Biliary imaging: a review1 John Baillie, Erik K. Paulson, Kenneth M. Vitellas  Gastroenterology  Volume 124, Issue 6, Pages 1686-1699 (May 2003) DOI: 10.1016/S0016-5085(03)00390-1

Figure 1 ERC showing extravasation of contrast medium from the cystic duct stump following laparoscopic cholecystectomy. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 2 ERCP showing a distal bile duct stricture raising concern for malignancy. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 3 ERCP showing a classic “double-duct sign”: both the bile duct and the pancreatic duct are narrowed in the head of the pancreas. In 90% of cases, this indicates the presence of adenocarcinoma of the pancreas. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 4 ERC showing a proximal extrahepatic biliary stricture suspicious for cholangiocarcinoma or gallbladder cancer. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 5 EUS image showing a common bile duct containing stones. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 6 ERC showing primary sclerosing cholangitis with a dominant extrahepatic biliary stricture. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 7 EUS of the gallbladder showing stones. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 8 Normal thick-slab MRC: this 30 mm MRC image shows normal extrahepatic and central intrahepatic bile ducts. Note the intrahepatic bile ducts are normally not visualized. Note the gallbladder and duodenum (arrows). Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 9 Pancreatic carcinoma. The extrahepatic bile duct and the pancreatic duct are dilated (“double-duct sign”) secondary to a pancreatic head mass. Note strictures of the distal common bile and pancreatic ducts (arrows). Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 10 Benign stricture: thick-slab MRC shows gallbladder, intrahepatic bile duct and extrahepatic bile duct dilatation secondary to a stricture (arrows) at the distal common bile duct in this patient with acute pancreatitis. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 11 Primary sclerosing cholangitis: MRC image (A) shows hilar, central, and peripheral bile duct strictures. The central intrahepatic bile ducts, which should normally be visualized in their entirety, are poorly visualized, compatible with the presence of strictures. Peripheral bile duct strictures prevent these ducts from distending in the presence of central strictures. (B) These findings are confirmed on the ERC image. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 12 Cholangiocarcinoma: ERC could not opacify the intrahepatic bile ducts because of a hilar obstruction. PTC image shows dilated intrahepatic bile ducts and obstruction at the hepatic hilum. MRC image provides a “road map” of the ducts above and below obstructing lesions. Note the hilar stricture on MRC (arrow). Other MR sequences (not shown) showed a large unresectable infiltrating cholangiocarcinoma. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 13 Bile duct leak: A 27-year-old man developed acute abdominal pain one hour after removal of a biliary T-tube. Axial gradient recall echo (GRE) MR images obtained 1 hour after the intravenous administration of mangafodipir trisodium shows contrast extravasation in the perihepatic space (white arrows). The leak was arising from the right hepatic duct (black arrow). Findings were confirmed at ERC. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)

Figure 14 MDCT with IV contrast in an 83-year-old man with obstructive jaundice. Using a workstation, the imaging set was rendered in an oblique sagittal plane along the porta hepatis. Images show a multiseptated fluid attenuation mass in the region of the common bile duct. Differential diagnoses for this mass include lymphocele, lymphangioma, or cystic nerve sheath tumor. Gastroenterology 2003 124, 1686-1699DOI: (10.1016/S0016-5085(03)00390-1)