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Lopes Vendrami C, Thorson DL, Borhani AA, Mittal PK, Hammond NA, Escobar DJ, Gabriel H, Recht HS, Horowitz JM, Kelahan LC, Wood CG, Nikolaidis P, Venkatesh SK, Miller FH. Imaging of Biliary Tree Abnormalities. Radiographics 2024; 44:e230174. [PMID: 39024175 DOI: 10.1148/rg.230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Pathologic conditions of the biliary system, although common, can be difficult to diagnose clinically. Challenges in biliary imaging include anatomic variants and the dynamic nature of the biliary tract, which can change with age and intervention, blurring the boundaries of normal and abnormal. Choledochal cysts can have numerous appearances and are important to diagnose given the risk of cholangiocarcinoma potentially requiring surgical resection. Choledocholithiasis, the most common cause of biliary dilatation, can be difficult to detect at US and CT, with MRI having the highest sensitivity. However, knowledge of the imaging pitfalls of MRI and MR cholangiopancreatography is crucial to avoid misinterpretation. Newer concepts in biliary tract malignancy include intraductal papillary biliary neoplasms that may develop into cholangiocarcinoma. New paradigms in the classification of cholangiocarcinoma correspond to the wide range of imaging appearances of the disease and have implications for prognosis. Accurately staging cholangiocarcinoma is imperative, given expanding curative options including transplant and more aggressive surgical options. Infections of the biliary tree include acute cholangitis or recurrent pyogenic cholangitis, characterized by obstruction, strictures, and central biliary dilatation. Inflammatory conditions include primary sclerosing cholangitis, which features strictures and fibrosis but can be difficult to differentiate from secondary causes of sclerosing cholangitis, including more recently described entities such as immunoglobulin G4-related sclerosing cholangitis and COVID-19 secondary sclerosing cholangitis. The authors describe a wide variety of benign and malignant biliary tract abnormalities, highlight differentiating features of the cholangitides, provide an approach to interpretation based on the pattern of imaging findings, and discuss pearls and pitfalls of imaging to facilitate accurate diagnosis. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Camila Lopes Vendrami
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Deanna L Thorson
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Amir A Borhani
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Pardeep K Mittal
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Nancy A Hammond
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - David J Escobar
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Helena Gabriel
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Hannah S Recht
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Jeanne M Horowitz
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Linda C Kelahan
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Cecil G Wood
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Paul Nikolaidis
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Sudhakar K Venkatesh
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Frank H Miller
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
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Chandarana H, Doshi AM, Shanbhogue A, Babb JS, Bruno MT, Zhao T, Raithel E, Zenge MO, Li G, Otazo R. Three-dimensional MR Cholangiopancreatography in a Breath Hold with Sparsity-based Reconstruction of Highly Undersampled Data. Radiology 2016; 280:585-94. [PMID: 26982678 DOI: 10.1148/radiol.2016151935] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop a three-dimensional breath-hold (BH) magnetic resonance (MR) cholangiopancreatographic protocol with sampling perfection with application-optimized contrast using different flip-angle evolutions (SPACE) acquisition and sparsity-based iterative reconstruction (SPARSE) of prospectively sampled 5% k-space data and to compare the results with conventional respiratory-triggered (RT) acquisition. Materials and Methods This HIPAA-compliant prospective study was institutional review board approved. Twenty-nine patients underwent conventional RT SPACE and BH-accelerated SPACE acquisition with 5% k-space sampling at 3 T. Spatial resolution and other parameters were matched when possible. BH SPACE images were reconstructed by enforcing joint multicoil sparsity in the wavelet domain (SPARSE-SPACE). Two board-certified radiologists independently evaluated BH SPARSE-SPACE and RT SPACE images for image quality parameters in the pancreatic duct and common bile duct by using a five-point scale. The Wilcoxon signed-rank test was used to compare BH SPARSE-SPACE and RT SPACE images. Results Acquisition time for BH SPARSE-SPACE was 20 seconds, which was significantly (P < .001) shorter than that for RT SPACE (mean ± standard deviation, 338.8 sec ± 69.1). Overall image quality scores were higher for BH SPARSE-SPACE than for RT SPACE images for both readers for the proximal, middle, and distal pancreatic duct, but the difference was not statistically significant (P > .05). For reader 1, distal common bile duct scores were significantly higher with BH SPARSE-SPACE acquisition (P = .036). More patients had acceptable or better overall image quality (scores ≥ 3) with BH SPARSE-SPACE than with RT SPACE acquisition, respectively, for the proximal (23 of 29 [79%] vs 22 of 29 [76%]), middle (22 of 29 [76%] vs 18 of 29 [62%]), and distal (20 of 29 [69%] vs 13 of 29 [45%]) pancreatic duct and the proximal (25 of 28 [89%] vs 22 of 28 [79%]) and distal (25 of 28 [89%] vs 24 of 28 [86%]) common bile duct. Conclusion BH SPARSE-SPACE showed similar or superior image quality for the pancreatic and common duct compared with that of RT SPACE despite 17-fold shorter acquisition time. (©) RSNA, 2016.
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Affiliation(s)
- Hersh Chandarana
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Ankur M Doshi
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Alampady Shanbhogue
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - James S Babb
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Mary T Bruno
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Tiejun Zhao
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Esther Raithel
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Michael O Zenge
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Guobin Li
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
| | - Ricardo Otazo
- From the Center for Advanced Imaging Innovation and Research (CAI2R) (H.C., J.S.B., R.O.) and Bernard and Irene Schwartz Center for Biomedical Imaging (H.C., A.M.D., A.S., J.S.B., M.T.B., R.O.), Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016; Siemens Healthcare, New York, NY (T.Z., M.O.Z.); Siemens Healthcare, Erlangen, Germany (E.R.); and Department of Radiology, Section of Medical Physics, Freiburg University Medical Center, Freiburg, Germany (G.L.)
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