Advertisement

Bile Duct and Gallbladder

  • Nathan C. HullEmail author
  • Gary R. Schooler
  • Edward Y. Lee
Chapter
  • 17 Downloads

Abstract

Disorders of the gallbladder and bile ducts are not uncommon in the pediatric population. Although ultrasound is typically the first-line imaging modality employed in the workup of right upper quadrant pain or suspected hepatobiliary diseases, magnetic resonance (MR) imaging can be utilized for evaluation of bile duct and gallbladder disorders in pediatric patients. MR imaging can provide excellent visualization of these structures and allow comprehensive evaluation of the biliary system and possible concurrent liver disease without potentially harmful ionizing radiation associated with other imaging modalities such as CT. MR imaging sequences such as magnetic resonance cholangiopancreatography (MRCP) and use of hepatobiliary contrast agents can provide a noninvasive way of evaluating the intrahepatic and extrahepatic bile ducts. Up-to-date working knowledge of techniques and tools available to perform MR imaging of the biliary system and familiarity with common disease processes that are encountered in the pediatric population is essential. Therefore, in this chapter, MR imaging techniques for evaluating bile duct and gallbladder anatomy are discussed followed by the review of bile duct and gallbladder anatomy including embryology, normal development, and anatomic variants. In addition, various congenital and acquired disorders affecting infants and children are discussed including clinical features and characteristic MR imaging findings.

Keywords

Child Pediatric Magnetic resonance imaging (MRI) Bile ducts Gallbladder Magnetic resonance cholangiopancreatography (MRCP) 

