End-stage primary sclerosing cholangitis: CT findings of hepatic morphology in 36 patients

PURPOSE: To determine if there is a significant difference in the hepatic morphology depicted on computed tomographic (CT) scans in patients with end-stage cirrhosis caused by primary sclerosing cholangitis versus that in patients with end-stage cirrhosis caused by other factors. MATERIALS AND METHODS: The frequency of five morphologic findings of the liver parenchyma and two intrahepatic biliary findings identified on CT scans in 36 patients with end-stage cirrhosis caused by primary sclerosing cholangitis were compared with the frequency of the same findings in 472 patients with end-stage cirrhosis caused by other factors. The morphologic findings were lobulation of the liver contour, atrophy of the lateral or posterior hepatic segments, hypertrophy of the caudate lobe, and pseudotumor of the caudate lobe. Lobulation, atrophy, and hypertrophy were subclassified as mild-moderate or severe. The biliary findings were ductal dilatation and calculi. RESULTS: Each of the 11 findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in the other 472 patients. Six findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in patients with cirrhosis caused by any other single agent. CONCLUSION: There is a significant difference in the hepatic morphology observed in patients with primary sclerosing cholangitis-induced end-stage cirrhosis versus that in patients with end-stage cirrhosis of other causes.     

Comparison of MR cholangiopancreatographic techniques with contrast-enhanced cholangiography in the evaluation of sclerosing cholangitis.

OBJECTIVE: The purpose of our study was to compare MR cholangiopancreatography and contrast-enhanced cholangiography in patients with sclerosing cholangitis. MATERIALS AND METHODS: Twenty patients with sclerosing cholangitis were evaluated on MR cholangiopancreatography using the single-shot fast spin-echo technique at 1.5 T. A group of 19 healthy volunteers underwent MR cholangiopancreatography as controls. Thick-slab (2-cm sections) coronal oblique and thin-slab (5-mm sections) interleaved straight coronal MR images were obtained. All patients with sclerosing cholangitis had an MR cholangiopancreatogram within 12 months of a contrast-enhanced cholangiogram (mean, 3.8 months). Seventy-five percent of patients had an MR cholangiopancreatogram within 3 months of the contrast-enhanced cholangiogram. The MR cholangiopancreatograms and contrast-enhanced cholangiograms were reviewed independently in a random fashion by two radiologists who were unaware of clinical history for the degree of ductal visualization and for the presence and location of strictures of the intrahepatic and extrahepatic bile ducts. All discrepancies were resolved by a consensus, and the contrast-enhanced cholangiograms were regarded as the gold standard. Statistically significant data were calculated using the signed rank test (p < 0.01), and agreement analysis was calculated using Cohen's kappa. RESULTS: All findings on MR cholangiopancreatograms in healthy subjects were interpreted as normal, and all findings on MR cholangiopancreatograms in patients with sclerosing cholangitis were interpreted as abnormal. When compared with the control group, scans of patients with sclerosing cholangitis usually showed good visualization (>50%) of the intrasegmental (86% vs 9%) and peripheral (67% vs 0%) intrahepatic ducts on thick-slab MR cholangiopancreatography. Thick-slab MR cholangiopancreatography showed good visualization in more ducts than contrast cholangiography (84% vs 70%; p = 0.10) and showed more strictured ducts than contrast cholangiography (47% vs 36%; p = 0.22). When comparing those ducts with good visualization on both MR cholangiopancreatography and contrast cholangiography, we found that disagreement occurred regarding 32% of ducts. Most of the discrepancies (60%) resulted when a stricture was noted on MR cholangiopancreatography but not on contrast-enhanced cholangiography. Good interobserver agreement (kappa > 0.4) was noted for detecting strictures of the extrahepatic, left hepatic, left medial, and right posterior ducts, with the greatest agreement for extrahepatic ductal strictures (kappa = 0.8). CONCLUSION: Thick-slab MR cholangiopancreatography is the best technique for depicting normal and strictured bile ducts and allows the differentiation of healthy patients from patients with sclerosing cholangitis. Although endoscopic retrograde cholangiopancreatography was considered the standard, MR cholangiopancreatography was superior for intrahepatic biliary ductal visualization. Therefore, this technique is of value in the diagnosis and follow-up of patients with sclerosing cholangitis.     

