Spectral Dual Layer CT for Choledocholithiasis: A Blinded Comparison Study

Authors: Cheng Hong YEO

Abstract:

Introduction: Objective: To evaluate the effectiveness of Spectral Dual Layer CT (DECT) in diagnosing choledocholithiasis, specifically focusing on its accuracy in detecting small biliary stones compared to other imaging modalities. Background: DECT has shown promise in improving the detection and characterization of gallstones in the common bile duct, offering potential advantages over traditional imaging methods like standard CT and ultrasonography. Methodology: Study Design: Single-blinded retrospective study conducted at a teaching hospital. Patient Selection: Reviewed records of patients who underwent DECT for suspected choledocholithiasis and had follow-up MRCP, ERCP, or IOC within 8 weeks. 23 patients with proven choledocholithiasis and 23 controls without biliary filling defects were included. DECT Protocol: Used a Philips IQ 256-slice dual-energy CT scanner with standard protocols including 120 kVp and 40 keV mono-E images. Assessment: Four radiologists, blinded to the study question, evaluated images for the presence of choledocholithiasis. Sensitivity, specificity, PPV, and NPV were calculated based on consensus diagnoses. Results: Diagnostic Performance: DECT showed an overall sensitivity of 47.8% and specificity of 78.3% for detecting choledocholithiasis. The accuracy of the diagnosis ranged from 54% to 63% among observers. Stone Detection: Of the identified stones, 6 were calcified and 17 non-calcified. Detection of calcified stones was more accurate (83.3%) compared to non-calcified stones (35.3%). Differences in signal between stones and bile were noted in certain imaging parameters. Interobserver Agreement: The agreement among radiologists was fair, with a Fleiss Kappa coefficient of 0.30. Conclusion: This is the first study to specifically analyse the performance of spectral CT in choledocholithiasis detection using a control group and blinding of reviewers. Our modest results demonstrating lower overall sensitivity than had been reported previously at 47.8% overall while identifying 40% of non-calcified stones <9 mm. We believe further research and development on advancements in spectral CT technology or newer techniques such as photon counting CT is warranted.

Keywords: dual energy CT, choledocholithiasis, gallstones, body imaging