Three-dimensional reconstruction of the biliary tract using spiral computed tomography

Abstract

Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.

On the mechanical behavior of the human biliary system

“…A 3D real-time ultrasonography technique is now being developed and has been applied to the measurement of gallbladder shape and volume [53] . The 3D spiral/helical computed tomography (CT) has also been involved in diagnosis of cholecystitis, since it not only shows the 3D images of the gallbladder but also of the whole biliary tract [54][55][56][57][58][59][60] . These techniques may in the future facilitate the development of specific models for measuring flow resistance.…”

Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction

“…The role of CT in the assessment of the biliary tract has been already discussed, with conventional [9,17,18,22,24] or single-slice helical scanners [10,11,12,13,14,15,16,20,25]. Unenhanced CT for detection of lithiasis has been tested in few papers [17,20,22,24,26], with reported sensitivities ranging from 25% [24] to 90% [22].…”

“…Many experiences have been reported using oral [9,15,16,25,27] or intravenous biliary contrast agents [10,11,12,13,14,28].…”

New Imaging Techniques in the Evaluation of Gastrointestinal Diseases

“…Thin slice volume acquisition of the biliary system after administration of intravenous cholangiographic contrast may offer a valuable alternative to patients who have difficult anatomy and, hence, are not candidates for endoscopic retrograde cholangiopancreatography (ERCP) and who cannot tolerate magnetic resonance cholangiography (ie, claustrophobia). Several recent studies have documented the ability of spiral intravenous cholangiography to demonstrate clearly the normal anatomy as well as pathological entities such as cholelithiasis, choledocholithiasis and a variety of neoplastic entities in the pancreaticoduodenal region (13) (Figures 5,6). Addition of three-dimensional reconstruction allows pathological entities to be seen in an image format, which facilitates interpretation for the radiologist and the treating physician because these images closely resemble ERCP-generated studies.…”