TY - JOUR
T1 - Biliary Duct Dilatation
T2 - AJR Expert Panel Narrative Review
AU - Ludwig, Daniel R.
AU - Itani, Malak
AU - Childs, David D.
AU - Revzin, Margarita V.
AU - Das, Koushik K.
AU - Anderson, Mark A.
AU - Arif-Tiwari, Hina
AU - Lockhart, Mark E.
AU - Fulcher, Ann S.
N1 - Publisher Copyright:
© 2024 American Roentgen Ray Society. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - Biliary duct dilatation is a common incidental finding in practice, but it is unlikely to indicate biliary obstruction in the absence of clinical symptoms or elevated levels on liver function tests (LFTs). However, the clinical presentation may be nonspecific, and LFTs may either be unavailable or difficult to interpret. The goal of this AJR Expert Panel Narrative Review is to highlight a series of topics fundamental to the management of biliary duct dilatation, providing consensus recommendations in a question-and-answer format. We start by covering a basic approach to interpreting LFT results, the strengths and weaknesses of the biliary imaging modalities, and how and where to measure the extrahepatic bile duct. Next, we define the criteria for biliary duct dilatation, including patients with prior cholecystectomy and advanced age, and discuss when and whether biliary duct dilatation can be attributed to papillary stenosis or sphincter of Oddi dysfunction. Subsequently, we discuss two conditions in which the duct is pathologically dilated but not obstructed: congenital cystic dilatation (i.e., choledochal cyst) and intraductal papillary neoplasm of the bile duct. Finally, we provide guidance regarding when to recommend obtaining additional imaging or testing, such as endoscopic ultrasound or ERCP, and include a discussion of future directions in biliary imaging.
AB - Biliary duct dilatation is a common incidental finding in practice, but it is unlikely to indicate biliary obstruction in the absence of clinical symptoms or elevated levels on liver function tests (LFTs). However, the clinical presentation may be nonspecific, and LFTs may either be unavailable or difficult to interpret. The goal of this AJR Expert Panel Narrative Review is to highlight a series of topics fundamental to the management of biliary duct dilatation, providing consensus recommendations in a question-and-answer format. We start by covering a basic approach to interpreting LFT results, the strengths and weaknesses of the biliary imaging modalities, and how and where to measure the extrahepatic bile duct. Next, we define the criteria for biliary duct dilatation, including patients with prior cholecystectomy and advanced age, and discuss when and whether biliary duct dilatation can be attributed to papillary stenosis or sphincter of Oddi dysfunction. Subsequently, we discuss two conditions in which the duct is pathologically dilated but not obstructed: congenital cystic dilatation (i.e., choledochal cyst) and intraductal papillary neoplasm of the bile duct. Finally, we provide guidance regarding when to recommend obtaining additional imaging or testing, such as endoscopic ultrasound or ERCP, and include a discussion of future directions in biliary imaging.
KW - CT
KW - MRI
KW - biliary duct dilatation
KW - biliary enzymes
KW - cholangiopancreatography
KW - cholecystectomy
KW - duct measurement
KW - obstruction
KW - ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85192113675&partnerID=8YFLogxK
U2 - 10.2214/AJR.23.29671
DO - 10.2214/AJR.23.29671
M3 - Article
C2 - 37493325
AN - SCOPUS:85192113675
SN - 0361-803X
VL - 222
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 4
ER -