References

  1. 1.
    Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS. Liver MR imaging in children: current concepts and technique. Radiographics. 2016;36(5):1517–32.PubMedGoogle Scholar
  2. 2.
    Antonov NK, Ruzal-Shapiro CB, Morel KD, Millar WS, Kashyap S, Lauren CT, et al. Feed and wrap MRI technique in infants. Clin Pediatr. 2017;56(12):1095–103.Google Scholar
  3. 3.
    Mitchell CL, Vasanawala SS. An approach to pediatric liver MRI. AJR Am J Roentgenol. 2011;196(5):W519–26.PubMedGoogle Scholar
  4. 4.
    Glockner JF. Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging. 2007;25(4):681–95.PubMedGoogle Scholar
  5. 5.
    Vitellas KM, Keogan MT, Spritzer CE, Nelson RC. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics. 2000;20(4):939–57; quiz 1107-8, 12.PubMedGoogle Scholar
  6. 6.
    Chavhan GB, Babyn PS, Manson D, Vidarsson L. Pediatric MR cholangiopancreatography: principles, technique, and clinical applications. Radiographics. 2008;28(7):1951–62.PubMedGoogle Scholar
  7. 7.
    Delaney L, Applegate KE, Karmazyn B, Akisik MF, Jennings SG. MR cholangiopancreatography in children: feasibility, safety, and initial experience. Pediatr Radiol. 2008;38(1):64–75.PubMedGoogle Scholar
  8. 8.
    Tipnis NA, Dua KS, Werlin SL. A retrospective assessment of magnetic resonance cholangiopancreatography in children. J Pediatr Gastroenterol Nutr. 2008;46(1):59–64.PubMedGoogle Scholar
  9. 9.
    Tipnis NA, Werlin SL. The use of magnetic resonance cholangiopancreatography in children. Curr Gastroenterol Rep. 2007;9(3):225–9.PubMedGoogle Scholar
  10. 10.
    Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancreatography of biliary system abnormalities in children. Clin Imaging. 2007;31(2):93–101.PubMedGoogle Scholar
  11. 11.
    Shimizu T, Suzuki R, Yamashiro Y, Segawa O, Yamataka A, Kuwatsuru R. Magnetic resonance cholangiopancreatography in assessing the cause of acute pancreatitis in children. Pancreas. 2001;22(2):196–9.PubMedGoogle Scholar
  12. 12.
    Suzuki M, Shimizu T, Kudo T, Suzuki R, Ohtsuka Y, Yamashiro Y, et al. Usefulness of nonbreath-hold 1-shot magnetic resonance cholangiopancreatography for the evaluation of choledochal cyst in children. J Pediatr Gastroenterol Nutr. 2006;42(5):539–44.PubMedGoogle Scholar
  13. 13.
    Trout AT, Podberesky DJ, Serai SD, Ren Y, Altaye M, Towbin AJ. Does secretin add value in pediatric magnetic resonance cholangiopancreatography? Pediatr Radiol. 2013;43(4):479–86.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Trout AT, Wallihan DB, Serai S, Abu-El-Haija M. Secretin-enhanced magnetic resonance cholangiopancreatography for assessing pancreatic secretory function in children. J Pediatr. 2017;188:186–91.PubMedGoogle Scholar
  15. 15.
    Courtier J, Rao AG, Anupindi SA. Advanced imaging techniques in pediatric body MRI. Pediatr Radiol. 2017;47(5):522–33.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HK. MR imaging and CT of the biliary tract. Radiographics. 2009;29(6):1669–88.PubMedGoogle Scholar
  17. 17.
    Fidler J, Hough D. Hepatocyte-specific magnetic resonance imaging contrast agents. Hepatology (Baltimore, Md). 2011;53(2):678–82.Google Scholar
  18. 18.
    Bremer JL. Description of a 4 mm human embryo. Am J Anat. 1906;5:459–80.Google Scholar
  19. 19.
    Ando H. Embryology of the biliary tract. Dig Surg. 2010;27(2):87–9.PubMedGoogle Scholar
  20. 20.
    Catalano OA, Sahani DV, Kalva SP, Cushing MS, Hahn PF, Brown JJ, et al. MR imaging of the gallbladder: a pictorial essay. Radiographics. 2008;28(1):135–55; quiz 324.PubMedGoogle Scholar
  21. 21.
    Choi JW, Kim TK, Kim KW, Kim AY, Kim PN, Ha HK, et al. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation. Korean J Radiol. 2003;4(2):85–90.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Mortele KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. AJR Am J Roentgenol. 2001;177(2):389–94.PubMedGoogle Scholar
  23. 23.
    Han SJ, Kim MJ, Han A, Chung KS, Yoon CS, Kim D, et al. Magnetic resonance cholangiography for the diagnosis of biliary atresia. J Pediatr Surg. 2002;37(4):599–604.PubMedGoogle Scholar
  24. 24.
    Jaw TS, Kuo YT, Liu GC, Chen SH, Wang CK. MR cholangiography in the evaluation of neonatal cholestasis. Radiology. 1999;212(1):249–56.PubMedGoogle Scholar
  25. 25.
    Lev-Toaff AS, Bach AM, Wechsler RJ, Hilpert PL, Gatalica Z, Rubin R. The radiologic and pathologic spectrum of biliary hamartomas. AJR Am J Roentgenol. 1995;165(2):309–13.PubMedGoogle Scholar
