Journal of Korean Society of Medical Ultrasound 1994;13(2): 103-107.
The role of B/D ratio and A/D ratio to defferentiate malignancy from benignancy in distal extrahepatic bileduct obstruction
Hyun Chul Rhim, JUng Hwan Baek, Eui Yong Jeon, Byung Hee Koh, On Koo Cho, Young Hwan Kim
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.
Keywords: Bile duct, obstruction,Bile duct, ultrasonography
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