Diagnostic imaging methods in the examination of the gallbladder and bile ducts

Native image of the abdomen
Native abdominal imaging is the basic examination method for acute conditions. From the pathologies of the bile ducts could be viewed:

metal clamps after cholecystectomy,
 * aerobilia,
 * gallstones (if those are calcified),
 * exceptionally gas in the wall of the gallbladder in emphysematous cholecystitis,
 * gallstone ileus (ileus caused by the penetration of the gallstone into the small intestine and its wedging usually in the area of ​​the Bauhin's valve),
 * sentinel loop (reactively dilated loop of the small intestine, e.g. in cholecystitis),
 * the position of the biliary stent.

Ultrasound
Also one of the basic methods of examination. It will show reliably:


 * widening of the bile ducts,
 * gallstones, sludge (sand, sediment),
 * '''inflammatory changes of the wall of the gallbladder (thickening, stratification, hyperemia, streak of fluid),
 * postoperative complications after cholecystectomy (bed hematoma, impaired vascular supply to the liver),
 * the position of the biliary stent (and its patency, which is manifested by aerobilia),
 * the cause of obstruction (sometimes it is possible to visualize the cause of obstruction leading to the enlargement of the bile ducts - tumor, gallstone in the bile duct, enlarged lymph node, expansion in the liver parenchyma or in the head of the pancreas).

Perioperative cholangiography
It is performed during the operation. The injection usually takes place via a cannula introduced through the ductus cysticus. The examination is usually performed with a focus on the presence of residual stones (filling defects) in the bile ducts. The outflow of contrast medium into the duodenum is also monitored.

Cholangiography by T-drain
If a T-drain is introduced into the hepatocholedochum perioperatively, it can be used for cholangiography to rule out residual choledocholithiasis, fistula detection, or bile leakage.

CT
Hepatocholedochus, the central intrahepatic bile duct, can be well imaged on computed tomography. CT is indicated for unclear findings on ultrasonography, suspected tumor of both the bile ducts, gallbladder and surrounding structures - especially the pancreas and liver , as well as to show the complications of cholangitis and cholecystitis (abscess).

MRCP
MR cholangiopancreatography is a native MR examination of the bile tree. It is a non-invasive alternative to ERCP where we do not anticipate the need for intervention. It is used to detect choledocholithiasis, strictures and dilatations (eg in sclerosing cholangitis), stenoses (including tumorous). In addition to the bile ducts, it also displays the Wirsungi duct.

ERCP
Endoscopic retrograde cholangiopancreatiography.

More detailed information can be found on the ERCP website .

PTC
Percutaneous transhepatic cholangiography is a radiological intervention method to provide so-called external biliary drainage where ERCP cannot be performed for difficult anatomical conditions or in postoperative conditions. A thin drain is inserted percutaneously through the liver parenchyma under sciascopic control using a Chiba needle (Seldinger's method) into the large bile ducts. The procedure is difficult to perform if the intrahepatic bile ducts are not dilated (here the procedure usually lacks an indication).

Reference

 * 1) ↑ VITELLAS, KM, MT KEOGAN and CE SPRITZER, et al. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics [online] . 2000 Jul-Aug, vol. 20, no. 4, pp. 939-57; quiz 1107-8, 1112, also available from < https://www.ncbi.nlm.nih.gov/pubmed/10903685 >. ISSN 0271-5333.