CT cholangiography (protocol)
Updates to Article Attributes
CT cholangiography is a technique of imaging the biliary tree with the usage of hepatobiliary excreted contrast. It is useful in delineating biliary anatomy, identifying a bile leak or looking for retained gallstones within the biliary system.
Indications
Second-line test (after ultrasound) when investigating for right upper quadrant pain, obstructive LFTs, etc. It can also be used in the postoperative setting (e.g. post cholecystectomy) where there is a concern for common bile duct injury or retained gallstones, or where intraoperative cholangiography (IOC) was unable to be performed due to extensive inflammation or a narrow cystic duct, proving direct cannulation difficult.
Contraindications
- bilirubin should be < 30 mmol/L nor should it be rising rapidly (as the impaired excretory ability of hepatocytes can affect contrast excretion in bile)
- severe hepatic or renal dysfunction
- thyroid dysfunction
- iodinated-contrast hypersensitivity or allergy
Technique
CT cholangiography may be performed with either intravenous or oral cholangiographic contrast agents both of which outline the biliary tree with positive contrast.
Agents
- meglumine iotroxate (BiliscopinTM): intravenous CT cholangiography agent
Findings
- choledocholithiasis
- biliary stricture
- bile leak / biloma
- aberrant biliary tree anatomy
- other causes of biliary tree obstruction, e.g. pancreatic head tumours
Contraindications
bilirubin should be < 30 mmol/L nor should it be rising rapidly (as impaired excretory ability of hepatocytes can affect contrast excretion in bile)severe hepatic or renal dysfunctionthyroid dysfunctioniodinated-contrast hypersensitivity or allergy
Alternative examinations
- magnetic resonance cholangiopancreatography (MRCP)
- contrast-enhanced MR cholangiography: with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid
- endoscopic retrograde cholangiopancreatography (ERCP): carries a 5% risk of post-procedure pancreatitis
- intraoperative cholangiography (IOC): performed during cholecystectomy to allow intraoperative detection of retained gallstones or common bile duct injury
Mimics
Occasionally vicarious contrast material excretion can give opacification of the gallbladder and biliary system
-<p><strong>CT cholangiography </strong>is a technique of imaging the <a href="/articles/biliary-tree-anatomy">biliary tree</a> with the usage of hepatobiliary excreted contrast. It is useful in delineating biliary anatomy, identifying a bile leak or looking for retained gallstones within the biliary system.</p><h4>Indications</h4><p>Second-line test (after ultrasound) when investigating for right upper quadrant pain, obstructive LFTs, etc. It can also be used in the postoperative setting (e.g. post cholecystectomy) where there is concern for common bile duct injury or retained gallstones, or where intraoperative cholangiography (IOC) was unable to be performed due to extensive inflammation or a narrow cystic duct, proving direct cannulation difficult.</p><h4>Technique</h4><p>CT cholangiography may be performed with either intravenous or oral cholangiographic contrast agents both of which outline the biliary tree with positive contrast. </p><h5>Agents</h5><ul><li>- +<p><strong>CT cholangiography </strong>is a technique of imaging the <a href="/articles/biliary-tree-anatomy">biliary tree</a> with the usage of hepatobiliary excreted contrast. It is useful in delineating biliary anatomy, identifying a bile leak or looking for retained gallstones within the biliary system.</p><h4>Indications</h4><p>Second-line test (after ultrasound) when investigating for right upper quadrant pain, obstructive LFTs, etc. It can also be used in the postoperative setting (e.g. post cholecystectomy) where there is a concern for common bile duct injury or retained gallstones, or where intraoperative cholangiography (IOC) was unable to be performed due to extensive inflammation or a narrow cystic duct, proving direct cannulation difficult.</p><h4>Contraindications</h4><ul>
- +<li>bilirubin should be < 30 mmol/L nor should it be rising rapidly (as the impaired excretory ability of hepatocytes can affect contrast excretion in bile) </li>
- +<li>severe hepatic or renal dysfunction</li>
- +<li>thyroid dysfunction</li>
- +<li>iodinated-contrast hypersensitivity or allergy</li>
- +</ul><h4>Technique</h4><p>CT cholangiography may be performed with either intravenous or oral cholangiographic contrast agents both of which outline the biliary tree with positive contrast. </p><h5>Agents</h5><ul><li>
-</ul><h4>Contraindications</h4><ul>-<li>bilirubin should be < 30 mmol/L nor should it be rising rapidly (as impaired excretory ability of hepatocytes can affect contrast excretion in bile) </li>-<li>severe hepatic or renal dysfunction</li>-<li>thyroid dysfunction</li>-<li>iodinated-contrast hypersensitivity or allergy</li>