaluation of primary sclerosing cholangitis: current applications and imaging findings. J Comput Assist Tomogr. 2006;30(3):398-404. Review/Other-Dx N/A To discuss the role of MR and MRCP in evaluating primary sclerosing cholangitis. No results stated in abstract. 4
126. Dave M, Elmunzer BJ, Dwamena BA, Higgins PD. Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography. Radiology 2010;256:387-96. Meta-analysis 6 studies To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for detection of primary sclerosing cholangitis (PSC) in patients with biochemical cholestasis. Six manuscripts with 456 subjects (with 623 independent readings)--185 with PSC--met the study inclusion criteria. The summary area under the ROC curve was 0.91. High heterogeneity (inconsistency index, 78%) was found but became moderate (inconsistency index, 36%) with the exclusion of one study in which the diagnostic threshold was set for high sensitivity. There was no evidence of publication bias (P = .27, bias coefficient analysis). Sensitivity and specificity of MRCP for PSC detection across all studies were 0.86 and 0.94, respectively. Positive and negative likelihood ratios with MRCP were 15.3 and 0.15, respectively. In patients with high pretest probabilities, MRCP enabled confirmation of PSC; in patients with low pretest probabilities, MRCP enabled exclusion of PSC. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 94% and 13% for positive and negative MRCP results, respectively. Good
127. Bali MA, Pezzullo M, Pace E, Morone M. Benign biliary diseases. Eur J Radiol 2017;93:217-28. Review/Other-Dx N/A To review benign biliary disease. No results stated in abstract. 4
128. Girometti R, Furlan A, Esposito G, et al. Relevance of b-values in evaluating liver fibrosis: a study in healthy and cirrhotic subjects using two single-shot spin-echo echo-planar diffusion-weighted sequences. J Magn Reson Imaging. 2008;28(2):411-419. Observational-Dx 29 cirrhotic patients;29 healthy patients To investigate the relevance of increasing b-values in evaluating liver fibrosis through the agreement of two diffusion-weighted (DW) sequences. ADCs resulted significantly lower in cirrhotic patients compared to controls using both DW1a (mean 1.14 +/- 0.20 x 10(-3)mm(2)/second vs. 1.54 +/- 0.12 x 10(-3)mm(2)/second; P < 0.0001) and DW2a (mean 0.91 +/- 0.18 x 10(-3)mm(2)/second vs. 1.04 +/- 0.18 x 10(-3)mm(2)/second; P = 0.0089). DW1 and DW2, respectively significantly differed in diagnostic performance at receiver operating characteristic (ROC) curve analysis (P = 0.003), showing AUCs of 0.93 (sensitivity 89.7%, specificity 100%) and 0.73 (sensitivity 62.1%, specificity 79.3%), respectively. Noise-scaled single-point ADCs showed a progressive convergence to similar values in cirrhotic and healthy livers at b = 800 seconds/mm(2) (1.12 +/- 0.27 x 10(-3)mm(2)/second vs. 1.13 +/- 0.17 x 10(-3)mm(2)/second). 4
129. Lewin M, Poujol-Robert A, Boelle PY, et al. Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology. 2007;46(3):658-665. Observational-Dx 20 healthy patients; 54 chronic HCV patients To evaluate evaluated a noninvasive method, so-called diffusion-weighted magnetic resonance imaging (DWMRI), which measures the apparent diffusion coefficient (ADC) of water, for the diagnosis of liver fibrosis in patients with chronic hepatitis C virus (HCV). Patients with moderate-to-severe fibrosis (F2-F3-F4) had hepatic ADC values lower than those without or with mild fibrosis (F0-F1; mean: 1.10 +/- 0.11 versus 1.30 +/- 0.12 x 10(-3) mm2/s) and healthy volunteers (mean: 1.44 +/- 0.02 x 10(-3) mm2/s). In discriminating patients staged F3-F4, the areas under the receiving operating characteristic curves (AUCs) were 0.92 (+/-0.04) for magnetic resonance imaging (MRI), 0.92 (+/-0.05) for elastography, 0.79 (+/-0.08) for FibroTest, 0.87 (+/-0.06) for the aspartate aminotransferase to platelets ratio index (APRI), 0.86 (+/-0.06) for the Forns index, and 0.87 (+/-0.06) for hyaluronate. In these patients, the sensitivity, specificity, positive predictive value, and negative predictive value were 87%, 87%, 72%, and 94%, respectively, with an ADC cutoff level of 1.21 x 10(-3) mm2/s. In discriminating patients staged F2-F3-F4, the AUC values were 0.79 (+/-0.07) for MRI, 0.87 (+/-0.05) for elastography, 0.68 (+/-0.09) for FibroTest, 0.81 (+/-0.06) for APRI, 0.72 (+/-0.08) for the Forns index, and 0.77 (+/-0.06) for hyaluronate. 3
130. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A To provide guidelines on exposure of patients to ionizing radiation. No abstract available. 4