  26. 26.
    Zheng RQ, Zhang B, Kudo M, Onda H, Inoue T. Imaging findings of biliary hamartomas. World J Gastroenterol. 2005;11(40):6354–9.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Wohlgemuth WA, Bottger J, Bohndorf K. MRI, CT, US and ERCP in the evaluation of bile duct hamartomas (von Meyenburg complex): a case report. Eur Radiol. 1998;8(9):1623–6.PubMedGoogle Scholar
  28. 28.
    Bornfors M. The development of cholangiocarcinoma from multiple bile-duct adenomas. Report of a case and review of the literature. Acta Pathol Microbiol Immunol Scand A. 1984;92(4):285–9.PubMedGoogle Scholar
  29. 29.
    Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics. 1999;19(2):431–51.PubMedGoogle Scholar
  30. 30.
    Knowlton JQ, Lowe LH. Chapter 88: congenital hepatobiliar anomalies; Reading BD, Lowe LH. Chapter 89: acquired biliary tract disease. In: Coley BD, Bates DG, Faerber EN, Hernanz-Schulman M, Kan H, Lee EY, Panigrahy A, Rigsby C, editors. Caffey’s pediatric diagnostic imaging. 12th ed. Philadelphia: Elsevier. p. 906–20.Google Scholar
  31. 31.
    Kim OH, Chung HJ, Choi BG. Imaging of the choledochal cyst. Radiographics. 1995;15(1):69–88.PubMedGoogle Scholar
  32. 32.
    Wiedmeyer DA, Stewart ET, Dodds WJ, Geenen JE, Vennes JA, Taylor AJ. Choledochal cyst: findings on cholangiopancreatography with emphasis on ectasia of the common channel. AJR Am J Roentgenol. 1989;153(5):969–72.PubMedGoogle Scholar
  33. 33.
    Brancatelli G, Federle MP, Vilgrain V, Vullierme MP, Marin D, Lagalla R. Fibropolycystic liver disease: CT and MR imaging findings. Radiographics. 2005;25(3):659–70.PubMedGoogle Scholar
  34. 34.
    de Vries JS, de Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A, et al. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification. J Pediatr Surg. 2002;37(11):1568–73.PubMedGoogle Scholar
  35. 35.
    Lazaridis KN, Gores GJ. Cholangiocarcinoma. Gastroenterology. 2005;128(6):1655–67.PubMedGoogle Scholar
  36. 36.
    Zheng LX, Jia HB, Wu DQ, Shang H, Zhong XY, Wang QS, et al. Experience of congenital choledochal cyst in adults:treatment, surgical procedures and clinical outcome in the Second Affiliated Hospital of Harbin Medical University. J Korean Med Sci. 2004;19(6):842–7.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst. J Hepato-Biliary-Pancreat Surg. 1999;6(3):207–12.Google Scholar
  38. 38.
    Gubernick JA, Rosenberg HK, Ilaslan H, Kessler A. US approach to jaundice in infants and children. Radiographics. 2000;20(1):173–95.PubMedGoogle Scholar
  39. 39.
    Carneiro RC, Fordham LA, Semelka RC. MR imaging of the pediatric liver. Magn Reson Imaging Clin N Am. 2002;10(1):137–64.PubMedGoogle Scholar
  40. 40.
    Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. 1977;134(2):263–9.PubMedGoogle Scholar
  41. 41.
    Jung G, Benz-Bohm G, Kugel H, Keller KM, Querfeld U. MR cholangiography in children with autosomal recessive polycystic kidney disease. Pediatr Radiol. 1999;29(6):463–6.PubMedGoogle Scholar
  42. 42.
    Boyden EA. The accessory gallbladder: an embryological and comparative study of aberrant biliary vesicles occurring in man and the domestic mammals. Am J Anat. 1926;38:177–231.Google Scholar
  43. 43.
    Lamah M, Karanjia ND, Dickson GH. Anatomical variations of the extrahepatic biliary tree: review of the world literature. Clin Anat. 2001;14(3):167–72.PubMedGoogle Scholar
  44. 44.
    Kothari PR, Kumar T, Jiwane A, Paul S, Kutumbale R, Kulkarni B. Unusual features of gall bladder duplication cyst with review of the literature. Pediatr Surg Int. 2005;21(7):552–4.PubMedGoogle Scholar
  45. 45.
    Desolneux G, Mucci S, Lebigot J, Arnaud JP, Hamy A. Duplication of the gallbladder. A case report. Gastroenterol Res Pract. 2009;2009:483473.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Horattas MC. Gallbladder duplication and laparoscopic management. J Laparoendosc Adv Surg Tech A. 1998;8(4):231–5.PubMedGoogle Scholar
  47. 47.
    Gigot J, Van Beers B, Goncette L, Etienne J, Collard A, Jadoul P, et al. Laparoscopic treatment of gallbladder duplication. A plea for removal of both gallbladders. Surg Endosc. 1997;11(5):479–82.PubMedGoogle Scholar
  48. 48.
    Tsakayannis DE, Kozakewich HP, Lillehei CW. Acalculous cholecystitis in children. J Pediatr Surg. 1996;31(1):127–30; discussion 30-1.PubMedGoogle Scholar
  49. 49.
    Barie PS, Fischer E. Acute acalculous cholecystitis. J Am Coll Surg. 1995;180(2):232–44.PubMedGoogle Scholar
  50. 50.
