EURORAD ESR

Case 9036

Anatomic and functional assessment of bilioenteric anastomosis with hepatobiliary contrast-enhanced MR cholangiography

Author(s)
Tonolini M, Bianco R
Department of Radiology, “Luigi Sacco" Hospital – Milan (Italy)
 
Patient
female, 47 year(s)
 
 
  • Figure 1
    CT during septic cholangitis
     

    Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Special Focus: Infection;

    Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Special Focus: Infection;

    Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Special Focus: Infection;
     
     
  • Figure 2
    Elective CT with MIP reconstructions
     

    At follow-up CT after disappearance of periportal oedema and peritoneal fluid, the bilioenteric anastomosis is indicated by the presence of two surgical clips.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT;

    The bilioenteric anastomosis, indicated by the presence of two surgical clips, is poorly assessed despite focused multiplanar CT reconstructions (b,c).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT;

    The bilioenteric anastomosis, indicated by the presence of two surgical clips, is poorly assessed despite focused multiplanar CT reconstructions (b,c).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT;
     
     
  • Figure 3
    Conventional MR cholangiopancreatography
     

    On T1-weighted images markedly hypointense artifacts correspond to pneumobilia (a) and metallic clips (b).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    On T1-weighted images markedly hypointense artifacts correspond to pneumobilia (a) and metallic clips (b).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    On a T2-weighted image the fluid-filled anastomotic jejunal loop is visualised.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    Thick-slab (d) and MIP-reformatted thin-slab (e) MRCP images show intrahepatic biliary dilatation with caliber irregularities. Bilioenteric anastomosis is poorly visualised because of fluid-filled enteric loop...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    Thick-slab (d) and MIP-reformatted thin-slab (e) MRCP images show intrahepatic biliary dilatation with caliber irregularities. Bilioenteric anastomosis is poorly visualised because of fluid-filled enteric loop...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;
     
     
  • Figure 4
    Hepatobiliary contrast-enhanced MR cholangiography
     

    After 15 minutes, during hepatocyte-specific phase, T1-hyperintense biliary enhancement is present and judged to be sufficient.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    After 15 minutes, during hepatocyte-specific phase, T1-hyperintense biliary enhancement is present and judged to be sufficient.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    Oblique-coronal MPR reformations of 3D-GRE isotropic images allow optimal visualisation of patent hepatico-jejunostomy and filling of the enteric loop with enhanced bile.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;

    Oblique-coronal MPR reformations of 3D-GRE isotropic images allow optimal visualisation of patent hepatico-jejunostomy and filling of the enteric loop with enhanced bile.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: MR; Procedure: Cholangiography;
     
     
Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.
 
Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.
 
Emergency contrast-enhanced CT (a...c) show moderate intrahepatic biliary dilatation and pneumobilia (mainly involving the left liver lobe), marked diffuse periportal oedema, and perihepatic fluid.
 
At follow-up CT after disappearance of periportal oedema and peritoneal fluid, the bilioenteric anastomosis is indicated by the presence of two surgical clips.
 
The bilioenteric anastomosis, indicated by the presence of two surgical clips, is poorly assessed despite focused multiplanar CT reconstructions (b,c).
 
The bilioenteric anastomosis, indicated by the presence of two surgical clips, is poorly assessed despite focused multiplanar CT reconstructions (b,c).
 
On T1-weighted images markedly hypointense artifacts correspond to pneumobilia (a) and metallic clips (b).
 
On T1-weighted images markedly hypointense artifacts correspond to pneumobilia (a) and metallic clips (b).
 
On a T2-weighted image the fluid-filled anastomotic jejunal loop is visualised.
 
Thick-slab (d) and MIP-reformatted thin-slab (e) MRCP images show intrahepatic biliary dilatation with caliber irregularities. Bilioenteric anastomosis is poorly visualised because of fluid-filled enteric loop superimposed.
 
Thick-slab (d) and MIP-reformatted thin-slab (e) MRCP images show intrahepatic biliary dilatation with caliber irregularities. Bilioenteric anastomosis is poorly visualised because of fluid-filled enteric loop superimposed.
 
After 15 minutes, during hepatocyte-specific phase, T1-hyperintense biliary enhancement is present and judged to be sufficient.
 
After 15 minutes, during hepatocyte-specific phase, T1-hyperintense biliary enhancement is present and judged to be sufficient.
 
Oblique-coronal MPR reformations of 3D-GRE isotropic images allow optimal visualisation of patent hepatico-jejunostomy and filling of the enteric loop with enhanced bile.
 
Oblique-coronal MPR reformations of 3D-GRE isotropic images allow optimal visualisation of patent hepatico-jejunostomy and filling of the enteric loop with enhanced bile.
 
 
 
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