Using CT and cholangiography to diagnose biliary tract carcinoma complicating primary sclerosing cholangitis

OBJECTIVE: The objective of our study was to determine the value of CT and cholangiography for diagnosing biliary tract carcinoma complicating primary sclerosing cholangitis. MATERIALS AND METHODS: One hundred thirteen abdominal CT examinations and cholangiograms in 45 patients with primary sclerosing cholangitis, including 18 patients with established biliary tract carcinoma, were analyzed for tumor. Four radiologists who were unaware of the presence or absence of carcinoma rated each study as to the probability of malignancy. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of CT and cholangiography, the value of imaging signs, and the degree of inter-observer variation in interpretation. Sensitivity and specificity values were calculated. RESULTS: CT outperformed cholangiography in the detection of carcinoma. The average area under the receiver operating characteristic curve was 0.82 for CT and 0.57 for cholangiography (p = 0.003). Sensitivity and specificity for detecting carcinoma using CT were good, with average values of 82% and 80%, respectively. Average sensitivity and specificity for cholangiography were 54% and 53%, respectively. The most reliable sign of tumor on CT was a discrete mass. Progressive biliary dilatation on sequential studies was the most useful sign on cholangiography. Interobserver agreement assessed using the Cronbach alpha was fair for cholangiography and good for CT. CONCLUSION: CT provides good sensitivity and specificity and significantly outperforms cholangiography in detecting biliary tract carcinoma complicating primary sclerosing cholangitis. Despite limitations, CT and cholangiography provide useful information not otherwise available in the treatment of patients with primary sclerosing cholangitis.     

Percutaneous cholecystography in children

Percutaneous cholecystography was performed on 13 children who had biliary system abnormalities: two had biliary hypoplasia, five had sclerosing cholangitis, three had cirrhosis, two had distal choledochal obstruction, and one had an obstructed portoenterostomy. In 12 patients transcholecystic cholangiography showed, without significant complications, the intra-and extrahepatic bile ducts. In one patient with primary sclerosing cholangitis, the intrahepatic bile ducts were not opacified satisfactorily; dilatation of the gallbladder required surgical drainage. The transcholecystic technique is indicated when the intrahepatic bile ducts are either mildly dilated or not dilated.     

Role of MR cholangiopancreatography in patients with failed or inadequate ERCP

OBJECTIVE: The purpose of this study was to evaluate the spectrum of MR imaging features of primary sclerosing cholangitis. MATERIALS AND METHODS: A retrospective review was performed of MR imaging findings including MR cholangiography and multiphasic contrast-enhanced dynamic sequences in 22 patients with primary sclerosing cholangitis. MR imaging analysis included abnormalities of intra- and extrahepatic bile ducts, abnormalities of liver parenchyma, changes in liver morphology, and lymphadenopathy. RESULTS: Abnormal findings of bile ducts were seen in all 22 patients; the most common finding was intrahepatic bile duct dilatation (77%), followed by intrahepatic bile duct stenosis (64%), extrahepatic bile duct wall enhancement (67%), extrahepatic bile duct wall thickening (50%), extrahepatic bile duct stenosis (50%), and intrahepatic bile duct beading (36%). Increased enhancement of the liver parenchyma on dynamic arterial-phase images, predominantly in the peripheral areas of the liver, was identified in 56% of patients. Other findings included periportal lymphadenopathy (77%), periportal high signal intensity on T2-weighted images (68%), hypertrophy of the caudate lobe (68%), and abnormal hyperintensity of the liver parenchyma on T1-weighted images (23%). CONCLUSION: On MR imaging, primary sclerosing cholangitis showed several characteristic features, including bile duct abnormalities and increased enhancement of the liver parenchyma. MR cholangiography and contrast-enhanced dynamic MR techniques are useful for revealing intra- and extrahepatic signs of primary sclerosing cholangitis.     

Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT

AIM: To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. METHODS: Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data. RESULTS: Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. CONCLUSION: Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.     

