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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 - PowerPoint PPT Presentation
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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.
Plain Abdo X-ray
Pros and Cons
•Cost- $30•Sensitivity is only 15% for stones•Doesn’t show the bilary tree
ERCP (Endoscopic Retrograde Cholecysto Pancreatography)
Pros and Cons
•Cost- $300+theatre fees+equipment•Allows diagnosis and treatment •Requires anaesthesia•Complications
▫Mortality rate of 1%▫Pancreatitis▫Bleeding▫Duodenal perforation
IV Cholangiography +/- CT
Pros and Cons
•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
HIDA Scan
Pros and Cons
•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.
MRI
Pros and Cons
•Cost- $400•Contraindicated in pts with pacemakers,
intracerebral metal clips or metal shards in their eyes.
•Good imaging of the bilary tree and stones
PTC (Percutaneous Transhepatic Cholangiography)
Pros and Cons•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.
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