Choledocholithiasis Detection on MRCP

Purpose	To detect choledocholithiasis on MRCP
Tag(s)
Panel	Abdominal
Define-AI ID	20020008
Originator	Luther B. Adair, II
Lead	Luther B. Adair, II
Panel Chair	Arun Krishnaraj
Panel Reviewers	Abdominal Panel
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES159

                               

Value Proposition

Choledocholithiasis is a potentially life-threatening but treatable emergency. AI meeting this use case would help in detecting, quantitating, and alerting both nonspecialists and radiologists to this potentially life-threatening abnormality. In clinical settings where a radiologist is not readily available, such detection would be of value to non-radiologists such as technologists who would perform a MRCP for this disease entity. In clinical settings where radiologists are available, such detection could be used to alert the radiologist and prioritize its reporting and notification to the treating physicians. One possible extension to this use case is to detect choledocholithiasis on MRCP and assess the need for further treatment with ERCP.

Narrative(s)

A 44-year old patient presents with constant right upper quadrant pain and is taken to the emergency room at which time an MRCP is ordered.

A 67-year old patient presents to an outpatient clinic with jaundice and right upper quadrant pain and is sent to the emergency room, at which time an MRI Abdomen with MRCP is ordered.

Workflow Description

The relevant images are obtained from modality and sent to PACS and the AI engine based on anatomic landmarks. The images are analyzed by the engine. The system then detects the relevant outputs providing associated categorical data or measurements. An alert message is sent to PACS from the engine with the information, identification, and graphics highlighting the common bile duct stone, the measurement of the stone, whether there is biliary ductal dilatation and measurement of the common bile duct, whether there is periductal fluid present, and whether there is gallbladder distention.

An algorithm evaluates the relevant MRCP sequences and categorizes whether a common bile duct stone is present, absent, or undetermined. If present, it then measures the stone; assesses whether biliary ductal dilatation is present, absent, or undetermined with a measurement of the common bile duct; assesses whether periductal fluid is present, absent, or undetermined; assesses whether the gallbladder is distended or not distended with a measurement of the gallbladder lumen from wall to wall. For cases returned where the algorithm returns a common bile duct stone present, the recommendation for ERCP is made and the radiologist is made aware. For cases returned where the algorithm returns a stone absent or undetermined, but there are any secondary output elements present (biliary ductal dilatation, periductal fluid, or a distended gallbladder) an alert is provided to the radiologist to consider a soft tissue mass obstruction. If a radiologist is present, these exams are prioritized in the radiologist worklist for urgent interpretation and reporting.

Procedures	{MRI abdomen with MRCP, MRCP, MRI Abdomen}
View(s)	{ thick-slab single-section sequence T2, T2 sequence, thin-section multisection sequence}
Age	[0,90]
Sex at Birth	{Male, Female}
Other	{pneumobilia, hemobilia, soft tissue mass anywhere in the biliary tree, susceptibility artifact from cholecystectomy clips, flow artifact, crossing vessel artifact, choldechocal cysts, biliary stricture, sclerosing cholangitis, hepaticojejunostomy/Whipple/etc}

 

Inputs

DICOM Study

Primary Outputs

Common Bile Duct Stone Detection

Common Bile Duct Stone Size

Secondary Outputs

Common Bile Duct Dilation Measurement 

Common Bile Duct Dilation Detection

Periductal Fluid Detection

Gallbladder Lumen Distention Measurement

• In the case of biliary ductal dilatation without an identified stone or prior gallbladder/biliary surgery, soft tissue mass obstruction within the common bile duct, ampulla, or pancreas should be considered.  

• In the case of periductal fluid and ducal wall thickening or enhancement, perhaps cholangitis should be considered.

• Consider adding the number of stones within the common bile duct if there are multiple in the future.  

No known related public datasets at this time,  please alert us if you know of any.