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Volume rendering of three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective study
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Medical Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.ORCID iD: 0000-0002-9446-6981
Department of Radiology, Hudiksvall Hospital, Sweden.ORCID iD: 0000-0002-4111-1693
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.ORCID iD: 0000-0002-7750-1917
Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden .
2005 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 78, no 936, 1078-1085 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to evaluate the diagnostic potential of prolonged drip infusion CT cholangiography (DIC-CT) using meglumine iotroxate (Biliscopin®) and 3D volume rendering in patients with suspected obstructive biliary disease. From a material of 142 patients who had undergone a drip infusion CT, all cases with a verified surgical or endoscopic retrograde cholangiography (ERC) diagnosis (n=33) were selected. Age-matched controls were selected from the remaining examinations. Three radiologists reviewed all 66 examinations in retrospect, independently as well as in consensus. The image quality and the estimated diagnostic quality were rated as good or moderate in 91% of the 198 reviews. The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively (with sensitivities ranging from 88% to 94% for individual observers, and specificities from 86% to 96%). Two out of three strictures were observed. No false positive strictures were described. The use of volume rendering technique (VRT) improved diagnostic certainty in 28/198 (14%) of the evaluations. The visualization of ductal stones was improved in 18/48 (38%). No differences in diagnostic quality between single and multislice CT were observed. We conclude that a detailed image of the biliary tree with good sensitivity and specificity can be obtained by means of bilirubin-governed infusion time DIC-CT with volume rendering reconstruction.

Place, publisher, year, edition, pages
2005. Vol. 78, no 936, 1078-1085 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-30833DOI: 10.1259/bjr/14176682Local ID: 16483OAI: oai:DiVA.org:liu-30833DiVA: diva2:251656
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2014-04-23Bibliographically approved
In thesis
1. Volume imaging of the abdomen: three-dimensional visualisation of tubular structures in the body with CT and MRI
Open this publication in new window or tab >>Volume imaging of the abdomen: three-dimensional visualisation of tubular structures in the body with CT and MRI
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overwhelming amount of image-based information in modem medicine makes it crucial to develop methods to handle and analyze images and make them comprehensible for users. The aim of this thesis was to study the radiological practice of three-dimensional (3D) visualization of tubular structures in the body with CT and MRI. All the studies cancern 3D imaging of tubular structures with camputed tomography (CT) and magnetic resonance imaging (MRI). The first three studies examine the abdominal aorta; the two later ones the, bile ducts.

Study I compared measurements of aorta diameters taken from MR images presented using two visualization methods - maximum intensity projection (MlP) and volume rendering (VRT) - with invasive angiography (DSA) and CT as reference methods. Mean diameters of MR images were smaller than those from DSA and CT when MlP was used, but in general not when VRT was used.

Study II evaluated the dependence on the observer and the choice of method and settings during rendering using the same material as in Study 1. In both MlP and VRT, the choice of settings had significant influence on the results. With DSA as the reference method, VRT gave larger measurement errors than MIP when the rendering parameters were set to fixed values, but not if the user was allowed to select the settings freely.

Study III evaluated three new techniques for standardizing VRT protocols for MRA. Inter-reader variability and agreement with DSA were studied by comparing diameter measurements of the abdominal aorta obtained by the three new techniques, by VRT with freely chosen parameters and by MlP. All three new methods were significantly better than MlP and VRT with freely chosen parameters conceming inter-observer agreement. Agreement with DSA was significantly better for one of the methods. Standardized protocols seem to have a potential to make VRT a clinically useful alternative to MlP for MR angiography measurements.

Study IV evaluated CT imaging of the bile ducts after drip intravenous infusion of the contrast medium iotroxate (CT cholangiography) in terms of adverse effects and visibility. With infusion time adjusted for individual variation in serum bilirubin concentration, a total side-effect frequency of less than 1% was found. A systematic review of previously published studies indicated a frequency of 2.3%. Good contrast excretion and visualization of bile ducts even in patients with elevated bilirubin levels were noted.

Study V evaluated the diagnostic benefits of the same imaging method by comparing it with findings from surgery and endoscopic retrograde cholangiopancreatography (ERCP). The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively. The use of VRT improved diagnostic certainty in 14% of the evaluatians, and the visualization of ductal stones was improved in 38% of the positive cases.

In conclusion, volume rendering technique with standardized parameters may become a clinically useful tool in the clinical MRI environment. DIC-CT with bilirubin-governed infusion time and volume rendering post-processing produces detailed images of the biliary tree, resulting in good sensitivity and specificity. Moreover the safety is acceptable.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. 103 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 912
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29581 (URN)14957 (Local ID)91-85299-25-1 (ISBN)14957 (Archive number)14957 (OAI)
Public defence
2005-10-07, Berzeliussalen, plan 09, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2013-10-21Bibliographically approved

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Persson, AndersDahlström, NilsSmedby, Örjan

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Center for Medical Image Science and Visualization (CMIV)Faculty of Health SciencesMedical RadiologyDepartment of Radiology in LinköpingRadiation PhysicsDepartment of Radiology in Linköping
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British Journal of Radiology
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