Imaging the Bilary Tree

Ultrasound

Pros and Cons

•Cost- $100•90-95% accurate•Good for detecting billary duct dilatation,

cholelithiasis, gallbladder wall thickness and the presence of pericholecystic fluid. Not good for choledocholithiasis.

Plain Abdo X-ray

Pros and Cons

•Cost- $30•Sensitivity is only 15% for stones•Doesn’t show the bilary tree

ERCP (Endoscopic Retrograde Cholecysto Pancreatography)

Pros and Cons

•Cost- $300+theatre fees+equipment•Allows diagnosis and treatment •Requires anaesthesia•Complications

▫Mortality rate of 1%▫Pancreatitis▫Bleeding▫Duodenal perforation

IV Cholangiography +/- CT

Pros and Cons

•Cost- $400•Provides detailed images of the anatomy

and is very sensitive for detecting choledocholithiasis.

•Need to have bilirubin <40 so the liver can excrete the contrast into the bilary tree.

•The contrast can cause allergic reactions•Not as good as ultrasound as detecting

cholelithiasis

HIDA Scan

Pros and Cons

•Cost- $400•Doesn’t give a detailed image of the bilary

tree•Provides an assessment of gallbladder

function.•Useful to diagnose cholecystitis when

ultrasound isn’t clear and is also useful for bile duct leaks and common bile duct obstructions.

MRI

Pros and Cons

•Cost- $400•Contraindicated in pts with pacemakers,

intracerebral metal clips or metal shards in their eyes.

•Good imaging of the bilary tree and stones

PTC (Percutaneous Transhepatic Cholangiography)

Pros and Cons•Cost- $180 for the x ray, $400 for the

procedururist and the costs of anaesthesia and admission.

•Complications▫ Bleeding▫ Bile leak

•Good when ERCP can’t be performed•Also good when there is a complete

obstruction of the bilary tree and you wish to visualise the proximal tree.