Imaging
Ascending Cholangitis
- Preliminary Diagnosis: Ascending Cholangitis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of Ascending Cholangitis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Ascending Cholangitis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Ascending Cholangitis
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the biliary tree.
II. Describe the advantages and disadvantages of this technique for diagnosis of Ascending Cholangitis.
Advantages
Highly portable imaging modality.
Does not expose patients to ionizing radiation.
May help guide percutaneous intervention and biopsy that will help clinch diagnosis of ascending cholangitis.
Disadvantages
Highly operator dependent.
Limited in evaluating the surrounding soft tissues.
Ascending cholangitis diagnosis is clinched with a histological diagnosis.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to sonographic imaging exist.
IV. What alternative imaging techniques are available?
Magnetic resonance cholangiopancreatography (MRCP).
CT imaging.
Cholangiography.
Endoscopic retrograde cholangiopancreatography (ERCP).
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Ascending Cholangitis.
MRCP
Advantages
Offers exquisite visualization of the intrahepatic and extrahepatic biliary tree.
Does not expose patients to ionizing radiation.
May be performed without contrast in patients who cannot receive contrast medium.
Diagnostic imaging modality.
Disadvantages
May be subject to motion and susceptibility weighted imaging, degrading image quality.
Less sensitive to mineralized and air densities.
Expensive.
Time-consuming..
Ascending cholangitis is a histological diagnosis.
CT imaging
Advantages
Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vasculature.
Highly sensitive to mineralized and air densities often present in the biliary system.
May help guide percutaneous intervention and treatment.
Disadvantages
Exposes patients to ionizing radiation.
Ascending cholangitis is a histological diagnosis.
Cholangiography
Advantages
Offers both diagnostic and therapeutic capabilities simultaneously.
Offers the ability for histological diagnosis and imaging diagnosis to be done simultaneously.
Disadvantages
Highly operator dependent.
Exposes patients to increased morbidity and mortality from being an invasive procedure.
Endoscopic retrograde cholangiopancreatography (ERCP)
Advantages
Gold standard in diagnosing and treating ascending cholangitis.
Disadvantages
May not be available at all institutions as ERCP must be performed by trained gastroenterology specialists.
Risk for trauma to common bile duct and pancreatic duct from procedure.
VI. What are the contraindications for the alternative imaging techniques?
MRCP
May be contraindicated in patients with non-MR compatible hardware.
CT imaging
May be contraindicated in pregnant patients.
Cholangiography
Contraindicated in patients in a severe hypocoagulable state.
ERCP
Contraindicated in patients in a severe hypocoagulable state.
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