This document discusses the radiological anatomy of the hepatobiliary system and imaging modalities used to evaluate it. It describes the normal anatomy and variants of the liver, gallbladder, bile ducts and vascular structures. Common developmental anomalies and variants are outlined, along with the embryological development of the biliary tract. A brief overview is provided of various imaging modalities used to evaluate the hepatobiliary system including ultrasound, CT, MRI, angiography and scintigraphy. Specific imaging findings and applications are highlighted.

1. Radiological anatomy
Hepatobiliary
Dr. Henock.N ,Radiology Resident
Ayder Hospital

4. Imaging modalities
• ULTRASOUND
• CT
• MRI
• Angiography
• Venography
• Hepatic scintigraphy

9. Requisite ultrasound

11. cont

13. Developmental anomalies
• Agenesis
• Anomalies of position and morphology
• Vascular anomalies

14. Anomalies of morphology

19. Reidels lobe

21. Normal liver vascular anatomy

23. Vascular variants of liver
• hepatic artery
• portal vein
• hepatic vein

24. Vascular anomales of the artery
• Relatively commn
A,In 18.5 hepatic artery arise from sma
…..10% Replaced RHA fromSMA
…..6% Accessory RHA from SMA
…..2.5 CHA from SMA

27. Replaced left hepatic artery

28. Replaced right hepatic artery

29. Right and left from celiac

30. Hepatic from aorta

31. portal vein
• Agenesis
• Stricture
• Obstructing valves
• Absecence of the right portal vein with
anomalies of branching from main and left
portal vein
• Absence of umblical segment of left portal
vien

32. Anomalies of the hepatic veins
• Branching
• Accessory
1.Of segment 8(1/3popn)----drain to mhv or join
rhv
2.Of segment 6—10%----drain to ivc
May be large as right or larger
3. marginal veins(lt =3%&rt=12%)—drain to
rhv&lhv
4.Absence of left hepatic veins =8%

34. Gallbladder and
Biliary system

35. Embryology of the biliary
tract
Hepatic diverticulum
pars hepatica pars cystica.
LIVER, IHD & CHD GB & cystic duct
 Elongates to form CBD

36. Gallbladder
• pear-shaped sac
• 7 to 10 cm long
• 3~4cm in width
• Wall thickness :
2~3mm
• average capacity
of 30 to 50 mL

37. • 4-6 hours fasting
• Sub costal or
intercostal scanning

38. Relations
• Superiorly - liver
• Inferiorly - transverse
colon, D2 segment of
the duodenum.
• Anteriorly - transverse
colon, 9th costal
cartilage.
• Medially-pylorus of
stomach.

39. Cystic duct
– 3-5cm long
– 3-7mm diameter
– Spiral valves of
Heister
–usually joins the
right side of the
common duct

40. CBD
• 5-15 cm in length but
it varies.
• 3-8mm diameter
• CHD: 2-3mm in
diameter
• Joins the pancreatic duct
and opens at 2nd part of
duodenum.(ampula of
vater)

41. Plain abdominal X ray
• This was used in the past, but has been widely
replaced by the ultrasound.
• Can be used to visualize
 calcified stones,
 emphysematous cholecystitis ,
 biliary fistula (gas within the biliary
system
 porcelain gallbladder.

42. Abdominal x-ray demonstrating stones in the gallbladder

43. • porcelain
gallbladder

44. Ultrasound
• Initial imaging modality of choice for
the gallbladder .
• It is fast, non-invasive, and does not
utilize ionizing radiation.
• 95% sensitivity for detection of
cholelithiasis.

45. Con….
Evaluation of biliary tree.(extra hepatic)
>90% sensitivity for detection of acute
cholecystitis.
Limited by skill of operator, and pt’s body
habitus.
 poor demonstration of peripheral IHD

46. Sagittal image of gallbladder

47. Transverse image of the GB

49. Dilated CBD

50. CT scan
The major application is to define the biliary
tree and near by structure.
Test of choice to evaluate for malignancy.
 CT can be used in situations where ultrasound
is difficult .

52. Endoscopic Retrograde
Cholangiopancreatography (ERCP)
• Used as both diagnostic and therapeutic.
• demonstrate the cause and extent of the
obstruction.
• Allows for examination of
 upper GI tract
 papilla of Vater and
 pancreatic duct

53. n…
• causes less discomfort
than PTC
• acute pancreatitis is a
common complication

54. Percutaneous Transhepatic
Cholangiogram (PTC)
• PTC is indicated:
- when percutaneous intervention is needed
-ERCP either is inappropriate or has failed.
• Can be used to drain biliary obstructions.
• Sepsis ,cholangitis is a risk after the procedure

55. PTC

56. • PTC after injection
of dye, showing a
large gallstone
trapped in the duct

57. Endoscopic Ultrasonography
• EUS uses ultrasound probes carried on
endoscopes.
• ultrasound images can be obtained from inside
the gastrointestinal tract
• It is important to avoid artifacts coming from
bones, fat and air.

58. Con…
Note the stone(red arrow)causing strong
acoustic shadowing (yellow arrow) is seen
within the dilated CBD

59. Magnetic Resonance Cholangiopancreatography (MRCP)
• Emerging as a new tool for non-invasive evaluation
of the pancreatic and biliary ductal systems.
• Gradually replacing PTC and ERCP for diagnostic
purposes.
• Images are taken in axial, coronal, and 3-D format

61.  GB variants

62. GB Duplication
• Boyden's classification
1. Bilobed incomplete
GB division with one
common cystic duct.
2. complete gallbladder
duplication with
separated cystic ducts
that goes to common
hepatic duct.(H type)

63. Con…
3. complete gallbladder
duplication with a
common cystic duct
entering the common
hepatic duct.(v shape)

65. GB diverticula
• Extremely rare
• Occurs any where
• Usually single

66. …

67. GB septation
• Can be acquired or
congenital.
• Septa cause impaired
motility, stasis of bile
flow.
• Chambers communicate
with orifice.
• Fine echogenic hori or
vertically oriented

68. Ectopic GB

69. Con…

72. Blood supply
• Cystic artery
-Rt hepatic artery(75%)
-left hepatic artery(10%)
-CHA , SMA or GDA(15%)
 Venous drainage
-cystic vein
-directly to the venous system of liver.

73. Thank you!