Diagnostic Accuracy of Ultrasound, Computed Tomography, and Endoscopic Retrograde Cholangiopancreatography in the Detection of Obstructive Jaundice

The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.