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Imaging the Bilary Tree

Imaging the Bilary Tree. Ultrasound. Pros and Cons. Cost- $100 90-95% accurate Good for detecting billary duct dilatation, cholelithiasis, gallbladder wall thickness and the presence of pericholecystic fluid. Not good for choledocholithiasis. Plai n Abdo X-ray. Cost- $30

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Imaging the Bilary Tree

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  1. Imaging the Bilary Tree

  2. Ultrasound

  3. Pros and Cons Cost- $100 90-95% accurate Good for detecting billary duct dilatation, cholelithiasis, gallbladder wall thickness and the presence of pericholecystic fluid. Not good for choledocholithiasis.

  4. Plain Abdo X-ray

  5. Cost- $30 Sensitivity is only 15% for stones Doesn’t show the bilary tree Pros and Cons

  6. ERCP (Endoscopic Retrograde CholecystoPancreatography)

  7. Cost- $300+theatre fees+equipment Allows diagnosis and treatment Requires anaesthesia Complications Mortality rate of 1% Pancreatitis Bleeding Duodenal perforation Pros and Cons

  8. IV Cholangiography +/- CT

  9. Cost- $400 Provides detailed images of the anatomy and is very sensitive for detecting choledocholithiasis. Need to have bilirubin <40 so the liver can excrete the contrast into the bilary tree. The contrast can cause allergic reactions Not as good as ultrasound as detecting cholelithiasis Pros and Cons

  10. HIDA Scan

  11. Cost- $400 Doesn’t give a detailed image of the bilary tree Provides an assessment of gallbladder function. Useful to diagnose cholecystitis when ultrasound isn’t clear and is also useful for bile duct leaks and common bile duct obstructions. Pros and Cons

  12. MRI

  13. Cost- $400 Contraindicated in pts with pacemakers, intracerebral metal clips or metal shards in their eyes. Good imaging of the bilary tree and stones Pros and Cons

  14. PTC (Percutaneous Transhepatic Cholangiography)

  15. Cost- $180 for the x ray, $400 for the procedururist and the costs of anaesthesia and admission. Complications Bleeding Bile leak Good when ERCP can’t be performed Also good when there is a complete obstruction of the bilary tree and you wish to visualise the proximal tree. Pros and Cons

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