Preoperative Noninvasive Imaging

  • Riccardo Manfredi
  • Sara Mehrabi
  • Massimiliano Motton
  • Roberto Pozzi Mucelli


The liver is divided into the left and right lobes, and each lobe is divided into segments on the basis of its vascular anatomy and biliary drainage. The in trahepatic bile ducts generally follow the internal hepatic segmental anatomy (Figs. 6.1, 6.2). In the left lobe, a left medial segment duct and a left lateral segment duct normally join to form the main left hepatic duct. The right hepatic duct branches near its origin at the common hepatic duct. Frequently, the right hepatic duct has a dorso-caudal branch, draining the posterior segment of the right lobe, and a ventro-cranial branch, draining the anterior segment of the right lobe (Fig. 6.1). Ductal drainage of the caudate lobe is variable and may be related to the left or right ductal system. The left and right hepatic ducts unite just outside the liver to form the common hepatic duct, which is usually 3–4 cm in length (Figs. 6.3, 6.4).


Bile Duct Cystic Duct Acute Cholecystitis Choledochal Cyst Bile Duct Stone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bortoff GA, Chen MY, Ott DJ et al (2000) Gallbladder stones: imaging and intervention. Radiographics 20:751–766PubMedGoogle Scholar
  2. 2.
    Nakayama F (1982) Intrahepatic calculi. A special problem in East Asia. World J Surg 6:802PubMedCrossRefGoogle Scholar
  3. 3.
    Irving HC, Bates L (1993) Bile duct pathology. In: Cosgrave D, Meire H, Dewbury K (eds) Abdominal and general ultrasound, vol 1. Edinburgh, Churchill Livingstone, pp 172–184Google Scholar
  4. 4.
    Sauerbrei EE, Nguyen KT, Nolan RL (eds) (1992) Abdominal sonography. New York, Raven, pp 51–72Google Scholar
  5. 5.
    Kim YK, Kim CS, Lee JM et al (2006) Value of adding T1-weighted image to MR cholangiopancreatography for detecting intrahepatic biliary stones. AJR Am J Roentgenol 187:267–274CrossRefGoogle Scholar
  6. 6.
    Teplick SK, Flick P, Brandon JC (1991) Transhepatic cholangiography in patients with suspected biliary disease and non-dilated intrahepatic bile ducts. Gastrointest Radiol 16:193–197PubMedCrossRefGoogle Scholar
  7. 7.
    Bilbao MK, Dotter CT, Lee TG, Katon RM (1976) Complications of endoscopic retrograde cholangiopancreatography (ERCP): a study of 10,000 cases. Gastroenterology 70:314–320PubMedGoogle Scholar
  8. 8.
    Lenriot JP, Le Neel JC, Hay JM et al (1993) Retrograde cholangiopancreatography and endoscopic sphincterotomy for biliary lithiasis. Prospective evaluation in surgical circle. Gastroenterol Clin Biol 17:244–250PubMedCrossRefGoogle Scholar
  9. 9.
    Guibaud L, Bret PM, Reinhold C et al (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197:109–115PubMedGoogle Scholar
  10. 10.
    Fulcher AS, Turner MA, Capps GW et al (1998) Half-Fourier RAME MR cholangiopancreatography: experience in 300 subjects. Radiology 207:21–32PubMedGoogle Scholar
  11. 11.
    Becker CD, Grossholz M, Becker M et al (1997) Choledocholithiasis and bile duct stenosis: accuracy of MR cholangiopancreatography. Radiology 205:523–530PubMedGoogle Scholar
  12. 12.
    Reinhold C, Taourel P, Bret PM et al (1998) Choledocholithiasis: evaluation of MR cholangiography for diagnosis. Radiology 209:435–442PubMedGoogle Scholar
  13. 13.
    Chan YL, Chan AC, Lam WW et al (1996) Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. Radiology 200:85–89PubMedGoogle Scholar
  14. 14.
    Soto JA, Barish MA, Yucel EK et al (1996) Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology 110:589–597PubMedCrossRefGoogle Scholar
  15. 15.
    Kim TK, Kim BS, Kim JH et al (2002) Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography. AJR Am J Roentgenol 179:429–434PubMedGoogle Scholar
  16. 16.
    Motohara T, Semelka RC, Bader TR (2003) MR cholangiopancreatography. Radiol Clin North Am 41:89–96PubMedCrossRefGoogle Scholar
  17. 17.
    Barish MA, Yucel EK, Ferrucci JT (1999) Magnetic resonance cholangiopancreatography. N Engl J Med 341:258–264PubMedCrossRefGoogle Scholar
  18. 18.
    Mitchell DG, Alam F (1999) Mangafodipir trisodium: effects on T2-and T1-weighted MR cholangiography. J Magn Reson Imaging 9:366–368PubMedCrossRefGoogle Scholar
  19. 19.
