Abdominal Imaging 腹部影像.ppt

Imaging of the Biliary Tract Methods of examination Normal anatomy and X-ray findings Common diseases Methods of examination (I) Plain film: calcium (10~20%) Oral cholecystography Intravenous cholangiography T tube cholangiography Endoscopic retrograde cholangio- pancreatography, ERCP percutaneous transhepatic cholangiography, PTC Plain film — gallstone Oral cholecystography T tube cholangiography ERCP PTC Method of examination (II) Ultrasonography (US) Angiography Computed tomography (CT) spiral CT cholangiography (SCTC) Magnetic resonance imaging (MRI) MR cholangiopancreatography (MRCP) MRCP Normal gallbladder anatomy right 12th rib level Round, oval or pear-shaped 7~10cm in length, 3~4cm in width four parts: funds, body, infundibulum, neck cystic duct: 3cm in length, 2~3cm in width Normal biliary tract findings Intrahepatic bile duct left、right hepatic duct common hepatic duct (3~4cm in length, 4~6mm in width) cystic duct common bile duct (6~10cm in length, 4~8mm in width) Position: between the left and right lobes of liver, at the porta section or below it. Shape: oval Size: 4 × 5cm Density: lower, a little higher than water, homogeneous Common bile duct : 1/3 is visualized Intrahepatic ducts are not visualized Common diseases of biliary tract Gallstone Cholecystitis Gallbladder cancer Gallstones (I) composition: cholesterol, bile pigment, calcium shape: round, multi-facet, shell-like location: gallbladder, intra- or extra-hepatic bile duct Gallstones (II) opaque stone (+): 10~20% plain film (differentiate: renal stone) non-opaque stone (-): 80~90% contrast study: filling defect Gallstones – non-opacifying Gallstones – non-opaque stone Stones in common bile duct Stones in common bile duct Hepatic bile duct stone Gallstones and hepatic duct stones Differentiation of calculi Acute cholecystitis Causes: bil