Abstract: Objective:To investigate the imaging features and differential diagnosis of obstructive jaundice caused from nonneoplastic diseases.
Methods:The retrospective descriptive study was conducted. The clinical data of 62 patients with obstructive jaundice caused from nonneoplastic diseases who were admitted 〖HJ〗to the Peking University People′s Hospital between August 2014 and August 2016 were collected, including 13 with immunoglobulin G4 associated cholangitis (IAC), 2 with primary sclerosing cholangitis (PSC), 21 with recurrent purulent cholangitis (RPC), 2 with Mirizzi syndrome, 4 with groove pancreatitis (GP) and 20 with Lemmel syndrome. All the patients underwent plain and enhanced scans of computed tomography (CT) and magnetic resonance imaging (MRI) and magnetic resonanced cholangiopancreatography (MRCP). Film reading were respectively done by 2 imaging doctors, and then was analyzed again by senior doctors when there is disagreement. Observation indicators: (1) situations of imaging examination and imaging features; (2) treatment and followup. Patients received laboratory and related examinations and then underwent corresponding treatment after diagnosis. Followup using outpatient examination and telephone interview was performed once every 6 months to detect patients′ prognosis up to November 2016.
Results:(1) Situations of imaging examination and imaging features: of 62 patients, 21 underwent plain and enhanced CT scans, 7 underwent plain and enhanced MRI scans, 4 underwent MRCP, 15 underwent plain and enhanced CT scans and MRCP, 1 underwent plain and enhanced CT scans and plain and enhanced MRI scans, 3 underwent plain and enhanced MRI scans and MRCP and 11 underwent plain and enhanced CT scans, plain and enhanced MRI scans and MRCP. Imaging features of 13 patients with IAC: MRI scans showed that diffuse and symmetrical bile duct walls were thickened, with delayed enhancement. The narrowed lumen of bile duct was mainly occurred in common bile duct, without occlusion. Of 13 patients with IAC, 9 were combined with IgG4 associated pancreatitis and 7 with bilateral nephropathy. Imaging features of 2 patients with PSC: MRI scans showed that bile duct wall was multiple localized thickening and persistent enhancement, that was imaging feature of liver cirrhosis. MRCP examination showed that intra and extrahepatic bile ducts had multifocality stricture and beadinglike and/or dry twiglike dilatation, and branches of intrahepatic peripheral bile duct were reduced. Imaging features of 21 patients with RPC: MRI and CT scans and MRCP examination showed that there was thickening bile duct wall and delayed enhancement. The first and second level of intrahepatic bile duct were segmental dilatation, distal bile duct dramatically narrowed and branches of intrahepatic bile duct were reduced. Most of extrahepatic bile duct was dilatation and a few were narrowlike changes. There were stones of intrahepatic bile duct and pneumobilia. Liver parenchymal atrophy with cholangiectasis occurred most frequently in left lobe or right posterior lobe of liver. There were secondary liver abscess and cholangiocarcinoma. Imaging features of 2 patients with Mirizzi syndrome: MRI scans showed that there was common hepatic duct stricture caused by stones in the junction between neck of gallbladder and common hepatic duct, and intra and extrahepatic bile ducts dilatation in proximal end of stones and normal bile duct in distal end of stones. There were gallbladder and biliary fistulas, irregular gallbladder wall thickening and inflammation around the gallbladder. Imaging features of 4 patients with GP: MRI scans showed that no clear mass was detected in duodenal loop and head of pancreas, with heterogeneous and slightly irregular enhancement. Cyst formation occurred in intramural wall of duodenum and head of pancreas. Enhanced MRI scans showed that common bile duct wall was thickened and slightly irregular stricture, pancreatic duct was normal or mild expansion, and thickened duodenal wall had varying degrees of stenosis of lumen. Imaging features of 20 patients with Lemmel syndrome: MRI scans showed that pouchlike structure was detected inside of the descending duodenum, with thin cyst wall and liquid in cyst wall. MRCP examination showed dilatations of common bile duct and intra and extrahepatic bile ducts. (2) Treatment and followup: of all the 62 patients, 30 underwent corresponding surgeries, including 2 with IAC, 1 with PSC, 7 with RPC, 2 with Mirizzi syndrome, 3 with GP and 15 with Lemmel syndrome, and the other 32 without surgery received corresponding medical treatment. Sixty of 62 patients were followed up for 3-17 months. During followup, 28 patients undergoing surgery received definitive diagnosis and good recovery, 2 were lost after definitive diagnosis and 32 undergoing medical treatment were in stable condition.
Conclusion:Nonneoplastic diseases can cause obstructive jaundice, with a higher misdiagnosis rate, imaging findings of which can be conducive to diagnose diseases and provide clinical treatment.