    Vitellas KM, El-Dieb A, Vaswani KK et al (2002) Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients. AJR Am J Roentgenol 179:409–416PubMedGoogle Scholar
  20. 20.
    Marchal G, Ni Y, Zhang X et al (1993) Mn-DPDP enhanced MRI in experimental bile duct obstruction. J Comput Assist Tomogr 17:290–296PubMedCrossRefGoogle Scholar
  21. 21.
    Sheppard D, Allan L, Martin P et al (2004) Contrast-enhanced magnetic resonance cholangiography using mangafodipir compared with standard T2W MRC sequences: a pictorial essay. J Magn Reson Imaging 20:256–263PubMedCrossRefGoogle Scholar
  22. 22.
    Cooperberg PL, Gibney RG (1987) Imaging of the gallbladder. Radiology 163:605–613PubMedGoogle Scholar
  23. 23.
    MacDonald FR, Cooperberg PL, Cohen MM (1981) The WES Triad: a specific sonographic sign of gallstones in the contracted gallbladder. Gastrointest Radiol 6:39–41PubMedCrossRefGoogle Scholar
  24. 24.
    Nemcek AA, Gore RM, Vogelzang R et al (1988) The effervescent gallbladder: a sonographic sign of emphysematous cholecystitis. AJR Am J Roentgenol 150:575–577PubMedGoogle Scholar
  25. 25.
    Kane RA, Jacobs R, Katz J et al (1985) Porcelain gallbladder: ultrasound and CT appearance. Radiology 154:769–770Google Scholar
  26. 26.
    Bova JG, Schwesinger WH, Kurtin WE (1992) In vivo analysis of gallstone composition by computed tomography. Gastrointest Radiol 17:253–256PubMedCrossRefGoogle Scholar
  27. 27.
    Liu YL, Wang JT (2006) Hyperplastic cholecystoses: efforts should be made to recognize and treat them. Hepatobiliary Pancreat Dis Int 5:334–336PubMedGoogle Scholar
  28. 28.
    Rapaccini GL, Pompili M, Caturelli E (1993) Colecisti e vie biliari. In: Poletto F (ed) Trattato italiano di ecografia, vol 1. Milan, Società Italiana di Ultrasonologia in Medicina e Biologia, pp 271–295Google Scholar
  29. 29.
    Berk RN, Van Der Vegt JH, Lichtenstein JE (1983) The hyperplastic cholecystoses: cholesterolosis and adenomyomatosis. Radiology 146:593–601PubMedGoogle Scholar
  30. 30.
    Kidney MR, Goiney R, Cooperberg PL (1986) Adenomyomatosis of the gallbladder: a pictorial exhibit. J Ultrasound Med 5:331–333PubMedGoogle Scholar
  31. 31.
    Fowler RC, Reid WW (1988) Ultrasound diagnosis of adenomyomatosis of the gallbladder: ultrasonic and pathological correlation. Clin Radiol 39:402–406PubMedCrossRefGoogle Scholar
  32. 32.
    De Albertis P, Quadri D, Serafini G, Cajano A (1995) Le lesioni benigne e maligne delta parete delta colecisti. In: Gnocchi G (ed) Colecisti. Naples, Liviana Medicina, pp 57–72Google Scholar
  33. 33.
    Bazzocchi M, Pozzi-Mucelli RS, Brizzi F et al (1984) Aspects echographiques des maladies infiammatories de la vesicule biliarie. J Fr Echo 1:23–28Google Scholar
  34. 34.
    Laing FC, Jeffrey RB Jr (1983) Choledocholithiasis and cystic duct obstruction: difficult ultrasonographic diagnosis. Radiology 146:475–479PubMedGoogle Scholar
  35. 35.
    Filly RA, Allen B, Minton MJ (1980) In vitro investigation of the origin of echoes within biliary sludge. J Clin Ultrasound 8:193–200PubMedCrossRefGoogle Scholar
  36. 36.
    Nemcek A, Gore RM, Vogelzang RL, Grant M (1988) The effervescent gallbladder: a sonographic sign of emphysematous cholecystitis. AJR Am J Roentgenol 150:575–577PubMedGoogle Scholar
  37. 37.
    Romano AL, Van Sonnenberg E, Casola G et al (1988) Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients. AJR Am J Roentgenol 150:123–127PubMedGoogle Scholar
  38. 38.
    Gryspeerdt S, Van Hoe L, Marchal G, Baert AL (1995) Imaging of hepatic perfusion disorders with double phase spiral CT. Radiology 193:511Google Scholar
  39. 39.
