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Does measurement of the hepatic artery velocity improve the sonographic diagnosis of cholangitis?

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the frequency of elevated peak systolic proper hepatic artery velocity (HAV) in patients with acute cholangitis and to determine the diagnostic performance of this metric relative to existing criteria.

Methods

Between 9/2016 and 11/2017, 107 patients clinically suspected to have cholangitis were referred for an abdominal ultrasound. Of these, 56 patients had HAV measurements and were included in the final analysis. Clinical and imaging features, including HAV, HAV resistive index (RI), portal vein velocity (PVV), biliary dilation, and presence of an obstructive etiology were extracted. The diagnostic performance of HAV was compared to the existing available clinical criteria (Charcot’s triad and 2018 Tokyo Guidelines). Elevated HAV was defined as HAV > 100 cm/s. Presence of cholangitis was determined by the discharge summary following medical workup and admission or observation.

Results

32% had cholangitis while 68% did not. Average HAV for patients with cholangitis was 152 ± 54 cm/s versus 91 ± 44 cm/s for those without (p < 0.0001; t test). The HAV was elevated in 83% of patients with cholangitis. When considered in isolation, an elevated HAV had a high negative predictive value (90%), was more accurate (77%; 95% confidence interval 64–87%) than Charcot’s triad (73%; 60–83%), and had similar accuracy compared to 2018 Tokyo Guidelines (79%; 66–88%). Substitution of conventional imaging criteria with elevated HAV in the 2018 Tokyo Guidelines yielded the highest overall accuracy of 84% (72–92%).

Conclusion

HAV is elevated in the majority of patients with cholangitis. Substitution of an elevated HAV for conventional sonographic criteria is more accurate than existing clinical criteria in identifying patients with cholangitis.

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References

  1. Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. 2000;14(3):521–546.

    Article  CAS  Google Scholar 

  2. Abbas AK, Fausto N, Robbins SL. Robbins and Cotran pathologic basis of disease. Elsevier Saunders; 2005.

  3. Huang T, Bass JA, Williams RD. The significance of biliary pressure in cholangitis. Arch Surg. 1969;98(5):629–632.

    Article  CAS  Google Scholar 

  4. Clements WD, Parks R, Erwin P, Halliday MI, Barr J, Rowlands BJ. Role of the gut in the pathophysiology of extrahepatic biliary obstruction. Gut. 1996;39(4):587–593.

    Article  CAS  Google Scholar 

  5. Sung JY, Shaffer EA, Olson ME, Leung JWC, Lam K, Costerton JW. Bacterial invasion of the biliary system by way of the portal-venous system. Hepatology. 1991;14(2):313–317.

    Article  CAS  Google Scholar 

  6. Qureshi WA. Approach to the Patient Who Has Suspected Acute Bacterial Cholangitis. Gastroenterology Clinics of North America. 2006. p. 409–423. http://dx.doi.org/10.1016/j.gtc.2006.05.005.

  7. Rahman SH, Larvin M, McMahon MJ, Thompson D. Clinical presentation and delayed treatment of cholangitis in older people. Dig Dis Sci. 2005;50(12):2207–2210.

    Article  Google Scholar 

  8. Kimura Y, Takada T, Kawarada Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15–26.

    Article  Google Scholar 

  9. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1992;79(7):655–658.

    Article  CAS  Google Scholar 

  10. Boey JH, Way LW. Acute cholangitis. Ann Surg. 1980;191(3):264–270.

    Article  CAS  Google Scholar 

  11. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):31–40.

    Article  Google Scholar 

  12. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic Biliary Drainage for Severe Acute Cholangitis. New England Journal of Medicine. 1992. p. 1582–1586. https://doi.org/10.1056/nejm199206113262401.

    Article  CAS  Google Scholar 

  13. Catalano OA, Sahani DV, Forcione DG, et al. Biliary infections: spectrum of imaging findings and management. Radiographics. 2009;29(7):2059–2080.

    Article  Google Scholar 

  14. Lee JG. Diagnosis and management of acute cholangitis. Nature Reviews Gastroenterology & Hepatology. 2009. p. 533–541. https://doi.org/10.1038/nrgastro.2009.126.

    Article  Google Scholar 

  15. Rumsey S, Winders J, MacCormick AD. Diagnostic accuracy of Charcot’s triad: a systematic review. ANZ J Surg. 2017;87(4):232–238.

    Article  Google Scholar 

  16. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17–30.

    Article  Google Scholar 

  17. Park SM, Kim WS, Bae I-H, et al. Common bile duct dilatation after cholecystectomy: a one-year prospective study. J Korean Surg Soc. 2012;83(2):97–101.

