Biliary



Biliary



METHODS OF INVESTIGATION




MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)




Technique



• Heavily T2-weighted coronal oblique fast spin-echo sequence to obtain source data (aligned along the plane of the common bile duct (CBD))



• Source data allows MIP reformats to be generated (highlighting fluid-filled structures) – usually a number of coronal MIP reformats over 180°


• Secretin: this stimulates exocrine pancreatic secretion, distending the pancreatic duct and improving its visualization (acts immediately, returning to baseline at 10 min)


• Functional MR cholangiography: using delayed imaging at 30–60 mins with the hepatobiliary excreted contrast agents Gd-EOB-DTPA (Primovist) or Gd-BOPTA (MultiHance)




Normal anatomy



• Normal morphology: only central intrahepatic ducts are normally seen (≤ 3mm) image extrahepatic ducts ≤ 7mm (CBD up to 10mm post cholecystectomy) image pancreatic duct ≤ 3mm image accessory pancreatic duct in 45%


• Right posterior hepatic duct (segments VI/VII): almost horizontal course


• Right anterior hepatic duct (segments V/VIII): more vertical course


• Left hepatic duct (segments II–IV): joins the right to form the common hepatic duct image separate drainage of segment I


• Cystic duct insertion into common hepatic duct: right lateral (50%) image anterior (30%) image posterior (20%)


• Common variants: an aberrant right posterior duct draining into the common hepatic duct or cystic duct image drainage of the right anterior or posterior duct into the left hepatic duct image a triple confluence at the hilum













CHOLELITHIASIS AND CHOLEDOCHOLITHIASIS


CHOLELITHIASIS


DEFINITION







PEARLS






CHOLEDOCHOLITHIASIS


DEFINITION






RADIOLOGICAL FEATURES


















CHOLECYSTITIS




ACUTE CALCULOUS CHOLECYSTITIS














Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Biliary

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