    Blankenberg F, Wirth R, Brooke Jeffrey R (1991) Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis Gastrointest Radiol 16:149–153PubMedCrossRefGoogle Scholar
  40. 40.
    Kim PN, Lee KS, Bae WK, Lee BH (1994) Gallbladder perforation: comparison of US findings with CT. Abdom Imaging 19:239–242PubMedCrossRefGoogle Scholar
  41. 41.
    Weissleder R, Stark DD, Compton CC et al (1988) Cholecystitis: diagnosis by MR imaging. Magn Reson Imaging 6:345–348PubMedCrossRefGoogle Scholar
  42. 42.
    Svanik J, Thornell E, Zettergren L (1981) Gallbladder function in experimental cholecystitis. Surgery 89:500–506Google Scholar
  43. 43.
    Johnson LW, Sehon JK, Lee WC et al (2001) Mirizzi’s syndrome: experience from a multi-institutional review. Am Surg 67:11–4PubMedGoogle Scholar
  44. 44.
    Haritopoulos KN, Labruzzo C, Tayar AR et al (2002) view of the literature. Int Surg 87:65–68PubMedGoogle Scholar
  45. 45.
    McSherry CK, Fertenberg H, Virshup M (1982) The Mirizzi syndrome: suggested classification and surgical therapy. Surg Gastroenterol 1:219–225Google Scholar
  46. 46.
    Mitchell S, Clark R (1984) A comparison of computed tomography and sonography in choledocholithiasis. AJR Am J Roentgenol 142:729–733PubMedGoogle Scholar
  47. 47.
    Wermke W, Schulz HJ (1987) Sonographic diagnosis of bile duct calculi: results of a prospective study of 222 cases of choledocholithiasis [in German]. Ultraschall Med 8:116–120PubMedCrossRefGoogle Scholar
  48. 48.
    Soto JA, Alvarez O, Munera F et al (2000) Diagnosing bile duct stones: comparison of unenhanced helical CT, oral contrast-enhanced CT cholangiography and MR cholangiography. AJR Am J Roentgenol 175:1127–1134PubMedGoogle Scholar
  49. 49.
    Griffin N, Wastle ML, Dunn WK et al (2003) Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis. Eur J Gastroenterol Hepatol 15:809–813PubMedCrossRefGoogle Scholar
  50. 50.
    Baron RL (1987) Common bile duct stones: reassessment of criteria for CT diagnosis. Radiology 162:419–424PubMedGoogle Scholar
  51. 51.
    Miller FH, Hwang CM, Gabriel H et al (2003) Contrast-enhanced helical CT of choledocholithiasis. AJR Am J Roentgenol 181:125–130PubMedGoogle Scholar
  52. 52.
    Neitlich J, Topazian M, Smith RC et al (1997) Detection of choledocholithiasis: comparison of unenhanced helical CT and endoscopic retrograde cholangiopancreatography. Radiology 203:753–757PubMedGoogle Scholar
  53. 53.
    Jimenez CI, del Olmo LM, Perez HM (2001) Helical CT without contrast in choledocholithiasis. Eur Radiol 11:197–201CrossRefGoogle Scholar
  54. 54.
    Pasanen P, Partanen K, Pikkarainen P et al (1992) Ultrasonography, CT and ERCP in the diagnosis of choledochal stones. Acta Radiol 33:53–56PubMedGoogle Scholar
  55. 55.
    Baron RL, Stanley RJ, Lee JKT et al (1982) A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography. Radiology 145:91–98PubMedGoogle Scholar
  56. 56.
    Jeffrey RB Jr, Federle MP, Laing FC et al (1983) Computed tomography of choledocholithiasis. AJR Am J Roentgenol 140:1179–1183PubMedGoogle Scholar
  57. 57.
    Baron RL, Tublin ME, Peterson MS (2002) Imaging the spectrum of biliary tract disease. Radiol Clin N Am 40:1325–1354PubMedCrossRefGoogle Scholar
  58. 58.
    Masci E, Toti G, Mariani A et al (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroentrol 96:417–23CrossRefGoogle Scholar
  59. 59.
    Frey CF, Burbige EJ, Meinke WB et al (1982) Endoscopic retrograde cholangiopancreatography. Am J Surg 144:109–114PubMedCrossRefGoogle Scholar
  60. 60.
    Watanabe Y, Dohke M, Ishimori T et al (2000) Pseudo-obstruction of the extrahepatic bile duct due to artefact from arterial pulsatile compression: a diagnostic pitfall of MR cholangiopancreatography. Radiology 214:856–860PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Riccardo Manfredi
    • 1
  • Sara Mehrabi
    • 1
  • Massimiliano Motton
    • 1
  • Roberto Pozzi Mucelli
    • 1
  1. 1.Department of Radiology University of VeronaG.B. Rossi University HospitalVeronaItaly

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