Cholangiocarcinoma complicating primary sclerosing cholangitis: cholangiographic appearances

Cholangiograms from 104 patients (and serial cholangiograms in 66 patients) with primary sclerosing cholangitis (PSC) were reviewed. In 13 patients the additional diagnosis of cholangiocarcinoma was made at biopsy or autopsy. Cholangiograms from patients with both PSC and carcinoma were compared with cholangiograms from patients with PSC alone. Marked dilatation of ducts or ductal segments (100% vs. 24%) and the appearance of a polypoid mass (46% vs. 7%) were common findings in the group of patients whose disease was complicated by malignancy. In the malignant group, polypoid masses were larger, measuring 1 cm or greater in diameter. On serial cholangiograms, four of 15 patients with progressive stricture formation and four of five with progressive ductal dilatation proved to have carcinomas. The frequent occurrence of bile duct carcinoma as a complication of PSC in this group of patients indicates that PSC has a strong tendency to undergo malignant degeneration. Cholangiographic findings which suggest malignant degeneration include markedly dilated ducts or ductal segments, presence of a polypoid mass 1 cm or greater in diameter, and progressive stricture formation or ductal dilatation.     

Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography

PURPOSE: To compare the accuracy of magnetic resonance (MR) cholangiography with that of direct cholangiography for the evaluation of recurrent pyogenic cholangitis. MATERIALS AND METHODS: Twenty-four patients with recurrent pyogenic cholangitis underwent MR cholangiography before surgery, and 18 of these 24 also underwent direct cholangiography. Two reviewers evaluated MR cholangiograms and direct cholangiograms and focused on identifying intrahepatic ductal dilatation, stricture, and calculi, as well as coexistent parenchymal abnormalities, on the basis of the classification of the internal lobes and segments of the liver. These observations were compared with surgical findings. RESULTS: According to examination results in the surgical specimens, 24 patients had 46 segmental abnormalities. MR cholangiography depicted all 46 (100%) segments with ductal dilatation, 22 (96%) of 23 segments with focal ductal stricture, and 43 (98%) of 44 segments with ductal calculi. Eighteen patients who underwent direct cholangiography had 32 segmental abnormalities according to examination results in the surgical specimens. Direct cholangiography depicted 15 (47%) of 32 segments with ductal dilatation, eight (44%) of 18 segments with focal ductal stricture, and 14 (45%) of 31 segments with ductal calculi. CONCLUSION: MR cholangiography is superior to direct cholangiography for accurate topographic evaluation of recurrent pyogenic cholangitis because it is able to depict all of the biliary tree, despite obstruction or stenosis.     

Pancreatic changes in primary sclerosing cholangitis: evaluation with MR imaging

OBJECTIVE: The purpose of this study was to determine the frequency and the spectrum of MR imaging findings of pancreatic abnormalities in patients with primary sclerosing cholangitis. MATERIALS AND METHODS: MR images in 24 patients with primary sclerosing cholangitis were retrospectively reviewed for evidence of pancreatic abnormalities, including abnormalities of signal intensity; changes in size and morphology; abnormalities of pancreatic ducts; presence of focal lesions, pseudocysts, and peripancreatic edema or fluid; and contrast-enhancement pattern if dynamic studies were available. RESULTS: Eleven patients with pancreatic abnormalities on MR images (case patients) and 13 patients with normal MR findings of the pancreas (cohort patients) were identified. The most common finding in case patients was increased signal intensity of the pancreas on T2-weighted images (73%), followed by decreased signal intensity on T1-weighted images (55%) and decreased enhancement on arterial-phase contrast-enhanced images (50%). Other findings included marked enlargement of the pancreas (27%), narrowing of pancreatic ducts (27%), and peripancreatic edema or fluid (27%). The mean value of the anteroposterior diameter of the pancreatic head in the case patients was significantly greater than that in the cohort patients (p = .039). The mean signal-intensity ratio on the T2-weighted images was significantly higher in the case patients than in the cohort patients (p = .007). CONCLUSION: Increased signal on T2-weighted images, decreased signal on T1-weighted images, enlargement of the pancreas, and decreased contrast-enhancement were MR findings of pancreatic disease associated with primary sclerosing cholangitis.     

Do patients with primary sclerosing cholangitis have a greater frequency of pancreatic abnormalities at MRI than patients with other liver diseases?

