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Review of ultrasound findings in abnormal biliary tree on MRCP
Poster Title: Review of ultrasound findings in abnormal biliary tree on MRCP
Submitted on 27 Sep 2019
Author(s): V Eze, F Din, D Murray, P Brown and M Steward
Affiliations: Radiology department, Whittington Hospital, London
Poster Views: 60
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Poster Information
Abstract: Ultrasound is the first line imaging modality in suspected biliary tree obstruction, useful particularly due to its non-ionising nature and availability. Interpretation is however highly operator dependent.

RCR Standards:
1. Where MRCP demonstrates extrahepatic biliary duct dilation (EHBD), ultrasound performed prior to the MRCP should identify EHBD in 90%.

2. Ultrasound reports should contain specific comments referring on the presence or absence of EHBD -100%

3. Recommendation for cross-sectional imaging/referral in the presence of biliary dilation if the cause is not identified on ultrasound–100%

Retrospective analysis of 100 patients with abnormal MRCPs and ultrasound performed in the preceding 4 weeks using PACS records. Ultrasound findings were compared with the MRCP to establish their accuracy. EHBD was defined as >/;5mm.

 Abnormal MRCPs with dilatation detected on ultrasound=72%
 Ultrasound reports with specific comment on the CBD=90%
 Ultrasound reports detecting EHBD with clear recommendation for further imaging =46%

Following this audit, it was agreed that our definition of EHBD as >5mm was too low based on the criteria stated in literature. Our diagnostic criteria has therefore been revised with a new pathway created for US assessment of the biliary tree. This suggests correlation with LFTs and further cross- sectional imaging (CT/MRI) in patients less than 80 years with CBD >6mm and patients more than 80 years with
CBD >8mm (with consideration of cholecystectomy status).

A structured reporting template has been proposed including reporting the degree of obstruction, level of obstruction, transition zone, cause of obstruction and site of CBD measurement (i.e. porta, middle or distal duct).
Summary: This audit has made us evaluate and reflect on our current practice as a department, and develop our own evidence based recommendations for standardising and streamlining our local pathways for assessing the biliary tree.

We are also reflecting on how we use MRCPs by participating in the SUNFLOWER study.
References: Kaim, A., Steinke, K., Frank, M. et al. Diameter of the common bile duct in the elderly patient: measurement by ultrasound. Eur Radiol (1998) 8: 1413.

Bachar G N, Maya Cohen Belenky A, Atar E, Gideon S. Effect of Aging on the Adult
Extrahepatic Bile Duct-A Sonographic Study. Journal of ultrasound in medicine 2013;22(9):879-882.

Lal N, Mehra S, Lal V. Ultrasonographic measurement of normal common bile duct diameter and its correlation with age, sex and anthropometry. J Clin Diagn Res. 2014;8(12):

Perret R.S, Sloop G.D, Borne J.A. Common bile duct measurements in an elderly population. Journal of Ultrasound in Medicine 2013;19(11):727-730.

Feng B, Song Q. Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients. American Journal of Roentgenology. 1995;165: 859-861. 10.2214/ajr.165.4.7676981.
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