Oral contrast-enhanced three-dimensional helical-CT cholangiography: clinical applications

Our objective was to define the possibility of using oral-contrast-enhanced helical CT for the assessment of patients with cholecystolithiasis and of cholecystectomized symptomatic patients. Twenty-seven patients with cholecystolithiasis and 20 with a painful abdominal symptomatology after cholecystectomy (12 laparoscopic and 8 laparotomic) were recruited for this study. Cholangio-CT was performed 12-14 h after oral administration of 6 g of hyopanoic acid. The acquired data were then transferred to a second workstation and 3D reconstruction of the biliary tract was obtained. In all the cases the extrahepatic bile ducts were recognizable. Seven patients had no gallbladder opacification: CT images showed in 3 cases an infundibular stone and in 4 cases sclero-atrophic gallbladder. The intrahepatic bile ducts were visible in 21 of 27 patients with lithiasis and in 14 of 20 cholecystectomized patients. In 5 cholecystectomized patients cholangio-CT demonstrated the presence of residual choledochal or intrahepatic stones. In 3 cholecystectomized patients 3D reconstruction allowed identification of a long and winding stump of the cystic duct. Cholangio-CT is a non-invasive method to evaluate the biliary tract in patients who cannot be subjected to cholangio-MR, or as a preliminary to endoscopic retrograde cholangiopancreatography in cases of doubtful diagnosis after US and cholangio-MR.