PURPOSE: It has been proposed that there is an increased frequency of pancreatic abnormalities in patients with primary sclerosing cholangitis (PSC). Our purpose is to compare the frequency of pancreatic abnormalities detected at MRI in patients with PSC and to compare these findings with those found in a matched cohort with other liver diseases. METHOD: We identified 29 patients who had either a histologic or an endoscopic retrograde cholangiopancreatography diagnosis of PSC and 29 age- and gender-matched patients with liver disease without PSC who underwent MRI at 1.5 T. The protocol included breath-hold T1-weighted gradient echo, echo train, fast spin echo, T2-weighted images and dynamic gadolinium-enhanced MRI. Two blinded readers retrospectively evaluated the MR images for abnormalities of pancreatic size and morphology, T1 and T2 signal intensity, duct size and irregularities, arterial-phase contrast enhancement, focal pancreatic masses, cystic lesions, peripancreatic fluid/edema, ascites, and capsular-like rim surrounding the pancreas. RESULTS: The prevalence of pancreatic and peripancreatic abnormalities was 10 of 29 (35%) in PSC patients and 14 of 29 (48%) in control patients. MR findings included ascites (9 PSC, 12 controls), peripancreatic edema (7 PSC, 11 controls), atrophy (4 PSC, 3 control), increased T2 signal (3 PSC, 4 controls), cystic lesions (2 PSC, 3 controls), abnormal T1 signal (1 PSC, 2 controls), and dilated pancreatic ducts (3 PSC, 2 controls). Quantitative parameters were not significantly different between PSC patients and the control subjects with pancreatic findings. CONCLUSION: There is no significant difference in pancreatic abnormalities detected on MRI between patients with PSC and those with other liver diseases.     

Sclerosing-cholangitis-like changes in pancreatic disease

In a retrospective analysis of endoscopic cholangiograms in 66 patients with pancreatic disease we found sclerosing-cholangitis-like changes in 83% of cases. Excluding patients with intrapancreatic constriction of the distal common bile duct, 70% of patients with chronic pancreatitis, 60% with acute pancreatitis and 100% with pancreatic cancer had these abnormalities. The possible significance of these changes, which are unlikely to be secondary to pancreatic disease, are discussed with reference to the published literature on sclerosing cholangitis.     

Gallbladder opacification on gadoxetate disodium-enhanced CT scan

This study aimed to evaluate the radiologist’s ability to identify excreted gadoxetate disodium within the gallbladder on CT scan. Thirty three healthy adults underwent imaging of the liver during work-up for potential liver donation. Three patients had undergone prior cholecystectomy and therefore were excluded. Imaging consisted of gadoxetate disodium-enhanced magnetic resonance cholangiography (MRC) and multiphase contrast-enhanced CT scan of the abdomen and pelvis. Two fellowship-trained abdominal imaging radiologists, who were blinded to the MRC images and the contrast agent used during MRC, independently reviewed the CT scans of the 30 patients that were included. The scans were evaluated for the presence or absence of abnormal hyperdensity within the gallbladder. Three patients did not receive intravenous gadoxetate disodium, 4 patients had their MRC after the CT scan, and 1 patient had the CT scans 5 days following the MRC. Twenty two patients had the CT scan within 24 h following the gadoxetate disodium-enhanced MRC. Of the 22 patients expected to have gadolinium in the gallbladder, both reviewers identified hyperdensity in the same 20 patients (90%). Both reviewers reported no abnormal hyperdensity within the gallbladder in the remaining 10 patients. CT scan can reveal excreted gadoxetate disodium within the gallbladder lumen and therefore gadoxetate disodium-enhanced CT scan can potentially play a role in the evaluation of cystic duct patency and work-up of acute cholecystitis.     

