Role of CT and MRCP in Evaluation of Biliary Tract Obstruction

Abstract

Obstructive jaundice which is caused by bile duct obstruction can be clinically and biochemically indistinguishable from cholestatic jaundice caused by hepatocellular disease. The management of both these conditions being radically different, the principle task of the radiologist is to differentiate between hepatocellular and obstructive jaundice, using available imaging modality and help in further management. With the availability of non-invasive modality like computed tomography and magnetic resonance imaging (MRI), it is possible to diagnose obstructive jaundice early and accurately without any patient discomfort. The purpose of this article is to describe the protocol for evaluation of obstructive jaundice with use of MDCT and magnetic resonance cholangio pancreatography sequence of MRI and to describe the imaging features of the most common causes of obstructive jaundice like biliary calculi, bile duct strictures, choledochal cyst, gall bladder carcinoma, cholangiocarcinoma, primary sclerosing cholangitis, and pancreatic head carcinoma.

The Role of Multidetector Row Computed Tomography in Biliary Tract Malignancy

“…Multidetector row Computed Tomography remains the most commonly used technique for imaging patients with suspected abdominal abnormalities. 1 It allows the rapid acquisition of multiphase data sets and continuous raw data for detailed reconstruction into three-dimensional (3D) images. 1 Invasive methods such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography were used earlier for the evaluation of the biliary tract.…”

“…1 It allows the rapid acquisition of multiphase data sets and continuous raw data for detailed reconstruction into three-dimensional (3D) images. 1 Invasive methods such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography were used earlier for the evaluation of the biliary tract. 7 The optimal contrast enhancement of both hepatic and pancreatic parenchyma afforded by the spiral technique allows excellent visualization of the biliary system from the level of intrahepatic ducts to the ampulla of Vater.…”

“…The role of a radiologist therefore is important in early diagnosis and in accurately delineating the level and the cause of obstruction, thus helping in staging as well as preoperative assessment of tumor respectability. 1 Ultrasound is a non-invasive and cost effective imaging technique available for evaluating biliary tract obstruction. Ultrasound demonstrates the presence of biliary tract obstruction by identifying dilated bile ducts but has a sensitivity of 55%-95% and specificity of 71%-96 %.…”

A rolling stone: vomiting of a gallstone without the presence of a biliary-enteric fistula

“…CT pancreatography is now the gold standard protocol for pancreatico-biliary malignancies, with a sensitivity of 72–78% for the detection of biliary stones [ 5 , 8 ]. Similarly to our case, biliary stones may be visible in a CT as hyperattenuating lesions surrounded by hypoattenuating bile and ampullary soft tissue.…”

Diagnostic performance of preoperative CT in differentiating between benign and malignant origin of suspicious gallbladder lesions

“…Attenuation of gallbladder lesions was determined in the portal venous phase using regions of interest (ROIs) at the largest part, measured twice and then averaged. Dilation of the extrahepatic bile ducts was defined as a diameter >5 mm up to the age of 50 years with an accepted increment of 1 mm per decade [17]. Intrahepatic bile ducts were considered dilated when the diameter exceeded 2 mm [18].…”