Computed Tomography CT

CT is less limited by artifacts, is less operator-dependent than US and reliably enables visualization of the entire biliary system in virtually all patients. Contrast-material-enhanced mulitslice CT (MSCT) studies with 1-2 mm sections enable multiplanar or curved reformatting, and are thus very suitable for the definition of the exact level of bile duct obstruction and the nature and extent of soft tissue masses causing ductal compression. Image processing with curved reconstructions allows visualization of the common bile duct in its entire length (Fig. 1),

Fig. 1. Choledocholithiasis. MSCT (curved coronal reconstruction) showing a large calculus in the main common bile duct

and minimum intensity algorithms allow the dilated biliary tree visualized with CT to be better delineated (Fig. 2a). It must be recognized, however, that despite its excellent contrast resolution, CT has a limited sensitivity for the detection of cholesterol calculi that are often isodense with the surrounding bile. Therefore, CT cannot be considered as the method of choice to rule out calculous disease. CT-angiography with two-dimensional (2D) and three-dimensional (3D) reconstruction has largely replaced catheter angiography for preoperative delineation of the major arterial and portal venous branches prior to surgery.

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