Transient arterial enhancement of the hepatic parenchyma in patients with acute cholangitis

Abstract

OBJECTIVES: Our objectives were to determine the clinical significance of transient arterial enhancement (TAE) of the hepatic parenchyma in patients with suspected biliary disease and to investigate the relationship between the pattern and extent of TAE and acute cholangitis. METHODS: A retrospective review of dynamic computed tomographic scans in 76 patients with suspected biliary disease was performed. Patterns of TAE were classified as polymorphous, sectorial, peribiliary, diffuse, and a combination of features. The extent of TAE was evaluated by counting the involved liver segments. The extent of TAE was correlated with laboratory and clinical findings. Patients were also divided into 2 groups: cholangitis group (n = 40) and noncholangitis group (n = 36). The pattern and extent of TAE were compared between these 2 groups. RESULTS: Among the laboratory findings that showed significant correlation with the extent of TAE, the white blood cell count and C-reactive protein concentration were found to have a relatively high correlation (r = 0.540 and 0.514, respectively). The presence of abdominal pain, fever, and cholangitis showed a statistically significant difference with the extent of TAE (P < 0.01). Statistically significant differences in the pattern and extent of TAE between the 2 groups were found (P < 0.001). Diffuse or diffuse heterogeneous TAE patterns that involve more than 5 liver segments, such as a polymorphous combined with a peribiliary pattern and a diffuse pattern, had a high association with acute cholangitis. CONCLUSIONS: Transient arterial enhancement in patients with suspected biliary disease is well correlated with clinical parameters suggestive of inflammation. Transient arterial enhancement provides useful complementary information for biliary infection in the computed tomographic diagnosis of acute cholangitis.