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CORE: GI > Biliary Imaging > Flashcards

Biliary Imaging Flashcards

1
Q

MRCP imaging techniques

A

MRCP = T2 weighted sequences to view fluid in biliary tract/surrounding structures

fast spin echo sequences

intremediate T2 (TE 80-100ms) best suited for biliary ductal syste

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2
Q

advantages/disadvantages of MRCP over ERCP

A

Advantages

  • MRCP has the ability to see extra-luminal findings.
  • MRCP can visualize excluded (obstructed) ducts.
  • MRCP is non-invasive.

Disadvantages

  • MRCP does not allow for concurrent therapeutic intervention.
  • MRCP does not actively distend the biliary ductal system with contrast. -MRCP has worse spatial resolution compared to ERCP.
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3
Q

gadoxetic acid disodium

A

Eovist

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4
Q

gadobenate dimeglumine

A

Multihance

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5
Q

contrast enhanced MRCP

A

FS T1 weighted with gadolinium contrast agents with biliary excretion

short T1 relaxation resulting in T1 hyperintense biliary fluid (20-45 min delay to allow for biliary excretion)

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6
Q

Todani system

A

divides choledochal cysts based on number, distribution, morphology

type I: fusiform dilation
type II: extrahepatic saccular dilation
type III: intraduodenal bile duct dilation
type IV: multiple segments dilated
type V: intrahepatic dilation/caroli disease

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7
Q

choledochal cysts vs hamartomas

A

choledochal cysts communicate with biliary tree

hamartomas do not communicate with biliary tree

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8
Q

biliary anatomic variants

A

low insertion of cystic duct

aberrant right posterior duct

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9
Q

aberrant right posterior duct clinical significance

A

right hepatic liver donor; 2 right hepatc ducts must be anastomosed separately

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10
Q

when are choledochal cysts diagnosed? increased risk?

A

childhood; increased risk for cholangiocarcinoma

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11
Q

most common type of extrahepatic cyst

A

type 1 choledochal cyst

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12
Q

caroli disease association

A

polycystic kidneys

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13
Q

caroli syndrome

A

caroli disease + hepatic fibrosis

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14
Q

central dot sign

A

CECT: small branch of portal vein and hepatic artery dilated bile ducts

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15
Q

type of cholcystitis seen in ICU pts

A

acalculus colecystitis

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16
Q

CT diagnosis of acute cholecystitis

A

gallbladder wall thickening >3mm
pericholecystic fluid
gallbladder hyperemia
galbladder calculi

17
Q

complications of acute cholecystitis

A

gangrenous cholecystitis, gallbladder perforation, emphysematous cholecystitis

18
Q

gangrenous cholecystitis cause? treatment?

A

increased intraluminal pressure&raquo_space; wall ischemia

wall thickening asymmetric/intraluminal membranes present

treat: emergent cholecystectomy/cholecystostomy

19
Q

acute gallbladder perforation complications

A

subacute peroration&raquo_space; pericholecystic abscess

bile peritonitis

cholecystoenteric fistula

20
Q

emphysematous cholecystitis

A

gas forming bacteria in the lumen/wall of gallbladder

typical patient: elderly diabetic

treatment: emergent cholecystectomy/cholcystostomy; conservative in high risk patients

21
Q

porcelain gallbaldder

A

peripherally calcified gallbladder wall, thought to be sequelae of chronic cholecystitis

controversial increased risk of gallbladder carcinoma; treatment with non-emergent cholecystectomy

22
Q

Charcot’s triad

A

fever, abdominal pain, jaundice

23
Q

most common cause of ascending cholangitis

A

choledocholithiasis

24
Q

imaging findings of ascending cholangitis

A

hyperenhancement/thickening of walls of bile ducts; often with CBD stone

25
Q

PSC, associations, complications

A

idiopathic inflammator destruction of bile ducts

associated with UC, more common in males

cirrhosis, cholangiocarcinoma, recurrent biliary imagings

26
Q

PSC imaging characteristics

A

beaded, irregular appearance of CBD and intrahepatic bile ducts

27
Q

PSC mimic

A

HIV cholangiopathy; although HIV cholangitis is more associated iwth papillary stenosis

28
Q

PBC

A

inflammation/destruction of smaller bile ducts than PSC

middle aged women –> pruritis –> hepatic cirrhosis

29
Q

AIDS cholangitis

A

biliary infection with ryptosporidium and CMV; present with RUQ pain, fever, elevated LFTs

papillary stenosis (different than PSC)

30
Q

recurrent pyogenic cholangitis/oriental cholangiohepatitis

A

parasie: clonorchis sinesis

pigment stone formation, biliary stasis, cholangitis

indigenous to SE asia

recurrent jaundice/fevers

increased risk of cholangiocarcinoma

31
Q

triad of recurrent pyogenic cholangitis

A

pneumobilia, lamellated bile duct filling defects, intrahepatic/extrahepatic bile duct dilation/strictures

32
Q

biliary cystadenoma

A

benign cystic neoplasm in middle aged women; does not communicate with biliary system

abdominal pain, n/v, obstructive jaundice; may be large may recur after resection

33
Q

biliary cystadenoma imaging

A

large multiloculated cystic mass; septations distinguish from simple cyst

no thick enhancing wall

large solid component/thick calcificationshould raise concern for cystadenocarcinoma

34
Q

cholangiocarcinoma

A

malignant tumor of biliary ductal epithelium –> duct obstruction and intrahepatic ductal dilation, capsular retraction &raquo_space; lobar atrophy

hilar tumor at intrahepatic ducts is known as Klatskin tumor

35
Q

risk factors for cholangiocarcinoma

A

Choledochal cyst(s).
Primary sclerosing cholangitis.
Familial adenomatous polyposis syndrome. Clonorchis sinensis infection.
Thorium dioxide (alpha-emitter contrast agent), not used since the 1950s. Thorium dioxide is also associated with angiosarcoma and HCC.

36
Q

gallbladder carcinoma

A

chronic gallblader inflammation&raquo_space; carcinoma

scirrhous infiltrating mass that invades through wall into liver; sometimes polypoid mass, rarelymural thickening

37
Q

gallbladder metastasis

A

melanoma

CORE: GI (9 decks)

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