Diseases of the Gallbladder and the Biliary Tree

Abstract

AbstractCross-sectional imaging modalities including ultrasound (US), magnetic resonance (MR) imaging, and computed tomography (CT) play a critical role in the diagnosis of diseases of the biliary tract and gallbladder. Biliary imaging for evaluation of obstructive jaundice seeks to diagnose the level of obstruction and its cause. The identification of dilated bile ducts necessitates evaluation for strictures or filling defects, which is best performed with thin-section CT or T2-weighted MR cholangiography (MRCP). Choledocholithiasis with accompanying cholecystolithiasis is the most common cause of biliary obstruction and modern thin-section three dimensional MR cholangiography is highly sensitive and specific for the detection of stones. Recognition of gallbladder wall thickening and surrounding edema may be seen in acute cholecystitis, identification of bile duct wall thickening raises concern for cholangitis or malignancy. Primary sclerosing cholangitis and secondary sclerosing cholangitis such as recurrent pyogenic cholangitis, and IgG4 related sclerosing disease can develop chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts. Familiarity with the typical clinical and radiologic appearances of various etiologies of cholangiopathies and biliary malignancies is also important for accurate image interpretation.