목적: 담관 폐쇄가 의심되는 환자에게 빠른 진단을 하여 적절한 치료를 시작하는 것이 중요하다. 본 연구의 목적은 원위부 총담관 폐쇄를 일으키는 원인 질환에 대하여 64-multidetector CT (MDCT) 담관 조영술의 진단 정확도를 알아보고자 했다. 대상 및 방법: 충북대 병원을 방문한 환자들 중에서 연속적으로 임상적, 간기능 검사로 담관 폐쇄가 의심되는 252명을 대상으로 하였다. 원위부 총담관 폐쇄를 일으키는 원인 질환을 조영 전후 축상 및 관상 다면재구성 MDCT 담관 조영술로 진단하였다. 기준검사는 48시간 내에 시행한 ERCP, 생검 및 수술 결과로 정하였다. 대상 환자들의 진단은 정상(34명, 13.5%), 담관석(179명, 71.0%), 팽대부주위종양(33명, 13.1%), 양성 폐쇄 질환(2명, 0.8 %), 혈액담즙증(2명, 0.8%) 및 담관낭종(4명, 0.8%) 등이었다. 결과: 총담관석에 대한 MDCT 담관조영술의 민감도 및 특이도는 각각 96.1%, 84.9%였다. MDCT 담관조영술은 7명의 환자에서 5 mm 이하의 작은 담석을 발견하지 못하였고, 11명의 환자에서 작은 담석으로 진단하였으나 기준 검사에서 담석이 발견되지 않았다. 악성 담관 폐쇄에 대한 MDCT 담관조영술의 민감도 및 특이도는 각각 97.0%, 98.6%였다. MDCT 담관조영술로 바터팽대부 종양과 원위부 담관암으로 진단한 3명은 기준검사에서 심한 유두염으로 진단되었고, 담관석으로 진단한 1명은 바터팽대부 종양이었다. 원위부 총담관 폐쇄 질환에 대한 MDCT 담관조영술의 진단 정확도는 90.5%였다. 결론: 64-MDCT 담관조영술은 원위부 총담관 폐쇄 질환을 진단하는 민감도 및 특이도가 높은 비침습적인 검사로 담관 질환을 진단하는데 유용하게 활용할 수 있을 것으로 생각한다. 그러나 작은 담석이나 유두부 병변은 ERCP를 통한 진단이 필요한 것으로 생각한다.

Background/Aims: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction. Methods: Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery. Results: The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%. Conclusions: MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction.

Background/Aims: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction. Methods: Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery. Results: The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%. Conclusions: MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction.

64 channel MDCT cholangiography, Bile duct obstruction, ERCP