Lee Jeong Min, Boll Daniel T.
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, BS, Switzerland
Cross-sectional imaging modalities including ultrasound (US), magnetic resonance (MR) imaging, and computed tomography (CT) play a critical role in the diagnosis of gallbladder and biliary disease. Biliary imaging for evaluation of obstructive jaundice seeks to diagnose the level of obstruction and its cause. The identification of dilated bile ducts necessitates evaluation for strictures or filling defects, which is best performed with thin-section CT or T2-weighted MR cholangiography. Choledocholithiasis is the most common cause of biliary obstruction, and modern thin-section three-dimensional MR cholangiography is highly sensitive and specific for the detection of stones. Identification of bile duct wall thickening raises concern for cholangitis or malignancy. Primary sclerosing cholangitis and secondary sclerosing cholangitis such as recurrent pyogenic cholangitis and IgG4-related sclerosing disease can develop chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts. Familiarity with the typical clinical and radiologic appearances of various etiologies of cholangiopathies and biliary malignancies is also important for accurate image interpretation. In order to detect and characterize diseases of the gallbladder appropriately, knowledge of congenital variants and anomalies of the gallbladder anatomy is essential. Understanding the pathogenesis responsible for gallstone formation and resultant imaging features will be outlined. Recognizing mechanisms leading to acute and chronic inflammatory scenarios of the gallbladder may influence the decision on appropriate treatment. Differentiating inflammatory gallbladder disease from gallbladder neoplasms can be challenging in early stages; recognizing imaging features which raise the suspicion for potential underlying neoplasms is essential in guiding potential treatment options.
包括超声（US）、磁共振（MR）成像和计算机断层扫描（CT）在内的横断面成像方式在胆囊和胆道疾病的诊断中起着关键作用。用于评估梗阻性黄疸的胆道成像旨在诊断梗阻的部位及其原因。识别扩张的胆管需要评估是否存在狭窄或充盈缺损，这最好通过薄层CT或T2加权磁共振胆胰管造影来进行。胆总管结石是胆道梗阻最常见的原因，现代薄层三维磁共振胆胰管造影对结石的检测具有高度敏感性和特异性。胆管壁增厚的识别会引发对胆管炎或恶性肿瘤的担忧。原发性硬化性胆管炎和继发性硬化性胆管炎，如复发性化脓性胆管炎和IgG4相关硬化性疾病，可发展为以胆管炎症、纤维化和狭窄为特征的慢性进行性胆汁淤积性肝病。熟悉各种胆管疾病和胆道恶性肿瘤病因的典型临床和影像学表现对于准确的图像解读也很重要。为了适当地检测和表征胆囊疾病，了解胆囊解剖结构的先天性变异和异常至关重要。本文将概述导致胆结石形成的发病机制及其相应的影像学特征。认识导致胆囊急性和慢性炎症情况的机制可能会影响适当治疗方案的决策。在早期阶段，将炎性胆囊疾病与胆囊肿瘤区分开来可能具有挑战性；识别引起对潜在肿瘤怀疑的影像学特征对于指导潜在的治疗选择至关重要。
