Pancreaticobiliary imaging

Question 1

List the different imaging modalities for the pancreaticobiliary system

Answer 1

• Plain film (x-ray)
• Ultrasound
• Computed Tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiography (PTC)
• Operative cholangiography
• Post operative (T-tube) cholangiography
• Angiography – diagnostic and interventional
• Radionuclide imaging

Question 2

What are x-rays used for in pancreaticobiliary imaging

Answer 2

• Demonstarting air in the biliary tract or portal venous tract
• Calcified gall stones
• Calcifications in chronic pancreatitis

Question 3

What are ultrasounds used for in pancreaticobiliary imaging

Answer 3

Its a good screening test
- Gas in stomach, gas in faecal matter dimineshes visualisation of the pancreas

Endoscopic ultrasound
- Used to visualise the pancreas

Question 4

What are CT scans used for in pancreaticobiliary imaging

Answer 4

When used together with MRI it is the most reliable technique for assessing the pancreas and peri-pancreatic tissue

Question 5

What are MRI’s used for in pancreaticobiliary imaging

Answer 5

Mainly reserved for problem solving
Further characterisation of lesion detected with other modalities

Question 6

What is MRCP used for in pancreaticobiliary imaging

Answer 6

Its the method of the biliary and pancreatic ducts by MRI

Demonstrates the pancreatic duct when total obstruction of the distal pancreatic duct is present and ERCP is unsuccessful

Question 7

What are ERCP used for in pancreaticobiliary imaging

Answer 7

It is used for further assessment of pancreatic abnormality demonstrated on CT/Ultrasound
Further assessment of the p;ancreas when Ultarsound and CT are normal or technically unsatisfactory

Can also be used interventionally for:
- Gallstone disimpaction
- Pancreatic duct stone extaction
- Balloon dilatation