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Biliary injuries are increasing in frequency
Imaging plays crucial role in identification & management
Direct Cholangiography
ERCP is best for evaluation of injury to major hepatic duct branches & CBD
Also guides therapeutic intervention (sphincterotomy & stent placement)
CT : Accurately depicts presence and extent of hepatic parenchymal injuries
Active bleeding is accurately depicted
Hepatic arterial (HA) occlusion may be depicted or suggested
Injuries to GB & bile ducts are suggested only indirectly
Presence of lower density (attenuation) fluid in GB fossa & peritoneal cavity
Eovist (Primovist) enhanced MR
Valuable in evaluation of patients with known or suspected biliary injuries
Superior to hepatobiliary scintigraphy (greater anatomic detail & spatial resolution)
Hepatobiliary Scintigraphy
Variations of Tc-99m "HIDA" scan (hepatobiliary iminodiacetic acid)
Look for extraluminal collections (bile leak) on sequential images over 60-120 minutes
SPECT (single photon emission computed tomography): Greater anatomic detail & spatial resolution
Provides greater anatomic detail & spatial resolution than conventional planar imaging due to tomographic sections
Recommended imaging protocol
CT is optimal for initial evaluation of hepatobiliary injuries
Hepatobiliary scintigraphy is useful when clinical suspicion of biliary injury is relatively low
MR with MRCP and gadoxetate enhancement is optimal noninvasive test when clinical suspicion is high
ERCP or PTC is most accurate for diagnosis and guidance for therapy
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