Biliary Imaging

download Biliary Imaging

of 35

  • date post

    02-Jun-2018
  • Category

    Documents

  • view

    220
  • download

    0

Embed Size (px)

Transcript of Biliary Imaging

  • 8/10/2019 Biliary Imaging

    1/35

    Biliary ImagingBiliary ImagingIan Scharrer, MIVIan Scharrer, MIV

    November 16, 2005November 16, 2005

  • 8/10/2019 Biliary Imaging

    2/35

    Clinical ScenarioClinical Scenario

    A 46 year old oman !re"en#" #o #he clinicA 46 year old oman !re"en#" #o #he clinic

    com!laining o$ e!iga"#ric !ain #ha# "hecom!laining o$ e!iga"#ric !ain #ha# "he

    e%!erience" a$#er ea#ing a large meal&e%!erience" a$#er ea#ing a large meal&

    'n e%amina#ion, #he !a#ien# i" an obe"e $emale'n e%amina#ion, #he !a#ien# i" an obe"e $emaleho doe" no# a!!ear #o be in any ac(#e di"#re""&ho doe" no# a!!ear #o be in any ac(#e di"#re""&

    She i" a$ebrile, i#h "#able vi#al "ign"& )he e%amShe i" a$ebrile, i#h "#able vi#al "ign"& )he e%am

    i" only "igni$ican# $or #he !a#ien# e%!eriencingi" only "igni$ican# $or #he !a#ien# e%!eriencing

    mild #enderne"" (!on !al!a#ion o$ #he righ#mild #enderne"" (!on !al!a#ion o$ #he righ#

    (!!er *(adran# o$ her abdomen&(!!er *(adran# o$ her abdomen&

  • 8/10/2019 Biliary Imaging

    3/35

    AC+ A!!ro!ria#ene"" Cri#eriaAC+ A!!ro!ria#ene"" Cri#eria

    or a !a#ien# i#h ac(#e righ# (!!er *(adran# !ain, ho i"or a !a#ien# i#h ac(#e righ# (!!er *(adran# !ain, ho i"a$ebrile i#h a normal -BC co(n#.a$ebrile i#h a normal -BC co(n#.

    +adiologic /%am roced(re+adiologic /%am roced(re A!!ro!ria#ene"" +a#ingA!!ro!ria#ene"" +a#ing

    S, abdomenS, abdomen

    C), abdomenC), abdomen 33

    NC, chole"cin#igra!hyNC, chole"cin#igra!hy 66

    ray, !!er I "erie"ray, !!er I "erie" 66

    ray, bari(m enemaray, bari(m enema 44

    ray, abdomenray, abdomen 44

  • 8/10/2019 Biliary Imaging

    4/35

    l#ra"o(nd Abdomenl#ra"o(nd Abdomen

    )he imaging modali#y o$ choice $or #he gallbladder i")he imaging modali#y o$ choice $or #he gallbladder i"

    (l#ra"o(nd& I# i" $a"#, real#ime, noninva"ive, and doe"(l#ra"o(nd& I# i" $a"#, real#ime, noninva"ive, and doe"

    no# (#ili7e ioni7ing radia#ion&no# (#ili7e ioni7ing radia#ion&

    859 "en"i#ivi#y $or de#ec#ion o$ choleli#hia"i"& :iagno"i"859 "en"i#ivi#y $or de#ec#ion o$ choleli#hia"i"& :iagno"i"

    ba"ed on vi"(ali7a#ion o$ a mobile, hy!erechoic,ba"ed on vi"(ali7a#ion o$ a mobile, hy!erechoic,

    in#ral(minal ma"" i#h aco("#ic "hadoing&in#ral(minal ma"" i#h aco("#ic "hadoing&

    ;809 "en"i#ivi#y $or de#ec#ion o$ ac(#e cholecy"#i#i"&;809 "en"i#ivi#y $or de#ec#ion o$ ac(#e cholecy"#i#i"&

    :iagno"i" ba"ed on !re"ence o$ choleli#hia"i",:iagno"i" ba"ed on !re"ence o$ choleli#hia"i",

    gallbladder all #hic

  • 8/10/2019 Biliary Imaging

    5/35

    Normal allbladderNormal allbladder

  • 8/10/2019 Biliary Imaging

    6/35

    allbladder, i#h n(mero(" "#one" !re"en#allbladder, i#h n(mero(" "#one" !re"en#

  • 8/10/2019 Biliary Imaging

    7/35

    allbladder, i#h "l(dge and "#one !re"en#allbladder, i#h "l(dge and "#one !re"en#

  • 8/10/2019 Biliary Imaging

    8/35

    allbladder, i#h "l(dge !re"en# ?arro@allbladder, i#h "l(dge !re"en# ?arro@

  • 8/10/2019 Biliary Imaging

    9/35

    Ac(#e cholecy"#i#i" no#ice increa"ed gallbladder all #hic

  • 8/10/2019 Biliary Imaging

    10/35

    C) "can, abdomenC) "can, abdomen

    all"#one" can be "een on C), b(# i# i" no#all"#one" can be "een on C), b(# i# i" no#

