HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shin, S. M. Articles by Kim, G. H. Search for Related Content PubMed PubMed Citation Articles by Shin, S. M. Articles by Kim, G. H. Social Bookmarking                      What's this?

Biliary Abnormalities Associated with Portal Biliopathy: Evaluation on MR Cholangiography

¹ Department of Diagnostic Radiology, College of Medicine, Pusan National University Hospital, 10, Ami-Dong, Suh-Ku, Busan 602-739, Republic of Korea.
² Department of Internal Medicine, College of Medicine, Pusan National University Hospital, Busan 602-739, Republic of Korea.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Graphic shows collateral circulation in portal cavernoma. ECVP = epicholedochal venous plexus, CV = cystic vein, PV = portal vein, GB = gallbladder, PCVP = paracholedochal venous plexus, PSPDV = posterior superior pancreaticoduodenal vein, CBD = common bile duct, LGV = left gastric vein, SMV = superior mesenteric vein, SV = splenic vein.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —45-year-old man with stricture and proximal ductal dilatation (patient 2 in Table 1). Initial CT scans show dotlike enhancing foci, suggesting epicholedochal veins within thickened wall (arrow, B), paracholedochal veins (arrowheads), and proximal ductal dilatation.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —45-year-old man with stricture and proximal ductal dilatation (patient 2 in Table 1). Initial CT scans show dotlike enhancing foci, suggesting epicholedochal veins within thickened wall (arrow, B), paracholedochal veins (arrowheads), and proximal ductal dilatation.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —45-year-old man with stricture and proximal ductal dilatation (patient 2 in Table 1). Initial MR cholangiopancreatography (MRCP) image shows multiple strictures (arrows) with proximal ductal dilatation.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —45-year-old man with stricture and proximal ductal dilatation (patient 2 in Table 1). Endoscopic retrograde cholangiography image shows focal stricture of common bile duct (arrow) without depiction of proximal bile duct.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —45-year-old man with stricture and proximal ductal dilatation (patient 2 in Table 1). MRCP image is able to depict entire biliary tree despite obstruction or stenosis. Physician attempted to perform endoscopic placement of plastic stent but failed. Follow-up MRCP (E) 26 months later shows there is also no significant interval change of bile duct (arrows). These changes in bile duct ("pseudocholangiocarcinoma sign") are caused by portal biliopathy.

View larger version (171K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —74-year-old man with stricture and proximal ductal dilatation (patient 8 in Table 1). Axial T2-weighted image (A) and dynamic 3D gradient-echo image (B) show focal and circumferential wall thickening with dotlike enhancing foci, suggesting epicholedochal veins (thick arrows) in proximal common hepatic duct (thin arrows). Paracholedochal veins (arrowheads) and gallbladder varices (open arrows) appear as low signal intensity on T2-weighted image (A) and as enhancing tortuous collaterals on dynamic 3D gradient-echo image (B).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —74-year-old man with stricture and proximal ductal dilatation (patient 8 in Table 1). Axial T2-weighted image (A) and dynamic 3D gradient-echo image (B) show focal and circumferential wall thickening with dotlike enhancing foci, suggesting epicholedochal veins (thick arrows) in proximal common hepatic duct (thin arrows). Paracholedochal veins (arrowheads) and gallbladder varices (open arrows) appear as low signal intensity on T2-weighted image (A) and as enhancing tortuous collaterals on dynamic 3D gradient-echo image (B).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —74-year-old man with stricture and proximal ductal dilatation (patient 8 in Table 1). Stricture with proximal bile duct dilatation is shown on MR cholangiopancreatography (MRCP) image (C) and endoscopic retrograde cholangiography (ERC) image (D). ERC image (D) shows stricture portion is not distended with pressure-guided injection of contrast material in this patient. Biliary ductal wall thickening (arrows) indicates delayed enhancement on dynamic 3D gradient-echo image (B).

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —74-year-old man with stricture and proximal ductal dilatation (patient 8 in Table 1). Stricture with proximal bile duct dilatation is shown on MR cholangiopancreatography (MRCP) image (C) and endoscopic retrograde cholangiography (ERC) image (D). ERC image (D) shows stricture portion is not distended with pressure-guided injection of contrast material in this patient. Biliary ductal wall thickening (arrows) indicates delayed enhancement on dynamic 3D gradient-echo image (B).

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —40-year-old man with irregular contour of bile duct (patient 7 in Table 1). Sequential CT scans from level of porta hepatis to level of suprapancreatic common bile duct show irregularity of biliary ductal wall (arrows) due to cavernous transformation (arrowheads).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —40-year-old man with irregular contour of bile duct (patient 7 in Table 1). MR cholangiopancreatography reveals compression of bile duct (arrows) by portal cavernoma (arrowhead).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —40-year-old man with irregular contour of bile duct (patient 7 in Table 1). MR portography shows portal cavernoma (arrowheads).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —59-year-old woman with varicoid type biliary abnormality (patient 4 in Table 1). T-tube cholangiography image after cholecystectomy shows smooth indentation of bile duct (arrows) by its cavernous transformation. Follow-up MRI for evaluation of biliary symptoms associated with cystic duct remnants was performed 1 month later (not shown).

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —59-year-old woman with varicoid type biliary abnormality (patient 4 in Table 1). Coronal dynamic 3D gradient-echo image (B) and MR cholangiopancreatography (C) show cavernoma (arrowhead, B) and irregular contour of bile duct (arrows).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —59-year-old woman with varicoid type biliary abnormality (patient 4 in Table 1). Coronal dynamic 3D gradient-echo image (B) and MR cholangiopancreatography (C) show cavernoma (arrowhead, B) and irregular contour of bile duct (arrows).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Paracholedochal venous plexus (arrowhead, A) appears as low signal intensity on MR cholangiopancreatography (MRCP) image (A) and as enhancing tortuous collaterals on dynamic 3D gradient-echo image (B). MRCP shows multifocal strictures of intrahepatic and extrahepatic bile ducts with upstream bile duct dilatation (arrows), which may be caused by portal cavernoma (arrowhead, B) and fibrous scarring. Three-dimensional gradient-echo images during delayed phase (not shown) revealed no delayed prolonged enhancement of stricture segment.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Paracholedochal venous plexus (arrowhead, A) appears as low signal intensity on MR cholangiopancreatography (MRCP) image (A) and as enhancing tortuous collaterals on dynamic 3D gradient-echo image (B). MRCP shows multifocal strictures of intrahepatic and extrahepatic bile ducts with upstream bile duct dilatation (arrows), which may be caused by portal cavernoma (arrowhead, B) and fibrous scarring. Three-dimensional gradient-echo images during delayed phase (not shown) revealed no delayed prolonged enhancement of stricture segment.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Percutaneous transhepatic cholangiography (PTC) images of mixed type biliary abnormality show irregular contour with repetitive portions of narrowing and dilatation. Narrowing portion (arrows) was obscured and distended on PTC with pressure-guided injection of contrast material.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Percutaneous transhepatic cholangiography (PTC) images of mixed type biliary abnormality show irregular contour with repetitive portions of narrowing and dilatation. Narrowing portion (arrows) was obscured and distended on PTC with pressure-guided injection of contrast material.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Choledochoscopic findings show common bile duct stricture before (E) and distension after (F) pressure-guided injection of water similar to findings on PTC.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F —43-year-old man with mixed type biliary abnormality (patient 11 in Table 1). Choledochoscopic findings show common bile duct stricture before (E) and distension after (F) pressure-guided injection of water similar to findings on PTC.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati