Search

A variety of patterns of enhancement of liver lesions and liver parenchyma is observed in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. It is becoming increasingly apparent that many lesions may exhibit HBP enhancement. Much of the literature regarding the role of gadoxetic acid-enhanced MRI in characterising liver lesions is dichotomous, focusing on whether lesions are enhancing or non-enhancing in the HBP, rather than examining the patterns of enhancement. We provide a pattern-based description of HBP enhancement of liver parenchyma and of liver lesions. The role of OATP1B3 transporters, hepatocyte function and lesion composition in influencing patterns of HBP hyperintensity are discussed.

Recent advances in diagnostic imaging of the hepatobiliary system include MRI, computed tomography (CT), contrast-enhanced ultrasound, and ultrasound elastography. With the advent of multislice CT scanners, sedated examinations in veterinary patients are feasible, increasing the utility of this imaging modality. CT and MRI provide additional information for dogs and cats with hepatobiliary diseases due to lack of superimposition of structures, operator dependence, and through intravenous contrast administration. Advanced ultrasound methods can offer complementary information to standard ultrasound imaging. These newer imaging modalities assist clinicians by aiding diagnosis, prognostication, and surgical planning., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: We conducted this prospective nested case-control study for the hepatic artery and portal vein hemodynamic changes after orthotopic liver transplantation., Methods: A total 128 cases of orthotropic liver transplantation were analyzed, including 25 cases of ischemic type biliary lesions (ITBL). The portal vein and hepatic artery flow velocities were detected by ultrasound on days 28, 42, and 84 after liver transplantation. In the GLM analysis of Lg(S/D), the P values of Group Effect, Time Effect, and Time×Group were 0.014, 0.376, and 0.008, respectively., Conclusion: Our results show a relatively reduced hepatic artery S/D in ITBL, especially in extrahepatic ITBL., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Cholescintigraphy with (99m)Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide., (© 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)

Objective: This paper focuses on a novel approach to biliary reconstruction after previous extensive liver surgery., Summary Background Data: Bile leak and subsequent biliary strictures are not uncommon after extensive liver surgery. Biliary reconstruction is then required, but the liver hilum is usually inaccessible for further surgical intervention., Methods: A novel surgical technique is described in two patients with biliary stenosis after previous extensive liver surgery. Access to the biliary tree was obtained using an anterior approach. A previously inserted PTC drain was used as guidance to the bile duct suitable for creating a biliary-digestive anastomosis., Results: The described technique proved to cause complete biliary drainage in both patients. There was no treatment-related morbidity nor was further biliary intervention needed during follow-up., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Endoscopic ultrasonography (EUS) is used to evaluate patients with hepatobiliary diseases. The technique is useful for the diagnosis of esogastric varices in selected cases of portal hypertension, and to evaluate the pathogenic role and prognostic value of the collateral circulation in patients with this condition. When coupled with the Doppler technique, EUS can be used to guide injection sclerotherapy and to verify the obliteration of varices (particularly fundal varices) after endoscopic treatment. Hemodynamic changes induced in the collateral circulation by vasoactive drugs can also be measured with Doppler-EUS. Fine-needle aspiration under EUS guidance is useful in the diagnosis of focal liver lesions and perihepatic adenopathy, and in the evaluation of biliary tract diseases. New indications can be developed in the future after adequate experimental validation.

The spectrum of causes of hepatic gas detected at computed tomography (CT) and ultrasonography (US) is widening. There are many iatrogenic and noniatrogenic causes of hepatic parenchymal, biliary, hepatic venous, and portal venous gas. Hepatic gas may be an indicator of serious acute disease (infarct, infection, abscess, bowel inflammation, or trauma). In other clinical scenarios, it may be an expected finding related to therapeutic interventions (such as surgery; hepatic artery embolization for a tumor or for active bleeding in acute trauma cases; percutaneous tumor ablation performed with radiofrequency, cryotherapy, laser photocoagulation, or ethanol). In some cases, hepatic gas is an incidental finding of no clinical significance. Familiarity with the expanding list of newer intervention-related causes of hepatic gas detected at CT and US, knowledge of the patient's clinical history, and a careful search for associated clues on images are all factors that may allow the radiologist to better determine the clinical relevance of this finding.

The purposes of this retrospective study were to assess the prevalence of gallbladder sludge (GBS) in a population of cats presented for abdominal ultrasound in a teaching hospital and to determine its association with increased serum alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB). Gallbladder sludge was detected in 152 (14%) of the cats undergoing abdominal ultrasound between 2004 and 2008. This population was compared to a control group of 32 cats without GBS. Alanine aminotransferase, ALP, and TB mean values were significantly higher in cats with GBS than in controls (P ≤ 0.0005) and odds for increased values in cats with GBS were 4.2 [95% confidence interval (CI): 1.6 to 11.0], 9.5 (95% CI: 2.2 to 41.7), and 4.1 (95% CI: 1.5 to 11.5), respectively (P ≤ 0.007). In conclusion, GBS is an uncommon ultrasonographic finding in cats that is predictive of increased liver enzymes and TB. More studies are needed to establish potential links between GBS and hepatobiliary disease in cats.

Aim: To investigate the diagnostic accuracy of hepatobiliary scintigraphy (HBS) in detecting biliary strictures in living donor liver transplantation (LDLT) patients., Methods: We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-to-duct anastomosis, who underwent HBS and cholangiography. The HBS results were categorized as normal, parenchymal dysfunction, biliary obstruction, or bile leakage without re-interpretation. The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography (ERCP)., Results: In 89 patients with biliary strictures, HBS showed biliary obstruction in 50 and no obstruction in 39, for a sensitivity of 56.2%. Of 15 patients with no biliary strictures, HBS showed no obstruction in 11, for a specificity of 73.3%. The positive predictive value (PPV) was 92.6% (50/54) and the negative predictive value (NPV) was 22% (11/50). We also analyzed the diagnostic accuracy of the change in bile duct size. The sensitivity, NPV, specificity, and PPV were 65.2%, 27.9%, 80% and 95%, respectively., Conclusion: The absence of biliary obstruction on HBS is not reliable. Thus, when post-LDLT biliary strictures are suspected, early ERCP may be considered.

Background: THADs are associated with a wide spectrum of hepato-biliary pathologies. The aim of this paper is to find out the role of THADs in the imaging assessment of biliary diseases. We performed a retrospective study to establish the frequency of arterial phenomena in patients with specific biliary diseases., Methods: Out of 1833 patients who underwent upper abdomen biphasic CT (2003-2007), we selected those with the following diagnoses: biliary duct dilation due to extrahepatic obstruction (20 patients-group A), intrahepatic-hilar cholangiocellular-carcinoma (19 patients-group B), and cholangitis (14 patients-group C). THAD presence/pattern was assessed for each group. Patients without any demonstrable clinical/imaging signs of liver/biliary pathology (1124) were the control group., Results: THADs were observed in 36/53 (67.9%) and 20/1124 (1.78%) in study and control groups respectively, with significant association between each diagnostic group and THAD patterns (P < 0.0001). Eleven out of 20 (55%) group A patients showed peribiliary-THAD around dilated biliary tracts; 15/19 (79%) group B patients demonstrated portal involvement and sectorial-THAD; 10/14 (71%) group C patients revealed polymorphous-THAD all along inflamed biliary duct., Conclusions: However, THADs are complex phenomena, their evaluation can be an additional diagnostic tool in patients with a biliary pathology. Diffuse peribiliary, sectorial, and polymorphous-THADs show a good rate of correlation (P < 0.0001) with biliary duct ectasia, portal infiltration, and cholangitis, respectively.

Gastroenterologists increasingly find themselves in the un-enviable position of having to choose the optimal radiographic test to visualize the biliary tree and the liver. This dilemma is compounded by the rapid evolution of the available technologies and their ever-increasing resolution capabilities. Endoscopic ultrasound (EUS) has shown itself to be equally capable of providing detailed imaging of the biliary tree and of surrounding structures; its potential for evaluating liver lesions is just now being realized. EUS-fine needle aspiration (FNA) may supplant some of the existing technologies as it offers a way to sample masses, strictures, lymph nodes, and now certain segments of the liver and periportal regions. This review takes an in-depth look at the role of EUS in evaluating bile duct dilatation, suspected choledocholithiasis, biliary strictures, and polyps and masses of the gallbladder. It also reviews the literature on the exciting and rapidly evolving role of EUS-FNA evaluation of occult, metastatic, and primary hepato-cellular malignancies, as well as periportal lesions. Technologies such as EUS elastography may completely obviate FNA of liver lesions.

Objective: Our objective was to quantitatively assess the value of early posttransplantation hepatic artery resistive indexes in predicting vascular and nonvascular complications in adult orthotopic liver transplant (OLT) patients., Materials and Methods: Between 1999 and 2001, 110 consecutive adults received grafts. Doppler sonographic graft evaluations measured main, right, and left resistive indexes within 24 to 48 hr after surgery (normal resistive index cutoff, 0.6). Clinical, operative, procedural, and radiologic reports were reviewed for vascular and biliary complications. Frequency, Student's t test, logistic, and regression statistical analyses were performed., Results: even patients (6.4%) had vascular complications, including two (1.8%) hepatic artery and two (1.8%) hepatic vein stenoses, one (0.9%) hepatic vein thrombosis, two (1.8%) portal vein thromboses, and one (0.9%) thrombosis and two (1.8%) stenoses of the inferior vena cava (IVC). In 19 patients (17.3%), biliary complications included anastomotic strictures and leaks 1 week to 18 months after transplantation. In 11 patients (10%), sonographically large hematomas required surgical evacuation. In grafts with vascular complications or large hematomas, the mean early posttransplant main, right, and left indexes were significantly lower (< or = 0.6) than without these complications (p < 0.01). In grafts with and without biliary complications, mean early posttransplant main, right, and left indexes did not differ significantly., Conclusion: In adult OLT patients, low early posttransplant hepatic artery resistive indexes were sensitive (100%) and specific (80%) predictors for vascular complications (e.g., hepatic artery, portal vein, hepatic vein, and IVC) but not for biliary complications. All patients with indexes less than 0.6 within 24-48 hr after surgery should be monitored closely for vascular complications.

Multidetector row computed tomography (MDCT) enables rapid thin-section acquisition of regional body anatomy. MDCT is adapted to hepatic and pancreatic imaging to produce, in appropriate clinical circumstances, a multipass multiplanar study obtained during defined circulatory phases to best outline vasculature and detect and characterize focal parenchymal lesions. In this chapter, a rational approach to hepatic and pancreatic MDCT acquisition is outlined with emphasis on circulatory phases and contrast material pharmacokinetics as well as biological characteristics of focal parenchymal lesions.

We present two cases, in which perfusion CT demonstrated diffusely increased arterial and decreased portal perfusion of the liver parenchyma around liver abscess and infectious bilomas. These cases suggested that perfusion CT may be useful for a quantitative analysis of perfusion changes in infectious hepatobiliary diseases with good anatomical detail.

Background/purpose: Nonoperative management of blunt liver trauma may delay diagnosis of related biliary complications leading to delayed surgical intervention and related morbidity. The aim of this study was to see whether technetium (tc) 99 trimethylbromo-im-indolacetic acid (TBIDA) nuclear scan would allow noninvasive early diagnosis of bile leak and pre-emptive management., Methods: Retrospective analysis of the patient records and radiologic investigations of 7 patients admitted between April 1998 and December 2000 with "major" blunt liver trauma (parenchymal fracture of less than 4 cm on computed tomography [CT] scan or involving porta hepatis) and various types of biliary complications. Patients with or without early TBIDA diagnosis were compared., Results: There were 7 patients. The first 2 patients were treated conventionally without TBIDA, and late diagnosis was associated with further related problems (sepsis, life-threatening hemorrhage in both cases) and prolonged hospital stay. The subsequent 5 consecutive patients benefited from early diagnosis (TBIDA scan, 2 to 4 days after trauma), and preemptive management was done (tailored to each case). There was no further or related morbidity. All 7 patients currently are alive and well., Conclusions: A TBIDA nuclear medicine scan was efficient in providing an early diagnosis of biliary leakage, thus, allowing adequate preemptive management. In turn, this may have helped avoid related added morbidity compared with cases of late diagnosis. Early TBIDA scan should be performed routinely when the initial CT scan confirms liver trauma graded as "major.", (Copyright 2002, Elsevier Science (USA). All rights reserved.)

Objective: To assess the value of intraoperative ultrasonography in hepatobiliary surgery., Methods: Aloka-650 and Aloka-500 with a 3.5 MHz probe were used in preoperative ultrasonography and those with 5 MHz or 7.5 MHz probes in intraoperative ultrasonography. All patients with carcinoma were confirmed pathologically., Results: In 44 patients with liver cancer (76 tumors), the diagnostic rate of intraoperative ultrasonography was 97% (74/76), which was markedly higher than 84% (64/76) of preoperative ultrasonography (P<0.05). The diagnostic rate (92%; 22/24) of intraoperative ultrasonography for tumors 0.05). Yet the diagnostic rate (100%; 12/12) of intraoperative ultrasonography for gallbladder carcinoma was markedly higher than that (66.7%; 8/12) of pre-operative ultrasonography (P<0.05). The diagnostic rates of intraoperative ultrasonography for choledocholith and biliary tract cancer were all 100%, markedly higher than those (83%; 20/24 and 75%; 12/16) of preoperative ultrasonography (P<0.05)., Conclusions: Intraoperative ultrasonography can raise the detective rate of the liver occupying lesions comparing with that of preoperative untrasonography. It is of valuable in selecting operative scheme and locating small lesions.

Quantitative hepatobiliary scintigraphy using 99mTc-mebrofenin was performed on eight normal cats and on the same cats after induction of experimental cholangiohepatitis by infection with the liver fluke Platynosomum concinnum. Hepatobiliary scintigraphy was performed 3 times at 10 weeks, 4 months and 6 months after infection. In addition, routine biochemical tests, hepatic ultrasound and ultrasound guided hepatic biopsy samples were obtained at the same time points, and the results compared with hepatobiliary scintigraphy. The normal hepatic extraction fraction was determined to be 85%, and the normal hepatic excretion half time (T 1/2) was 14 minutes. There was no significant change in scintigraphic parameters compared to pre-infection values at any time following infection with the liver fluke. No correlation between scintigraphic parameters and histologic scores was found; however, significant correlation was identified between parasite burden and histologic scores 6 months following infection. Despite the presence of severe multifocal histologic abnormalities, minimal clinical, biochemical and scintigraphic derangements were identified using this model of cholangiohepatitis. Based on this study, hepatobiliary scintigraphy appears to be an insensitive test for structural hepatobiliary abnormalities. The role of hepatobiliary scintigraphy in functional hepatobiliary abnormalities of the feline liver has not been determined.

Background: On the basis of personal experience and literature, this study has been carried out in order to clarify the impact of ultrasonography on the diagnosis and prevention of hepatobiliary complications Total Parenteral Nutrition (TPN)-related., Methods: Between April 1995-April 1997 in the Department of General Surgery-University of Catanzaro, 18 adult patients submitted to major thoracic or abdominal surgery, underwent to TPN for perioperative time (range: 9-55 days). In these patients ultrasonography was performed at pre-established days in pre- and postoperative time in order to diagnose precociously the possibility of hepatobiliary complications., Results: Ultrasonography showed: 3 cases of hepatic steatosis, 5 cases of steatosis and gallbladder biliary sludge, 2 cases of gallbladder biliary sludge alone, 1 case of gallbladder biliary sludge with microlithiasis, 1 case of acute acalculous cholecystitis. The other 6 patients presented only little laboratory tests alterations, but normal ultrasonographic findings., Conclusions: Therefore it is underlined the importance of systematic ultrasonographic follow-up of patients on TPN as a non invasive method in the early diagnosis of hepatobiliary complications TPN-related. The good compliance of the patients to this instrumental investigation and the not excessive increase of their management's costs are also underlined.

Ultrasonography of the gallbladder was performed in 3 groups of dogs: 30 clinically healthy dogs, 50 dogs with hepatobiliary disease, and 50 dogs with diseases other than hepatobiliary disease. The gallbladder was evaluated for the presence of sludge (echogenic material without acoustic shadowing). Maximal gallbladder length, width, height, and area were measured as well as the gallbladder wall thickness. The relative sludge area was calculated as the ratio of sludge area over gallbladder area on longitudinal images. No significant difference was found in the prevalence of gallbladder sludge among healthy dogs (53%), dogs with hepatobiliary diseases (62%), and dogs with other diseases (48%). The mean age of dogs with sludge was higher than the mean age of dogs without sludge in dogs with hepatobiliary disease and dogs with other diseases (p < 0.05). The mean relative sludge area did not differ significantly among the 3 groups. A trend to larger gallbladder dimensions in dogs with sludge compared to dogs without sludge was detected within the 3 groups. The gallbladder wall thickness was not different between dogs with and without sludge within the 3 groups. However, the gallbladder wall was more frequently isoechoic than hyperechoic to the liver in dogs with sludge than in dogs without sludge. The results of this study indicate that gallbladder sludge, in dogs, is not particularly associated with hepatobiliary disease and should be considered an incidental finding.

Purpose: The work was aimed at presenting the indications, techniques and results of the percutaneous transjejunal approach to the biliary tree in patients with hepatobiliary complications due to surgery., Patients and Methods: Ten patients, 7 males and 3 females, mean age 50 years (range, 10-62) with hepatico-jejunostomy, who developed cholangitis together with jaundice or bile leakage, underwent this procedure, performed through the anastomotic loop that was not surgically anchored to the abdominal wall in all cases but one. The transjejunal approach was chosen because of non-dilated bile ducts in 3 patients, complex pathologic situations in 5 patients and to avoid complications to a transplanted liver in 2 patients. The jejunal loop was identified using CT, US and fluoroscopy in 4 patients and after its opacification in the remaining 6 (by percutaneous transhepatic or intravenous cholangiography or fistulography)., Results: The procedure was technically and diagnostically successful in all cases. Therapeutic procedures (stenting, dilation, litholysis) were also performed using the transjejunal approach in 7 patients and in 6 of them complete pathological resolution was achieved. There were no complications., Conclusions: Different pathologies of the biliary tree, in patients with bilio-enteric anastomoses, have been identified and treated by this technique; they were fistulas, anastomotic and/or multiple segmental benign or malignant stenoses of the bile duct, and diffuse intrahepatic lithiasis. The procedure was safe and reliable.

Hepatobiliary scintigraphy using iminodiacetic (IDA) radiopharmaceuticals provides clinically useful information on the function of the biliary tract in a variety of pathological processes in children, including neonatal jaundice, gallbladder dysfunction, trauma, and liver transplantation. Phenobarbital premedication (5 mg/kg per day for a minimum of 5 days in divided doses) is used in infants who are being examined for neonatal jaundice to increase the accuracy of 99mTc-IDA scintigraphy in differentiating extrahepatic biliary atresia from neonatal hepatitis. Biliary atresia can be ruled out in an infant if a patent biliary tree is shown with passage of activity into the bowel. If no radiopharmaceutical is noted in the bowel on imaging up to 24 hours, distinction between severe hepatocellular disease and biliary atresia cannot be made. The literature reports 91% accuracy, 97% sensitivity, and 82% specificity for hepatobiliary imaging in the diagnosis of biliary atresia. The impairment of both intrahepatic and extrahepatic biliary drainage is an important cause of liver disease in cystic fibrosis. Hepatobiliary scintigraphy in cystic fibrosis has shown characteristic patterns of dilatation of mainly the left hepatic duct, narrowing of the distal common bile duct, gallbladder dysfunction, and delayed bowel transit. Cholecystitis in children may be acalculous. Sensitivity and specificity for the scintigraphic diagnosis of acute acalculous cholecystitis is reported to range from 68% to 93% and 38% to 93%, respectively. Cholescintigraphy in a suspected bile leak provides information generally not available with other techniques, except for direct cholangiography. If the amount of intraperitoneal accumulation of the tracer is greater than that entering the gastrointestinal tract, surgery is usually indicated. Hepatobiliary imaging in children who have undergone liver transplantation will assess graft vascularity, parenchymal function, biliary drainage, presence of a leak, and obstruction.

Intrahepatic cholangiography of primary sclerosing cholangitis (PSC) is characterized by stricture with or without dilation of the biliary tree. To evaluate whether this cholangiographic appearance is present in non-PSC livers as well as the histological features seen in non-PSC livers with this cholangiographic appearance, we performed postmortem intrahepatic cholangiography in 154 liver autopsy specimens. The PSC-like cholangiographic appearance was frequently found in cirrhosis with or without hepatocellular carcinoma (4 of 6, 67%), hepatocellular carcinoma (1 of 1, 100%), adult-type polycystic disease of the liver and kidneys (2 of 3, 67%), submassive hepatic necrosis (2 of 5, 40%), amyloidosis (1 of 2, 50%), and intrahepatic extensive thrombosis (1 of 1, 100%). It was also found but at lower frequency in metastatic carcinomas (3 of 13, 23%) and leukemia/lymphoma infiltration (2 of 12, 17%). Histologically, in livers with such a PSC-like cholangiographic appearance, the intrahepatic bile ducts were compressed by fibrosis, inflammatory infiltrates, liver cysts, cancer cell infiltration, amyloid deposition, or portal thrombi. Dilated ducts had less pronounced changes than strictured ducts. In these hepatobiliary diseases, the changes of intrahepatic bile ducts in the livers without the PSC-like cholangiographic appearance were much less marked than those in the livers with it. These data suggest that the PSC-like intrahepatic cholangiographic appearance is present in several hepatobiliary diseases and that clinicians should take such diseases into consideration if stricture with or without dilation is found on intrahepatic cholangiography.

We studied 8 adult patients who received total parenteral nutrition (TPN). An abdominal ultrasound and liver functions test were done weekly looking for biliary sludge, thickening of the gallbladder wall, changes en bile ducts and liver parenchyma. Seven patients developed biliary sludge at week four. We didn't detect changes in bile ducts neither in the gallbladder wall. Two patients had elevations of bilirubin, Alkaline phosphatase and aminotransferase during TPN. 3 patients developed mild liver steatosis detected by ultrasound during the third and sixth week of NPT. Our findings agree with other studies that describe the development of biliary sludge, gallbladder stones, liver steatosis and colestasis in patients receiving TPN. Once TPN is stopped and oral feeding is restarted this changes usually disappear.

Hepatobiliary scintigraphy provides a noninvasive assessment of hepatobiliary structure and function, and has been used extensively in people. Hepatocellular measurements determined in the cats of this study include cardiac washout (< or = 2 minutes) and time of maximal hepatic activity (< or = 5 minutes) and hepatic washout (< or = 30 minutes). The gallbladder response to synthetic cholecystokinin was determined to be < or = 3 minutes. Additional measurements also were identified. Potential use of hepatobiliary scintigraphy in feline medicine is discussed.

Our purpose was to characterize the spectrum of hepatobiliary abnormalities on sonography in children with vertically transmitted HIV infection. Abdominal sonograms were performed on 41 children with HIV infection and correlated with clinical and histopathologic data. Hepatobiliary abnormalities were noted in 26 (63%) children. Hepatomegaly (n = 13) and abnormal hepatic echotexture (n = 13) were the most common abnormalities noted. Preexisting AIDS-related infections or neoplasms were noted significantly more frequently in children with hepatic or biliary abnormalities on sonography (18/26, 69%) than in children without abnormalities (5/15, 33%) (P = 0.0001). Most children with hepatobiliary abnormalities on sonography who underwent hepatic tissue sampling, however, did not have evidence of acute infection or neoplasia. Hepatobiliary abnormalities are frequently noted on sonography in children with HIV infection. Hepatomegaly and abnormal hepatic echotexture are the most frequent sonographic findings and are usually nonspecific.

Twenty-four locality-, age- and sex-matched groups of village residents with no light, moderate and heavy Opisthorchis viverrini infection were examined by ultrasonography. Highly significant differences were observed between the groups in the relative size of the left lobe of the liver and the fasting and post-meal size of the gall-bladder. In addition, indistinct gall-bladder wall, the presence of gall-bladder sludge and strongly enhanced portal vein radicle echoes were most frequently observed in the heavily infected group. Two suspected cases of cholangiocarcinoma were identified from the heavy group. The results highlight the importance of intensity of infection on the frequency and severity of fluke-associated hepatobiliary disease.

