SPIRAL CT CHOLANGIOGRAPHY AND 3D RECONSTR UCTION OF THE PEDIATRIC BILIARY-TRACT

Purpose: endoscopic retrograde cholangiography may be difficult or unf easible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contributio n of spiral CT cholangiography in pediatric patients. Subjects and met hods: seven patients. age ranging from 10 months to 13 years were expl ored without general anesthesia. Eight spiral CT cholangiographies wer e performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of io dipamide (Transbilix - Guerbet). The dose was correlated to the body s urface. 3D reconstructions were done using the surface rendering or th e MIP technique. Results: biliary tract opacification and 3D reconstru ctions were considered of good quality in 6 out of 8 studies. It was n ormal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile du cts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quali ty due to inadequate sedation and a case of Caroli's disease with a hi gh serum bilirubin level. Four patients had an endoscopic or a percuta neous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of C aroli's disease. Conclusion: spiral CT is feasible even in young child ren. It should reduce the indications for endoscopic or percutaneous c holangiography. It has to be performed as the first examination in cas es of biliary or pancreatic diseases when surgery is contemplated.