@article{oai:shiga-med.repo.nii.ac.jp:00004475,
 author = {新谷, 修平 and 稲富, 理 and 馬場, 重樹 and 今井, 隆行 and 友澤, 裕樹 and 井上, 明星 and 大田, 信一 and 竹田, 善哉 and 藤本, 剛英 and 西田, 淳史 and 久津見, 弘 and 渡邉, 嘉之 and 安藤, 朗 and SHINTANI, Shuhei and INATOMI, Osamu and BAMBA, Shigeki and IMAI, Takayuki and TOMOZAWA, Yuki and INOUE, Akitoshi and OTA, Shinichi and TAKEDA, Yoshiya and FUJIMOTO, Takehide and NISHIDA, Atsushi and KUTSUMI, Hiromu and WATANABE, Yoshiyuki and ANDOH, Akira},
 journal = {Japanese Journal of Radiology},
 month = {Mar},
 note = {Purpose:
Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction., Purpose:
Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction., Results:
A total of 40 patients (mean age 70.6 years; 18 female) were enrolled. The BPDS was observed in 15 patients. Stone impaction occurred in 13/40 (32.5%) cases. Overall accuracy, sensitivity, and specificity were 34/40 (85.0%), 11/13 (84.6%), and 23/27 (85.2%), respectively; 14/16 (87.5%), 5/6 (83.3%), and 9/10 (90.0%) for iso-attenuating stones; and 20/24 (83.3%), 6/7 (85.7%), and 14/17 (82.4%) for high-attenuating stones. Interobserver agreement of the BPDS was substantial (κ = 0.68). In addition, the BPDS was significantly correlated with the number of factors in the systemic inflammatory response syndrome (P = 0.03) and total bilirubin (P = 0.04)., Conclusion:
The BPDS was a unique CT imaging finding to identify common bile duct stone impaction regardless of stone attenuation with high accuracy., Journal Article},
 title = {Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla},
 year = {2023}
}