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[Ultrasonographic anomalies of intrahepatic biliary ducts: contribution of the comet-tail image].

OBJECTIVES
The aim of this study was to evaluate the sensitivity and specificity of the ultrasound intrahepatic bile duct wall comet-tail artifact for the diagnosis of biliary disease.


METHODS
All subjects who underwent upper abdominal ultrasound examination were included in the study over an 18-month period. The presence or absence of the comet-tail artifact (that is hyperechoic pattern with several parallels lines, constant, lining on the intrahepatic biliary ducts) was noted.


RESULTS
Fourteen thousand four hundred and ninety-eight patients were included. The comet-tail artifact was only found in 10 of the 14 211 patients without biliary tract disease (99.9% specificity), but in 35 of the 287 patients with biliary disease (12.2% sensitivity). The positive predictive value for the diagnosis of biliary tract disease was 77.7%. The artifact was associated with an angiocholitis in 83% of the patients.


CONCLUSION
Despite its low sensitivity, the sonographic comet-tail artifact of the intrahepatic bile duct wall was strongly correlated with the presence of biliary disease. This artifact may be related to an enlargement of the bile duct wall.