    ("ed !rimarily $or #hi" !(r!o"e&("ed !rimarily $or #hi" !(r!o"e&

    C) can be ("ed in "i#(a#ion" hereC) can be ("ed in "i#(a#ion" here

    (l#ra"o(nd i" di$$ic(l# "(ch a" in obe"e(l#ra"o(nd i" di$$ic(l# "(ch a" in obe"e

    !a#ien#"& I# can al"o be ("ed i$ #he!a#ien#"& I# can al"o be ("ed i$ #he

    (l#ra"o(nd i" no# de$ini#ive&(l#ra"o(nd i" no# de$ini#ive&

  • 8/10/2019 Biliary Imaging

    11/35

  • 8/10/2019 Biliary Imaging

    12/35

    N(clear medicine "#(die"N(clear medicine "#(die"

    er$ormed ("inger$ormed ("ing 88m88m)Clabelled N)Clabelled N"(b"#i#(#ed iminodiace#ic acid com!o(nd""(b"#i#(#ed iminodiace#ic acid com!o(nd"??88m88m)CI:A@&)CI:A@&

    Can be ("ed #o de#ec# lograde biliaryCan be ("ed #o de#ec# lograde biliaryob"#r(c#ion", ac(#e cholecy"#i#i", biliaryob"#r(c#ion", ac(#e cholecy"#i#i", biliarylea

  • 8/10/2019 Biliary Imaging

    13/35

    Normal he!a#obiliary "cin#igra!hyNormal he!a#obiliary "cin#igra!hy

    A. liver !arenchymaA. liver !arenchyma

    B. gallbladderB. gallbladder

    C. "mall boelC. "mall boel

    :. common bile d(c#:. common bile d(c#

    /. in#rahe!a#ic bile/. in#rahe!a#ic biled(c#d(c#

  • 8/10/2019 Biliary Imaging

    14/35

    Scin#igra!hy in ac(#eScin#igra!hy in ac(#echolecy"#i#i"& )he livercholecy"#i#i"& )he liveri" vi"(ali7ed, a" i"i" vi"(ali7ed, a" i"e%cre#ion o$ bilee%cre#ion o$ bile#hro(gh #he#hro(gh #he

    in#rahe!a#ic bilein#rahe!a#ic biled(c#", #he commond(c#", #he commonbile d(c# and "mallbile d(c# and "mallboel& )heboel& )hegallbladder i" no#gallbladder i" no#"een&"een&

  • 8/10/2019 Biliary Imaging

    15/35

    ray o$ #he Abdomenray o$ #he Abdomen

    )hi" a" an imaging #echni*(e ("ed in #he)hi" a" an imaging #echni*(e ("ed in #he

    !a"#, b(# ha" been idely re!laced by #he!a"#, b(# ha" been idely re!laced by #he

    (l#ra"o(nd&(l#ra"o(nd&

    Can be ("ed #o vi"(ali7e calci$ied "#one",Can be ("ed #o vi"(ali7e calci$ied "#one",

    em!hy"ema#o(" cholecy"#i#i" ?ga" i#hinem!hy"ema#o(" cholecy"#i#i" ?ga" i#hin

    #he all o$ #he gallbladder@, biliary $i"#(la#he all o$ #he gallbladder@, biliary $i"#(la

    ?ga" i#hin #he biliary "y"#em@, or a?ga" i#hin #he biliary "y"#em@, or a!orcelain gallbladder&!orcelain gallbladder&

  • 8/10/2019 Biliary Imaging

    16/35

    Abdominal %ray demon"#ra#ing "#one" in #he gallbladderAbdominal %ray demon"#ra#ing "#one" in #he gallbladder

  • 8/10/2019 Biliary Imaging

    17/35

    Abdominal %ray $ilm,Abdominal %ray $ilm,

    "hoing a !orcelain"hoing a !orcelaingallbladder&D )hi" i" #hegallbladder&D )hi" i" #he#erm ("ed #o de"cribe a#erm ("ed #o de"cribe agallbladder i#h agallbladder i#h acalci$ied all&calci$ied all&

  • 8/10/2019 Biliary Imaging

    18/35

    'ral Cholecy"#ogra!hy ?'C@'ral Cholecy"#ogra!hy ?'C@

    'C ("ed #o be #he imaging modali#y o$ choice'C ("ed #o be #he imaging modali#y o$ choice

