Imaging of the biliary tract.

Although endoscopic retrograde cholangiopancreatography is the technique of choice for examining the biliary tract when ultrasonography does not demonstrate dilated ducts, the transhepatic cholangiopancreatogram was shown to be useful when endoscopic retrograde cholangiopancreatography fails. On cholangiography, ultrasonography, and CT, clonorchiasis and cryptosporidiosis were found to have duct dilatation and contour irregularity, and in some patients, papillary stenosis. The value of cholangiography in determining the prognosis and appearance of primary sclerosing cholangitis and in diagnosing Klatskin tumor was examined. Patients with high-grade extrahepatic strictures, diffuse intrahepatic strictures, and marked intrahepatic dilatation had decreased survival. The preoperative cholangiogram diagnosis of Klatskin tumor was found to be accurate in only two-thirds of cases. In patients with liver transplantation who had dilatation of both donor and native extrahepatic bile ducts and abnormal liver function tests, but no evidence of anastomotic stricture, malfunction of the sphincter of Oddi was suggested as a possible cause. The sonographic features of acute gallbladder disease were evaluated and striations in the thickened gallbladder wall were shown not to be a specific sign for acute cholecystitis. Also, the ultrasonographic diagnosis of early gallbladder carcinoma was not accurate enough, but ultrasonography was reaching a sensitivity of 70% to 80% for advanced gallbladder cancer.