An audit of biliary scintigraphy in a district general hospital (1993-1998) with special reference to the investigation of acalculous gallbladder disease

One hundred and ninety nine cholescintigrams were performed at our hospital between January 1993 and December 1998. Of these, 96 were performed as part of the investigation of right upper quadrant or epigastric pain in patients whose prior biliary ultrasound scans had shown no abnormalities. In this group of patients, 60 cholescintigrams were reported as normal, 28 as abnormal and eight as equivocal. A review of the case notes for this group was made, with 91 out of 96 case notes being retrieved. Thirteen of the 58 (22%) patients with normal cholescintigrams either underwent or had been offered cholecystectomy, compared with 22 of the 27 (81%) with 'definitely abnormal' cholescintigrams. Of the subset of patients with abnormal cholescintigrams subsequently undergoing cholecystectomy, 16 out of 18 were found to have histologically abnormal gallbladders, while 11 out of 18 reportedly had their symptoms cured or improved. A fatty meal is used in our unit as the stimulus to gallbladder contraction, in contrast to the majority of papers published in the literature. We believe that the use of a fatty meal is acceptable and that the use of intravenous exogenous cholecystokinin is probably best reserved for the small group of patients with equivocal scintigrams who may require further investigation.     

Chemotherapy-induced sclerosing cholangitis

AIM: To review the computed tomography (CT), magnetic resonance imaging (MRI) and cholangiographic findings of chemotherapy-induced sclerosing cholangitis (CISC). METHODS: Between January 1995 and December 2004, 11 patients in the endoscopic retrograde cholangiography database were identified with CISC. Twelve CT, four MRI, 69 endoscopic and nine antegrade cholangiographic studies in these patients were reviewed. Serial change in appearance and response to endoscopic treatment were recorded. RESULTS: CISC showed segmental irregular biliary dilatation with strictures of proximal extrahepatic bile ducts. The distal 5cm of common bile duct was not affected in any patient. CT and MRI findings included altered vascular perfusion of one or more liver segments, liver metastases or peritoneal carcinomatosis. Biliary strictures needed repeated stenting in 10 patients (mean: every 4.7 months). Cirrhosis (n=1) or confluent fibrosis (n=0) were uncommon findings. CONCLUSION: CISC shares similar cholangiographic appearances to primary sclerosing cholangitis (PSC). Unlike PSC, biliary disease primarily involved ducts at the hepatic porta rather than intrahepatic ducts. Multiphasic contrast-enhanced CT or MRI may show evidence of perfusion abnormalities, cavitary liver lesions, or metastatic disease.     

Primary sclerosing cholangitis: MR imaging findings with pathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate MR imaging findings of primary sclerosing cholangitis, to compare them with histopathologic findings, and to determine if these findings help differentiate primary sclerosing cholangitis from other disorders that result in end-stage liver disease. MATERIALS AND METHODS: MR imaging was performed in 40 patients (27 men, 13 women; age range, 13-72 years; mean, 47 years) with primary sclerosing cholangitis over a 9-year period. In 16 patients who underwent orthotopic hepatic transplantation and in seven patients who underwent needle biopsy, correlation was made between MR imaging and pathologic findings. RESULTS: Focal signal changes in the liver parenchyma were seen on T2-weighted images as peripheral wedge-shaped zones of increased signal intensity in 29 patients (72%), as a reticular pattern in 15 patients (38%), and as periportal edema in 16 patients (40%). Lobar atrophy involved the right lobe in three patients (8%) and the left lobe in 11 patients (28%); hypertrophy of the caudate lobe was seen in nine patients (23%). Features of portal hypertension were seen in 14 patients (35%). Histologic assessment showed zones of segmental atrophy and scarring on the periphery of the liver. CONCLUSION: Peripheral wedge-shaped areas of high T2 signal intensity and dilatation of bile ducts are characteristic MR features of primary sclerosing cholangitis. Pathologic correlation suggests that these features may be related to underlying perfusion changes and bile duct inflammation in patients with primary sclerosing cholangitis.     

Patients with partial seizures: evaluation by MR, CT, and PET imaging

Fifty patients who experienced partial seizures were imaged with computed tomography (CT) and magnetic resonance imaging (MR); 14 of these also had imaging studies of local cerebral glucose metabolism with positron emission tomography (PET). Thirteen patients with attenuation abnormalities on CT scans also had abnormal signals on MR images; ten other patients had MR-image signal abnormalities but normal CT scans. In all seven patients undergoing PET who had MR-signal and sometimes also CT-attenuation abnormalities, areas of metabolic asymmetry were present. Positive PET scans were also seen in three patients with no evidence of abnormality on CT and MR studies. Focal cerebral substance loss on CT and MR studies, present in 21 patients, did not correlate well with electroencephalographic findings. MR is utilized as the initial imaging procedure in patients with partial seizures because it is more readily available and less invasive than PET and more sensitive than CT scanning.     

