CT evaluation of the bile ducts in patients with fatty liver

Computed tomographic (CT) evaluation of the bile ducts in the fatty liver can be difficult, since hepatic attenuation decreases with increased triglyceride content, and liver parenchyma may become isodense with bile. Forty-seven patients with fatty infiltration of the liver were retrospectively identified. In 7 of these patients, attenuation of liver and bile differed by less than 10 HU. In 2 patients, dilated intrahepatic ducts were invisible using CT, because bile was isodense with fatty liver parenchyma. Thus, the fatty liver presents a potential pitfall in CT evaluation of the bile ducts. Obstructive jaundice can be diagnosed in patients with fatty liver, if the extrahepatic ducts and peribiliary vascular plexus region are carefully scrutinized. For maximal accuracy, scans should be obtained both before and after administration of intravenous urographic contrast material.