Abstract
Clinical data such as history, physical examination, and laboratory tests are useful
in identifying patients with biliary obstruction and biliary sources of infection.
However, if intervention is planned, noninvasive imaging is needed to confirm the
presence, location, and extent of the disease process. Currently, the most commonly
available and used noninvasive modalities are ultrasound (US), computed tomography
(CT), magnetic resonance (MR), and nuclear medicine hepatobiliary scintigraphy (HIDA).
US is quick, portable, readily available, and is commonly the first imaging modality
used when biliary pathology is suspected. It is excellent in the detection of cholelithiasis
and acute cholecystitis but is limited in detecting choledocholithiasis. CT is excellent
at detecting infected postoperative fluid collections, bilomas, biliary obstruction,
and biliary infection but is limited in the detection of cholelithiasis. Therefore,
US may be more useful than CT for the initial screening of acute biliary disease.
MR has inherent advantages over CT, as it does not use ionizing radiation, can be
done without intravenous contrast, and its detection of cholelithiasis is not affected
by the internal composition of the stone. Magnetic resonance cholangiopancreatography
can be used to determine the cause and location of biliary obstruction but is limited
in the detection of small stones and the evaluation of the biliary tract near the
ampulla. HIDA is used to evaluate for cholecystitis, biliary obstruction, and bile
leaks. The main limitation is its lack of anatomical detail, and it is therefore frequently
performed in conjunction with other described modalities.
Keywords
cholelithiasis - cholecystitis - interventional radiology - biliary obstruction -
biloma
