Cholangiographic Techniques Using Iodinated Contrast Material

The term CT cholangiography refers to MSCT acquisition usually including 2D or 3D reformatted images obtained after the administration of intravenous cholangio-graphic agents. Since bile duct opacification depends on intact hepatic excretory function, it cannot be used in patients with significant hyperbilirubinemia. For this reason, but also because the cholangiographic agents are unavailable in several countries, CT cholangiography has only a minor role in daily practice.

ERCP and percutaneous transhepatic cholangiography (PTC) are used to opacify the biliary system directly by means of contrast material under fluoroscopic vision. Their main diagnostic advantage is the superior spatial resolution of the biliary anatomy, offering maximum anatomic detail (Fig. 2). ERCP is often used as the firstline approach, whereas PTC is mainly used when ERCP fails due to technical reasons or cannot be performed,

Fig. 2. Primary sclerosing cholangitis (PSC) a MSCT image reconstruction with a coronal minimum intensity projection algorithm showing dilated peripheral intrahepatic bile ducts with caliber irregularities. b Percutaneous transhepatic cholangiography showing muli-tiple irregularities of the intra- and extrahepatic bile ducts consistent with diffuse inflammatory strictures in the context of advanced PSC

Fig. 2. Primary sclerosing cholangitis (PSC) a MSCT image reconstruction with a coronal minimum intensity projection algorithm showing dilated peripheral intrahepatic bile ducts with caliber irregularities. b Percutaneous transhepatic cholangiography showing muli-tiple irregularities of the intra- and extrahepatic bile ducts consistent with diffuse inflammatory strictures in the context of advanced PSC

Percutaneous Cholangiography

e.g., in the presence of surgical anastomoses. The main advantage of ERCP and PTC is that therapeutic interventions may be performed during the same session, which is how these procedures are currently most commonly performed.

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