Ultrasonic Doppler measurement of the blood flow in the portal vein and hepatic artery was conducted to evaluate the function and functional reserve of the liver in 146 patients with various forms of cholangitis combined with biliary cirrhosis and hepatic insufficiency. The functional reserve of the liver was judged by comparison of the basic blood flow on a fasting stomach with the blood flow after a functional histamine load. Five types of responses of the portal vein blood flow to the functional load according to the degree of disturbed hepatic function were revealed. Comparison of the flow of blood along the portal vein in healthy individuals with that in patients with diabetes mellitus and a formed splenorenal shunt showed that disconnection of the blood flow from the splenic vein has no effect on the flow of blood in the portal vein. The latter is regulated at the level of microcirculation in the liver, which is confirmed by the correlation between the blood flow in the portal vein and in the hepatic artery.

Evaluation of the liver and biliary tract is one of the principal applications of abdominal ultrasonography in small animals. Indications include hepatomegaly, mass in the area of the liver, suspected hepatic metastasis, jaundice, ascites, suspected diaphragmatic rupture, and weight loss. Ultrasonography is a valuable method for evaluating the internal structure of the liver and biliary tract. Certain functional assessments also may be made, for example, measurement of induced gallbladder emptying after cholecystokinin injection. Limitations of ultrasonography include lack of specificity for focal or multifocal hepatic lesions and insensitivity for certain infiltrative diseases, such as lymphosarcoma. These limitations contribute to diagnostic difficulties, which are adequately addressed only by biopsy. The technique of ultrasound-guided biopsy is described briefly.

Kinetic evaluation of 170 hepatobiliary scintigrams was performed using direct integral linear least square regression method (DILS method). Liver time-activity curve (TAC) data were fitted to 2 types of 1 compartment model using heart TAC as input function. One model was 1 compartment model with 2 parameters (extraction rate (ku) and excretion rate (ke)), the other had another parameter for representing non-specific volume of distribution (Vn) in liver. Obtained parameter estimate was then examined to see how they correlate with three major visual findings of scintigram; low tracer uptake, intrahepatic cholestasis, extrahepatic cholestasis. In both models, ku showed significant difference between low uptake positive and negative groups and ke showed significant difference between extrahepatic cholestasis positive and negative groups. Only mean uptake time (Vn/ku) by 3 parameter model showed significant difference between intrahepatic cholestasis positive and negative groups, although the other 2 parameters (ku, ke) were insensitive to intrahepatic cholestasis in either model. Thus, the 3 parameter model was superior to the 2 parameter model because of its sensitivity to intrahepatic cholestasis and ability to differentiate extrahepatic and intrahepatic cholestasis as the difference of parameter values. Based on this 3 parameter model, parametric images were generated by calculating parameter value of each pixel using the DILS method. The DILS method could determine parameters by simple calculation, and hence was very powerful in processing parametric images, which processing otherwise required immense calculation.

A study was undertaken to check the feasibility of measuring the hepatic extraction fraction (HEF) and excretion T-1/2 values as an integral part of hepatobiliary imaging with technetium-99m-mebrofenin in health and disease. In 18 controls subjects, the HEF was 100% and the T-1/2 excretion mean +/- s.e. value was 15.23 +/- 1.4 min. The mean appearance times of the common bile duct (CBD), gallbladder (GB), and small intestine were 15.8 +/- 1.52, 20.2 +/- 2.7, and 23.8 +/- 3.08 min, respectively. Rising serum bilirubin in patients decreased HEF and increased T-1/2 excretion value resulting in delayed appearance of CBD, GB, and small intestine. In control subjects and patients with bilirubin less than 5 mg%, T-1/2 excretion values at 30, 40, and 50 min were similar to those values calculated using the entire 60 min of data, suggesting that the hepatic phase study time could be reduced to 30-40 min and still use the normal reference values established for 60 min. In patients with bilirubin greater than 5 mg%, the data collection duration should be continued for 60 min.

