Department of Diagnostic Radiology, College of Medicine, Hanyang University Department of Diagnostic Radiology, College of Medicine, Ulsan University1
ABSTRACT
PURPOSE : To determine wheter bilirubin/extrahepatic bile duct diameter ratio(B/D ratio) or alkalinephosphatase/extrahepatic bile duct diameter ratio (A/D ratio) can be used to differentiate malignant from benigndisease in distal extrahepatic bile duct obstruction during ultrasonographic examination. MATERIALS AND METHODS :We retrospectively reviewed the sonograms and laboratory data of 100 patients with obstructive jaundice (benign ;n=50, malignant; ; n=50). The diagnosis was confirmed either surgically (n=66) or clinically (n=34). The B/D ratioand A/D raio were calculated by means of dividing total bilirubin (mg/dl) and alkaline phosphatase (I.U.)respectively by maximum extrahepatic bile duct diameter(mm) on ultrasonogram. RESULTS : Significant difference inB/D ratio was found between the benignancy (0.28+0.25) and malignancy (0.98+0.84) groups (P<0.001). Significantdifference in A/D ratio was also found between the benignancy (15.00+10.22) and malignancy (32.44+30.28) groups(P<0.001) Accuracies to predict malignancy according to criteria of B/D and A/D ratios were less than 75% and 65%respectively. On the other hand, the positive predictive value and specificity were relatively high. CONCLUSION :The B/D ratio and A/D ratio calculated from ultrasonograms can be used as a valuable screening index todifferentiate malignancy from benignacy in patients with distal extrahepatic bile duct obstruction, especiallywhen the sonography is difficult because of the interposition of bowel gas or obesity.
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