    $or de#ec#ing choleli#hia"i"& I# i" no ("ed a" an$or de#ec#ing choleli#hia"i"& I# i" no ("ed a" an

    adE(nc# #o (l#ra"o(nd& I# i" ob#ained hen #he !#adE(nc# #o (l#ra"o(nd& I# i" ob#ained hen #he !#

    ha" #he "ym!#om" o$ choleli#hia"i", b(# aha" #he "ym!#om" o$ choleli#hia"i", b(# anega#ive (l#ra"o(nd&nega#ive (l#ra"o(nd&

    I# i" more ("e$(l #ha# (l#ra"o(nd $or vi"(ali7ingI# i" more ("e$(l #ha# (l#ra"o(nd $or vi"(ali7ing

    large "#one", and al"o i" ("e$(l $or co(n#ing #helarge "#one", and al"o i" ("e$(l $or co(n#ing #he

    n(mber o$ "#one" !re"en#&n(mber o$ "#one" !re"en#&

    Con#raindica#ion". #" i#h bilir(bin ; FmgGd=, orCon#raindica#ion". #" i#h bilir(bin ; FmgGd=, or

    in !regnancy&in !regnancy&

  • 8/10/2019 Biliary Imaging

    19/35

    'C'C

  • 8/10/2019 Biliary Imaging

    20/35

  • 8/10/2019 Biliary Imaging

    21/35

    erc(#aneo(" )ran"he!a#icerc(#aneo(" )ran"he!a#ic

    Cholangiogram ?)C@Cholangiogram ?)C@

    )C i" indica#ed hen !erc(#aneo(")C i" indica#ed hen !erc(#aneo("

    in#erven#ion i" needed and /+C ei#her i"in#erven#ion i" needed and /+C ei#her i"

    ina!!ro!ria#e or ha" $ailed&ina!!ro!ria#e or ha" $ailed&

    Can be ("ed #o drain biliary ob"#r(c#ion"&Can be ("ed #o drain biliary ob"#r(c#ion"&

  • 8/10/2019 Biliary Imaging

    22/35

    )C)C

  • 8/10/2019 Biliary Imaging

    23/35

  • 8/10/2019 Biliary Imaging

    24/35

    )C a$#er inEec#ion o$)C a$#er inEec#ion o$dye, "hoing a largedye, "hoing a large

    gall"#one #ra!!ed ingall"#one #ra!!ed in#he d(c#he d(c#&

  • 8/10/2019 Biliary Imaging

    25/35

    )C. )he "ame d(c#)C. )he "ame d(c#a" be$ore, a$#era" be$ore, a$#er

    removal o$ #he "#oneremoval o$ #he "#one#hro(gh #he drainage#hro(gh #he drainageca#he#er&ca#he#er&

  • 8/10/2019 Biliary Imaging

    26/35

    /ndo"co!ic +e#rograde/ndo"co!ic +e#rograde

    Cholangio!ancrea#ogra!hy ?/+C@Cholangio!ancrea#ogra!hy ?/+C@

    /+C i" #he !rimary me#hod o$ direc#/+C i" #he !rimary me#hod o$ direc#cholangiogra!hy, and ha" #hera!e(#iccholangiogra!hy, and ha" #hera!e(#ic!o#en#ial& I# al"o allo" $or e%amina#ion o$!o#en#ial& I# al"o allo" $or e%amina#ion o$

    #he (!!er I #rac#, #he !a!illa o$ Va#er, and#he (!!er I #rac#, #he !a!illa o$ Va#er, and#he !ancrea#ic d(c#& Bio!"ie" o$ m(l#i!le#he !ancrea#ic d(c#& Bio!"ie" o$ m(l#i!le"i#e" can be #a

  • 8/10/2019 Biliary Imaging

    27/35

    /+C. )he endo"co!e i" in#rod(ced and i" #hreaded aro(nd #o #he/+C. )he endo"co!e i" in#rod(ced and i" #hreaded aro(nd #o #he

    "!hinc#er o$ 'ddi& )here, dye can be inEec#ed in#o #he d(c#"&"!hinc#er o$ 'ddi& )here, dye can be inEec#ed in#o #he d(c#"&

    In"#r(men#" can al"o be in"er#ed #hro(gh #he "co!e #o remove "#one",In"#r(men#" can al"o be in"er#ed #hro(gh #he "co!e #o remove "#one",

    in"er# drain", remove #i""(e "am!le", o$ !er$orm o#her #rea#men#"&in"er# drain", remove #i""(e "am!le", o$ !er$orm o#her #rea#men#"&

  • 8/10/2019 Biliary Imaging

    28/35

    /+C/+C

    )he mo"# im!or#an# indica#ion $or /+C i")he mo"# im!or#an# indica#ion $or /+C i"

    ob"#r(c#ive Ea(ndice, a" i#