A. Gillams et al., 3-DIMENSIONAL COMPUTED-TOMOGRAPHY CHOLANGIOGRAPHY - A NEW TECHNIQUE FOR BILIARY-TRACT IMAGING, British journal of radiology, 67(797), 1994, pp. 445-448
Knowledge of the segmental anatomy and intersegmental biliary connecti
ons is an essential prerequisite to the effective management of patien
ts with complex biliary strictures. Three dimensional (3D) imaging has
the ability to demonstrate complex anatomical relationships that are
difficult to appreciate on simple noninvasive two dimensional (2D) ima
ging. Our aim was to develop a technique for accurate, non-invasive 3D
computed tomography (CT) cholangiography. Contiguous 4 mm CT sections
were obtained through the liver during a dynamic bolus of 200 ml IV c
ontrast. 3D surface reconstructions were then performed, the biliary s
ystem was isolated from surrounding hepatic parenchyma using segmentat
ion and contrast threshold algorithms. 14 patients (six females, eight
males, median age 68 years (range 48-82)) were studied. 13/14 had mal
ignant biliary obstruction and one had obstruction secondary to a panc
reatic pseudocyst. Obstruction was at the liver hilum in eight, the co
mmon bile duct in five and the common hepatic duct in one. Four patien
ts had biliary endoprostheses but were symptomatic from inadequate dra
inage. There was good demonstration of the biliary anatomy, obstructed
segments and intersegmental biliary connections in 13/14; irregular b
iliary dilatation secondary to primary sclerosing cholangitis rendered
interpretation difficult in one. 3D cholangiography provided a useful
adjunct to other imaging techniques. In particular, in patients with
complex hilar strictures it aided implementation of appropriate interv
entional drainage procedures.