Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging (original) (raw)

Diagnosis of biliary tract and ampullary carcinomas

Journal of Hepato-Biliary-Pancreatic Surgery, 2008

Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither defi nite methods for early diagnosis nor specifi c markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice. Although rare, abdominal pain and pyrexia, as well as abnormal fi ndings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases. On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure diffi cult. When gallbladder cancer is suspected, enhanced CT is carried out. Multidetector computed tomography (MDCT), in particular -one of the methods of enhanced CT -is useful for decision of surgical criteria, because MDCT shows fi ndings such as localization and extension of the tumor, and the presence or absence of remote metastasis. Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients. However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer.

Imaging of Idiopathic Biliary Duct Dilatation

Journal of Clinical Gastroenterology, 1980

What is called "idiopathic biliary duct system dilatation" or better to name it "un-explained biliary dilatation" is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fi elds; the technical and the clinical ones. This clinical review is trying to fi ll this gap and introduce a comprehensive discussion of the subject. Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really diffi cult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to fi nd a correlation rationale. At some point verifi cation of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.

Isolated and unexplained dilation of the common bile duct on computed tomography scanscans

Gastroenterology Insights, 2012

Isolated dilation of common bile duct (CBD) (with normal sized pancreatic duct) and without identifiable stones or mass lesion (unexplained) is frequently encountered by computed tomography/magnetic resonance imaging. We studied the final diagnoses in these patients and tried to elucidate factors that can predict a malignant etiology. This is a retrospective analysis of prospective database from a University based clinical practice (2002)(2003)(2004)(2005)(2006)(2007)(2008). We included 107 consecutive patients who underwent endoscopic ultrasound (EUS) for evaluation of isolated and unexplained CBD dilation noted on contrast computed tomography scans. EUS examination was performed using a radial echoendoscope followed by a linear echoechoendoscope, if a focal mass lesion was identified. Fine-needle aspirates were assessed immediately by an attending cytopathologist. Main outcome measurements included i) prevalence of neoplasms, CBD stones and chronic pancreatitis and ii) performance characteristics of EUS/EUS-fine needle aspiration (EUS-FNA). A malignant neoplasm was found in 16 patients (14.9%) of the study subjects, all with obstructive jaundice (ObJ). Six patients had CBD stones; three with ObJ and three with abnormal liver function tests. EUS findings suggestive of chronic pancreatitis were identified in 27 patients. EUS-FNA had 97.3% accuracy (94.1% in subset with ObJ) with a sensitivity of 81.2% and specificity of 100% for diagnosing malignancy. Presence of ObJ and older patient age were only significant predictors of malignancy in our cohort. Amongst patients with isolated and unexplained dilation of CBD, the risk of malignancy is significantly higher in older patients presenting with ObJ. EUS-FNA can diagnose malignancy in these patients with high accuracy besides identifying other potential etiologies including missed CBD stones and chronic pancreatitis.

Multidetector CT of Emergent Biliary Pathologic Conditions

RadioGraphics, 2013

Various biliary pathologic conditions can lead to acute abdominal pain. Specific diagnosis is not always possible clinically because many biliary diseases have overlapping signs and symptoms. Imaging can help narrow the differential diagnosis and lead to a specific diagnosis. Although ultrasonography (US) is the most useful imaging modality for initial evaluation of the biliary system, multidetector computed tomography (CT) is helpful when US findings are equivocal or when biliary disease is suspected. Diagnostic accuracy can be increased by optimizing the CT protocol and using multiplanar reformations to localize biliary obstruction. CT can be used to diagnose and stage acute cholecystitis, including complications such as emphysematous, gangrenous, and hemorrhagic cholecystitis; gallbladder perforation; gallstone pancreatitis; gallstone ileus; and Mirizzi syndrome. CT also can be used to evaluate acute biliary diseases such as biliary stone disease, benign and malignant biliary obstruction, acute cholangitis, pyogenic hepatic abscess, hemobilia, and biliary necrosis and iatrogenic complications such as biliary leaks and malfunctioning biliary drains and stents. Treatment includes radiologic, endoscopic, or surgical intervention. Familiarity with CT imaging appearances of emergent biliary pathologic conditions is important for prompt diagnosis and appropriate clinical referral and treatment. ©

Imaging of Ampullary and Periampullary Conditions

Journal of Gastrointestinal and Abdominal Radiology, 2021

The ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which controls the flow of bile and pancreatic juices into the duodenum in response to food. The ampulla is also an important embryological landmark as it marks the anatomical transition from foregut to the midgut. Because of this, it is a watershed zone where the blood supply changes from the celiac axis to the superior mesenteric artery. Radiologic evaluation of the ampulla and the periampullary region is challenging because it requires an understanding of the embryology, the normal appearance, and different anatomic variants. Also, a wide variety of pathologies can occur in this region. The purpose of this review is to present the normal anatomy of the ampulla and the periampullary region on different imaging modalities and to summarize the i...

Malignant biliary obstruction: value of imaging findings

Abdominal Imaging, 2005

This review focuses on the clinical impact of different modalities to image primary and secondary malignant biliary obstruction. The detection and staging of cancers of the pancreatic and biliary tract are best accomplished with endoscopic ultrasound, contrast-enhanced computed tomography, and magnetic resonance cholangiopancreatography. Three-dimensional ultrasound is a new noninvasive method that may be used increasingly as an initial test to select patients who require further diagnostic evaluation by magnetic resonance cholangiopancreatography or therapeutic endoscopic retrograde cholangiopancreatography. All-in-one computed tomography including three-dimensional reconstructions of the biliary tree may be competitive against all-in-one magnetic resonance imaging for diagnosis and staging of pancreatic tumors. Magnetic resonance cholangiopancreatography is excellent for identifying the presence and the level of biliary obstruction. With newer diagnostic imaging technologies emerging, endoscopic retrograde cholangiopancreatography is evolving into a predominantly therapeutic procedure.

Nonoperative imaging techniques in suspected biliary tract obstruction

HPB: Official Journal of The International Hepato Pancreato Biliary Association, 2006

Evaluation of suspected biliary tract obstruction is a common clinical problem. Clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment plan. In the present summary, the literature on competing technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed. Patients with obstructive jaundice secondary to choledocholithiasis or pancreaticobiliary malignancies are the primary focus of this review. Algorithms for the management of suspected obstructive jaundice are put forward based on current evidence. Published data suggest an increasing role for EUS and other noninvasive imaging techniques such as MRCP, and hCT following an initial transabdominal ultrasound in the assessment of patients with suspected biliary obstruction to select candidates for surgery or therapeutic ERCP. The management of patients with a suspected pancreaticobiliary condition ultimately is dependent on local expertise, availability, cost, and the multidisciplinary collaboration between radiologists, surgeons, and gastroenterologists.

Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts

Abdominal Radiology, 2020

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Their most common metastatic sites are the liver and the peritoneum, but GISTs rarely metastasize to the bones. We report a case of a 58-yearold man with sternoclavicular joint metastasis from a GIST manifesting 28 months after surgical resection of the small intestine tumor. We will discuss through this paper and a literature review the clinical characteristics, imaging features, and management of this unusual metastatic location of GIST.