1. IMAGING OF BILE DUCT DR.SUDHEER HEGDE CONSULTANT RADIOLOGIST DEPARTMENT OF RADIOLOGY COLUMBIA ASIA HOSPITALS Courtesy : Dr.Shalini Govil
2. NORMAL ANATOMY cross-sectional and cholangiographic CAUSES OF LOWER BILIARY OBSTRUCTION APPEARANCES ON DIFFERENT IMAGING MODALITIES ALGORITHM FOR OBSTRUCTIVE JAUNDICE
16. CHOLANGIOGRAPHY Invasive (ERCP / PTC) - High spatial resolution Possible therapeutic options Complication rate (2-3%) Non-invasive CT Cholangiogram - with IV contrast (maxIP) bilirubin > 2mg% - ineffective - without IV contrast (minIP) MR Cholangiogram
17. MR CHOLANGIOGRAPHY Breath-hold (HASTE, RARE) Non-breath-hold (IRTSE) Bile appears bright on heavily T2W images Mapping of biliary tree proximal to obstruction Contraindicated in presence of aneurysm clips, cardiac pacemakers.
24. MR/CT CHOLANGIOGRAPHY visualisation of the proximal biliary tree involvement of CHD, confluence, RHD, LHD, second order ducts SECTIONAL IMAGES nodes, liver metastases, ascites, peritoneal metastases, hilar vessel involvement
25. PANCREATIC / PERIAMPULLARY CARCINOMA US β Double duct sign (CBD & PD dilated) - Mass (+) - Ca Pancreas(95%) βUS guided FNAC - Mass (β )-Perimpullary Ca β ERC with Biopsy Spiral CT - 80% accuracy(resectability) Endoscopic US β local extent of disease.
29. ALGORITHM for OBSTRUCTIVE JAUNDICE ULTRASOUND BILIARY DILATATION MASS+ MR (MRC, MRA) or CT (CTC + CTA) or MRC + CT + CTA STENT or SURGERY ? STRICTURE ? CALCULUS (intact bile duct) (THERAPEUTIC) ERC CALCULUS+ MASS -
30.
31. Pancreatic adenocarcinoma encasing the portal vein, distal superior mesenteric vein. Intraluminal filling defect suggestive of a thrombus is seen in the superior mesenteric vein
45. ABERRANT BILE DUCTS non invasive cholangiogram β prior to laproscopic cholecystectomy MRC HIGH DIAGNOSTIC CT C ACCURACY MRC 0.5 T β SUBOPTIMAL VISUALISATION OF NORMAL CALIBER DUCTS
56. GALL STONE associated obstructions GALL STONE ILEUS Riglerβs triad - air in the biliary tree small bowel obstruction ectopic gall stone MIRIZZI SYNDROME