    Article  Google Scholar 

  18. Bachar GN, Cohen M, Belenky A, Atar E, Gideon S. Effect of aging on the adult extrahepatic bile duct: a sonographic study. J Ultrasound Med. 2003;22(9):879–882; quiz 883–885.

    Article  Google Scholar 

  19. Jakab F, Ráth Z, Schmal F, Nagy P, Faller J. The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry. Hepatogastroenterology. 1995;42(1):18–21.

    CAS  PubMed  Google Scholar 

  20. Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol. 2010;16(48):6046–6057.

    Article  Google Scholar 

  21. Doi R, Inoue K, Kogire M, et al. Simultaneous measurement of hepatic arterial and portal venous flows by transit time ultrasonic volume flowmetry. Surg Gynecol Obstet. 1988;167(1):65–69.

    CAS  PubMed  Google Scholar 

  22. Loehfelm TW, Tse JR, Jeffrey RB, Kamaya A. The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis. Abdom Radiol (NY). 2018;43(5):1159–1167.

    Article  Google Scholar 

  23. Tse JR, Jeffrey RB, Kamaya A. Performance of Hepatic Artery Velocity in Evaluation of Causes of Markedly Elevated Liver Tests. Ultrasound Med Biol. 2018;44(11):2233–2240.

    Article  Google Scholar 

  24. Vellar ID. The blood supply of the biliary ductal system and its relevance to vasculobiliary injuries following cholecystectomy. Aust N Z J Surg. 1999;69(11):816-820.

    Article  CAS  Google Scholar 

  25. Horrow MM, Horrow JC, Niakosari A, Kirby CL, Rosenberg HK. Is age associated with of adult extrahepatic bile duct: sonographic study. Radiology. 2001;221(2):411-414.

    Article  CAS  Google Scholar 

  26. Wu CC, Ho YH, Chen CY. Effect of aging on common bile duct diameter: a real-time US study. J Clin Ultrasound. 1984;12(8):473-478.

    Article  CAS  Google Scholar 

  27. Itoi T, Kamisawa T, Fujii H et al. Extrahepatic bile duct measurement by using transabdominal US in Japanese adults: multicenter prospective study. J Gastroenterol. 2013;48(9):1045-1050.

    Article  Google Scholar 

  28. Perret RS, Sloop GD, Borne JA. Common Bile Duct Measurements in an elderly population. J Ultrasound Med. 2000;19(11):727-730.

    Article  CAS  Google Scholar 

  29. Parulekar SG Ultrasound evaluation of common bile duct size. Radiology. 1979;133(3):703-707.

    Article  CAS  Google Scholar 

  30. Rumack CM, Levin D. Diagnostic Ultrasound. Elsevier Health Sciences; 2018.

  31. McArthur TA, Planz V, Fineberg NS, Berland LL, Lockhart ME. CT evaluation of common duct dilation after cholecystectomy and advancing age. Abdom Imaging. 2015;40(6):1581-1586.

    Article  Google Scholar 

  32. Kiriyama S, Takada T, Hwang T-L, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. Journal of Hepato-Biliary-Pancreatic Sciences. 2017;24(6):329-337.

    Article  Google Scholar 

  33. Hertzberg MD B, Middleton MD W. Ultrasound: The Requisites. Elsevier Health Sciences; 2015.

  34. Breen DJ, Rutherford EE, Stedman B, Lee-Elliot C, Hacking CN. Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver. Eur Radiol. 2004;14(12):2249-2260.

    Article  Google Scholar 

  35. Thumar V, Vallurupalli VM, Robinson AL et al. Doppler ultrasound can help diagnose children with hepatic sinusoidal obstructive syndrome after hematopoietic stem cell transplantation. Ultrasound Q. 2016;32(1):58-66.

    Article  Google Scholar 

  36. Go S, Kamaya A, Jeffrey RB, Desser TS. Duplex Doppler ultrasound of the hepatic artery: a window to diagnosis of diffuse liver pathology. 2017;36(4):725-730.

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-1330, Stanford, CA, 94305, USA

    Justin R. Tse, Tie Liang, R. Brooke Jeffrey & Aya Kamaya

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  1. Justin R. Tse
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  2. Tie Liang
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  3. R. Brooke Jeffrey
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Correspondence to Aya Kamaya.

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Aya Kamaya, Book royalties, Elsevier. The other authors declare that they have no conflict of interest.

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Tse, J.R., Liang, T., Jeffrey, R.B. et al. Does measurement of the hepatic artery velocity improve the sonographic diagnosis of cholangitis?. Abdom Radiol 44, 4004–4010 (2019). https://doi.org/10.1007/s00261-019-02284-w

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