Radiologic aspects of noncalculous inflammation of the biliary tract in AIDS

Six cases of non-lithiasic cholecystitis and 7 cases of inflammatory cholangitis caused by cryptosporidium and/or cytomegalovirus infections have been studied in HIV-1 + patients. All patients were examined with ultrasound and 5 with computed tomography (CT). The appearance is the same as that described for non-lithiasic cholecystitis (pain when the ultrasound probe is applied, thickened gallbladder wall) and sclerosing cholangitis (dilatation and/or stenosis of the bile duct, thickened gallbladder wall). The ultrasound or CT examination of HIV + patients with gallbladder involvement is sufficient to guide treatment when a thickened gallbladder wall is demonstrated. On the other hand, bile duct opacification is the only method allowing the accurate assessment of the extent of lesions in cholangitis, on which the indication for eventual sphincterotomy is based.     

Thoracic outlet syndrome: evaluation with CT

Diagnosis of the thoracic outlet syndrome is often difficult, particularly in patients without osseous abnormalities on plain radiographs. The radiographic and computed tomographic (CT) findings were reviewed from 27 patients with thoracic outlet syndrome and 21 normal subjects. The plain radiographs and CT scans were assessed by two independent observers without awareness of the clinical history. Fifteen patients with thoracic outlet syndrome had osseous abnormalities (anomalous cervical ribs; abnormally long, drooping C-7 transverse processes) identifiable on plain radiographs. CT did not provide further diagnostic information in the patients with abnormal radiographs. Eight of 12 patients (66%) with normal plain radiographs had abnormal findings on CT scans, consisting of impingement of the C-7 transverse process on the scalene triangle or anteromedial aspect of the middle scalene muscle. Only two of 21 control patients (9.5%) displayed this CT abnormality (P less than .01). CT may be useful in patients with symptoms suggestive of thoracic outlet syndrome and no osseous abnormalities on plain radiographs.     

Hepatobiliary manifestations of cystic fibrosis in children: correlation of CT and US findings.

MATERIAL AND METHODS: Abdominal US and CT scans of 50 pediatric cystic fibrosis (CF) patients were evaluated to search for specific data that can be attributed to the involvement of the hepatobiliary system. The liver findings of the two patients who were HBs antigen carriers were excluded from the study. RESULTS: 30 out of 48 patients had at least one abnormal finding of liver on CT and/or US. Although increased echogenicity of the liver was detected in 24 of 48 patients (50%), only six of these (12%) were regarded as steatosis according to CT criteria of low attenuation values. CT and US scans both showed unique multilobular fatty pattern, described as "pseudomasses" in three patients. Increased periportal echogenicity was seen in 18 (37%) patients on US, while CT could not demonstrate any sign of increased periportal thickness. Findings of cirrhosis were present in five patients with either modalities. Lymph nodes of less than 10-15 mm in diameter were detected at the hepatico-duodenal ligament in 18 (37%) patients. Anomalies of the gallbladder (absence or microgallbladder or stone) were detected in 12 cases (24%). CONCLUSION: Although US is the most widely used modality in CF patients, CT and US correlation will help to better delineate the abnormalities between steatosis and periportal fibrosis and increase the sensitivity of the imaging methods to achieve the most accurate diagnosis.     

原发性胆囊癌的CT诊断及鉴别诊断

目的探讨不同类型胆囊癌的CT表现，以提高对该病的诊断和鉴别诊断水平。方法回顾性分析18例经手术病理证实的胆囊癌的CT资料，均经螺旋CT平扫及增强扫描，分析其CT表现。结果18例胆囊癌按影像学表现分为4种类型：a)胆囊壁增厚型5例，b)腔内型3例，c)肿块型9例，d)胆囊颈型1例。其中5例合并胆囊结石，8例伴肝脏侵犯。结论CT在胆囊癌的诊断与鉴别诊断中具有重要作用。