Hilar Biliary Obstruction: Preliminary Results with Levovist-Enhanced Sonography
Korosh Khalili1,
Ur Metser and
Stephanie R. Wilson
1 All authors: Department of Medical Imaging, Toronto General Hospital,
University Health Network, 200 Elizabeth St., Toronto, Ontario, Canada M5G
2C4.
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Fig. 1A. —Malignant biliary obstruction in 68-year-old man with
invasive cholangiocarcinoma. Transverse unenhanced sonogram shows segmental
dilated ducts in right lobe that terminate blindly in region of porta hepatis.
No mass is visualized.
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Fig. 1B. —Malignant biliary obstruction in 68-year-old man with
invasive cholangiocarcinoma. Transverse postvascular contrast-enhanced
sonogram shows large invasive tumor with intraductal and periductal
extension.
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Fig. 2A. —Malignant hilar obstruction from cholangiocarcinoma with
metastatic liver nodules in 77-year-old man. Transverse unenhanced sonogram
shows mass in left lobe and dilated ducts (arrowheads) in right lobe
of liver.
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Fig. 2B. —Malignant hilar obstruction from cholangiocarcinoma with
metastatic liver nodules in 77-year-old man. Transverse contrast-enhanced
sonogram clearly shows larger mass with increased conspicuity and better
defined borders. Also visible is small isolated metastasis in liver
(arrow) that was seen only on enhanced imaging.
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Fig. 2C. —Malignant hilar obstruction from cholangiocarcinoma with
metastatic liver nodules in 77-year-old man. Confirmatory CT scan shows large
primary tumor and liver metastasis (arrow).
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Fig. 3A. —Malignant hilar obstruction from invasive gallbladder
carcinoma with extensive intraductal tumor extension in 83-year-old woman.
Transverse unenhanced sonogram shows dilated intrahepatic biliary ducts and
visible intraductal tumor (arrowheads).
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Fig. 3B. —Malignant hilar obstruction from invasive gallbladder
carcinoma with extensive intraductal tumor extension in 83-year-old woman.
Transverse contrast-enhanced sonogram improves conspicuity of duct walls and
intraductal tumor (arrowheads). No invasive tumor is seen at this
level.
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Fig. 3C. —Malignant hilar obstruction from invasive gallbladder
carcinoma with extensive intraductal tumor extension in 83-year-old woman. CT
scan obtained at same level does not depict intraductal tumor. Invasive
obstructing mass (not shown) at porta hepatis was seen on another CT scan and
on postvascular phase contrast-enhanced sonogram.
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Fig. 4A. —Malignant hilar obstruction from cholangiocarcinoma in
42-year-old man with large intraductal tumor. Transverse unenhanced sonogram
of left lobe of liver shows poorly defined mass (arrowheads).
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Fig. 4B. —Malignant hilar obstruction from cholangiocarcinoma in
42-year-old man with large intraductal tumor. Transverse contrast-enhanced
sonogram shows abnormality to be tumor-filled left hepatic duct
(arrowheads). No parenchymal invasion is seen.
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Fig. 4C. —Malignant hilar obstruction from cholangiocarcinoma in
42-year-old man with large intraductal tumor. Confirmatory CT scan shows same
findings as contrast-enhanced sonogram (B).
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Fig. 5A. —Benign biliary obstruction due to primary sclerosing
cholangitis in 42-year-old woman with periductal thickening. Transverse
unenhanced sonogram obtained through porta hepatis reveals periportal region
with vague slightly hypoechoic areas (arrowheads).
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Fig. 5B. —Benign biliary obstruction due to primary sclerosing
cholangitis in 42-year-old woman with periductal thickening. Transverse
contrast-enhanced sonogram shows extensive periductal soft-tissue thickening
(arrowheads) around central biliary tree.
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Fig. 5C. —Benign biliary obstruction due to primary sclerosing
cholangitis in 42-year-old woman with periductal thickening. Confirmatory
contrast-enhanced CT scan shows regions (arrowheads) as
hypoattenuating relative to enhancing liver.
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Fig. 6A. —Benign inflammatory masses mimicking cholangiocarcinoma on
contrast-enhanced sonography and MR imaging in 63-year-old man 6 years after
left liver resection for cholangiocarcinoma. Transverse sonogram shows dilated
segmental bile duct (arrow) at resection margin in liver ventral
relative to right portal vein.
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Fig. 6B. —Benign inflammatory masses mimicking cholangiocarcinoma on
contrast-enhanced sonography and MR imaging in 63-year-old man 6 years after
left liver resection for cholangiocarcinoma. Transverse postvascular
contrast-enhanced sonogram obtained in same plane as A shows multiple
nonenhancing nodules (arrowhead) in periductal region
(arrow).
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Fig. 6C. —Benign inflammatory masses mimicking cholangiocarcinoma on
contrast-enhanced sonography and MR imaging in 63-year-old man 6 years after
left liver resection for cholangiocarcinoma. Confirmatory gadolinium-enhanced
T1-weighted MR image shows same dilated segmental bile duct (arrow)
surrounded by enhancing soft-tissue nodules (arrowhead). Both MR
image and sonogram were interpreted as showing recurrent
cholangiocarcinoma.
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Copyright © 2003 by the American Roentgen Ray Society.