Clinical usefulness of mean transit time (MTT) through the liver was evaluated by deconvolution analysis using 99mTc-EHIDA hepatobiliary scintigraphy in 82 patients with various hepatobiliary diseases and 18 normal controls. Initial transfer factor was also obtained according to the method of Rutland. Results obtained were as follows. 1) Effect of the age on MTT was not observed in normal controls. 2) MTT in left lobe of normal controls was significantly prolonged compared with that of right lobe (P less than 0.01). This kind of difference was not observed in patients with liver cirrhosis. 3) MTT in patients with obstructive jaundice, chronic liver diseases, liver cirrhosis at decompensative state and primary biliary cirrhosis was significantly prolonged compared with that in normal controls (P less than 0.01). 4) MTT in patients with liver cirrhosis at compensative state showed normal values, although blood clearance rate in those patients was significantly decreased (P less than 0.05). 5) Positive correlation was observed between MTT and values of T-Bil, ALP, LAP, and gamma-GTP. Negative correlation was observed between MTT and value of cholinesterase. 6) Initial transfer factor correlated with blood clearance rate. (r = 0.76, P less than 0.01). 7) Initial transfer factor in left lobe of normal controls was significantly decreased compared with that of right lobe (P less than 0.01). This kind of difference was not observed in patients with liver cirrhosis. 8) Initial transfer factor in patients with liver cirrhosis in both compensative and decompensative states and PBC was significantly decreased compared with that in normal controls. Estimation of MTT and initial transfer factor could be a useful parameters to assess transfer function of the liver.

This report proffers a diagram of radiologic procedures to aid in the diagnosis of traumatic hemobilia and updates the most important radiologic findings of hemobilia to demonstrate the value of the coordinated use of liver scintigraphy and angiography. According to the diagnostic schema, evaluation of biliary tract hemorrhage progresses from plain films through liver scintigraphy and angiography. Depending on the procedure yielding positive results, logical termination or progression is possible at any stage of the work-up.

99Tcm-labelled HIDA administered intravenously is promptly taken up by the liver and excreted into the bile duct and gallbladder. In this study the use of this agent in hepatoscintigraphy was evaluated. Thirty patients with a variety of hepatobiliary pathology were studied. After an overnight fast 2 mCi of 99Tcm HIDA were given intravenously and the patient was scanned continuously for 1 h. A rapid outline of the liver and biliary tract was usually obtained and the T 1/2 of the tracer in the blood stream was 20 min. In total obstructive jaundice, isotope was excreted through the renal tract without visualization of the liver. Hepatoscintigraphy was compared with conventional radiographs and ultrasonography in 19 patients presenting an emergencies with suspected hepatobiliary disease and was found to be comparable to the latter modes of investigation. In the jaundiced patients hepatoscintigraphy was inferior to percutaneous transhepatic cholangiography and to ultrasonography. No adverse side effects have followed the use of the radiopharmaceutical.

A patient with traumatic hemobilia documented by retrograde endoscopic cholangiography and treated by right hepatic artery ligation, is described. The role of ERCP in making the diagnosis of traumatic hemobilia is discussed.

The diagnostic value of computed tomography (CT) of the liver depends on proper conduct of the examination, knowledgeable interpretation of findings, and an appreciation of the capabilities and limitations of the method. This report documents 10 months of experience with abdominal CT in more than 600 liver examinations using a system fast enough to eliminate respiratory motion. This experience supplied data on the CT appearance of the normal liver and its variations and of various hepatic abnormalities, on the conduct of the examination, including the appropriate of contrast material, and on some of the problems that reduce the technical quality of the examination. CT was highly accurate, but not infallible, in detecting and defining space-occupying lesions and in detecting fatty infiltration; it was less helpful in detecting diffuse hepatic disease. In bile duct obstruction, CT displayed not only the dilated ducts but often the obstructing lesion.

In order to compare the reliability of hepatobiliary scintigraphy using DISIDA (DHS) and ultrasonography (US) in the diagnosis of obstructive jaundice, 36 consecutive patients clinically suspected for obstruction were examined with both methods. Sixteen patients who were definitively shown to have obstruction, were all correctly detected with DHS; US was positive in 15 cases, revealing the cause of the obstruction in four cases. The site of obstruction was predicted in eight cases by DHS and in 11 cases by US. Associated gallbladder diseases were evaluated better by US than by DHS, but a perforation was only demonstrated clearly by DHS. In the 20 patients with nonobstructive disease the false positive results were found in one case using DHS and in two cases using US. In this series of patients DHS and US showed high sensitivity and specificity, which were further increased when the two techniques were combined.