    Watanabe Y, Nagayama M, Okumura A, Amoh Y, Katsube T, Suga T, et al. MR imaging of acute biliary disorders. Radiographics. 2007;27(2):477–95.PubMedGoogle Scholar
  51. 51.
    Watanabe Y, Dohke M, Ishimori T, Amoh Y, Oda K, Okumura A, et al. High-resolution MR cholangiopancreatography. Crit Rev Diagn Imaging. 1998;39(2–3):115–258.PubMedGoogle Scholar
  52. 52.
    Kim KW, Park MS, Yu JS, Chung JP, Ryu YH, Lee SI, et al. Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology. 2003;227(2):580–4.PubMedGoogle Scholar
  53. 53.
    Guarise A, Baltieri S, Mainardi P, Faccioli N. Diagnostic accuracy of MRCP in choledocholithiasis. Radiol Med. 2005;109(3):239–51.PubMedGoogle Scholar
  54. 54.
    Arcement CM, Meza MP, Arumanla S, Towbin RB. MRCP in the evaluation of pancreaticobiliary disease in children. Pediatr Radiol. 2001;31(2):92–7.PubMedGoogle Scholar
  55. 55.
    Feldstein AE, Perrault J, El-Youssif M, Lindor KD, Freese DK, Angulo P. Primary sclerosing cholangitis in children: a long-term follow-up study. Hepatology. 2003;38(1):210–7.PubMedGoogle Scholar
  56. 56.
    Sisto A, Feldman P, Garel L, Seidman E, Brochu P, Morin CL, et al. Primary sclerosing cholangitis in children: study of five cases and review of the literature. Pediatrics. 1987;80(6):918–23.PubMedGoogle Scholar
  57. 57.
    Ferrara C, Valeri G, Salvolini L, Giovagnoni A. Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children. Pediatr Radiol. 2002;32(6):413–7.PubMedGoogle Scholar
  58. 58.
    Debray D, Pariente D, Urvoas E, Hadchouel M, Bernard O. Sclerosing cholangitis in children. J Pediatr. 1994;124(1):49–56.PubMedGoogle Scholar
  59. 59.
    Ibrahim SH, Lindor KD. Current management of primary sclerosing cholangitis in pediatric patients. Paediatr Drugs. 2011;13(2):87–95.PubMedGoogle Scholar
  60. 60.
    Chung YE, Kim MJ, Park YN, Choi JY, Pyo JY, Kim YC, et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics. 2009;29(3):683–700.PubMedGoogle Scholar
  61. 61.
    Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004;24(5):1381–95.PubMedGoogle Scholar
  62. 62.
    Wittenberg A, Minotti AJ. CT diagnosis of traumatic gallbladder injury. AJR Am J Roentgenol. 2005;185(6):1573–4.PubMedGoogle Scholar
  63. 63.
    Melamud K, LeBedis CA, Anderson SW, Soto JA. Biliary imaging: multimodality approach to imaging of biliary injuries and their complications. Radiographics. 2014;34(3):613–23.PubMedGoogle Scholar
  64. 64.
    Zimmitti G, Roses RE, Andreou A, Shindoh J, Curley SA, Aloia TA, et al. Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: an experience with 2,628 consecutive resections. J Gastrointest Surg. 2013;17(1):57–64; discussion p.-5.PubMedGoogle Scholar
  65. 65.
    Kapoor V, Baron RL, Peterson MS. Bile leaks after surgery. AJR Am J Roentgenol. 2004;182(2):451–8.PubMedGoogle Scholar
  66. 66.
    Hoeffel C, Azizi L, Lewin M, Laurent V, Aube C, Arrive L, et al. Normal and pathologic features of the postoperative biliary tract at 3D MR cholangiopancreatography and MR imaging. Radiographics. 2006;26(6):1603–20.PubMedGoogle Scholar
  67. 67.
    Valek V, Kala Z, Kysela P. Biliary tree and cholecyst: post surgery imaging. Eur J Radiol. 2005;53(3):433–40.PubMedGoogle Scholar
  68. 68.
    Ernst O, Sergent G, Mizrahi D, Delemazure O, L’Hermine C. Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology. 1999;211(2):345–8.PubMedGoogle Scholar
  69. 69.
    Kantarci M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol. 2013;23(10):2713–22.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Aduna M, Larena JA, Martin D, Martinez-Guerenu B, Aguirre I, Astigarraga E. Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. Abdom Imaging. 2005;30(4):480–7.PubMedGoogle Scholar
  71. 71.
    Egritas O, Nacar N, Hanioglu S, Soyer T, Tezic T. Early but prolonged gallbladder hydrops in a 7-month-old girl with Kawasaki syndrome: report of a case. Surg Today. 2007;37(2):162–4.PubMedGoogle Scholar
  72. 72.
    Suddleson EA, Reid B, Woolley MM, Takahashi M. Hydrops of the gallbladder associated with Kawasaki syndrome. J Pediatr Surg. 1987;22(10):956–9.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nathan C. Hull
    • 1
    Email author
  • Gary R. Schooler
    • 2
  • Edward Y. Lee
    • 3
  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Department of RadiologyDuke University Medical CenterDurhamUSA
  3. 3.Division of Thoracic Imaging, Department of RadiologyBoston Children’s Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations