Image Appraisal: Biliary Studies Review Copy

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Image AppraisalBiliary Studies Review Copy

• Medical Radiation 300A
• 2006
• Cristina Blefari

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Case 1

• View Case1-1 (over the page) answer the
  following questions
• Describe the radiopharmaceutical uptake within
  the liver from 5 60 mins.
• What is the area of activity depicted by the
  arrow on the 15 min image? Is this normal
  uptake?
• Is there a Gallbladder visualised on this study?
  If so, at what time is it first visualised?
  Circle its location on each image that is
  visible.
• What is the area of activity depicted by the
  arrow on the 50 min image? Is this normal
  uptake?
• This study was acquired using a series of static
  images. Discuss some of the advantages
  disadvantages of this imaging protocol.
• Describe an alternative, suitable imaging
  protocol for this type of study.

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CASE 1-1
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Case 1-2

• 2. At 60 mins, the patient was given a meal of
  milk a biscuit (image 1-2, over the page).
• Why was this done?
• What further quantitative information could be
  obtained from giving the patient a meal.
  Describe how you would proceed to calculate this
  value, including ROI the formula/calculations
  you would use.
• Why do you think this quantitative value was not
  calculated from these images?
• Discuss the alternative to a giving a meal and
  the advantages disadvantages associated with it.

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CASE 1-2
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Case 1 - Review

• 1.
• 5 mins diffuse uptake throughout liver
• 10 mins liver uptake increases (normal)
  hepatic ducts visualised
• Small focus of activity which appears to be a GB
  as it increases in size on subsequent images

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Case 1 - Review

• b) Bladder, yes, some renal excretion of RP does
  occur
• c) Yes, 15 mins.
• d) Excretion of tracer into small bowel. Yes,
  normal uptake. Shows that common bile duct is
  patent.

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Case 1 - Review

• e) Advantages
• Patient can rest between images
• Camera can be used for other quick views
• Disadvantages
• Flow to liver other organs not visualised
• Statics may miss important filling phases
• f) Dynamic Images.
• Initial flow 2 5 sec/frame for 1 min
• Dynamic 1 4 min/frame for 60 mins

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Case 1 - Review

• 2.
• To stimulate GB contraction
• GBEF to calculate
• Draw ROI around GB on pre post meal image
• Background ROI (in adjacent liver), subtract
  from GB counts
• GBEF net GB ctsmax net GB ctsmin
• x 100
• net GB ctsmax
• c) Information obtained that GB was functioning.

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Case 2

• History
• 6 week baby. Neonatal jaundice.
• 1. View the image 2-1
• Describe all the scan appearances of this study.
• Can a gallbladder be visualised? If so, at what
  time?
• 2. View the image 2-2
• Why were the lateral views acquired? What
  information do they add to the study?
• 3. View the image 2-3
• Why were the delayed images acquired? What do
  they show?
• Can a gallbladder now be visualised? If yes,
  describe which view best depicts it.
• 4. Considering the scan appearances and the
  history provided
• Is this a normal or abnormal study? If
  abnormal, give the likely pathology and discuss
  briefly. Justify your answer with reference to
  the scan appearances.

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CASE 2-1
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CASE 2-2
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CASE 2-3
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Review Case 2

• 1.
• Initial image heart visible, this fades liver
  intensity increases
• Uptake in kidneys increase over time then
  decrease as bladder activity increases
• b) No biliary tree, gallbladder or small bowel
  seen

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Review Case 2

• 2. To see position of suspected activity in
  kidneys. Show that activity is indeed posterior,
  therefore kidney.
• 3.
• To see if GB does appear over time. Show
  persistent hepatic renal uptake
• No.

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Review Case 2

• 4.
• Abnormal - Biliary Atresia congenital absence of
  one or more of the biliary structures, causing
  jaundice liver damage.
• No GB or biliary structures or small bowel
  activity are visualised.

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Case 3

• View Case 3 (over the page).
• 1. Discuss the patient preparation for this
  type of study?
• 2.
• Describe the scan appearances from 0 to 90 mins.
• Can the gallbladder be visualised? If so, state
  which frame (time) and its position.
• Why was the morphine administered?
• What is an alternative to morphine
  administration?
• In your opinion, what pathology is the patient
  suffering from?

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CASE 3
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Review Case 3

• Fasting (min 2 hrs, preferably 4 hrs but not more
  than 24 hrs)
• Off opium medications (or 4 hrs from last dose)
• 2. a) Liver uptake increases over time. Common
  hepatic duct noted at 40 mins, with definite
  excretion into small bowel at 45 mins.
• b) No

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Review Case 3

• c) No GB visualised, to distinguish between acute
  chronic cholecystisits.
• d) Delayed imaging at 4 hrs.
• e) Acute Cholecystisits.