2007 Volume 27 Issue 4 Pages 595-599
A precise diagnosis and the optimum appropriate primary care decide the prognosis of the biliary emergency represented by acute cholangitis, cholecystitis, and obstructive jaundice. Direct biliary contrasting imaging, such as Percutaneous transheptatic cholangio drainage and endoscopic retrograde cholangio pancreatography, has been performed conventionally, but in recent years various devices such as Multidetector computed tomography, drip infunsion cholangiography-CT, and the fusion of direct biliary tract contrasting with contrast enhancement MDCT have been performed in the emergency clinical setting. We developed a new technique of MDCT-virtual cholangiography based on negative contrasting of carbon dioxide (CO2) injection from endoscopic naso-biliary drainage or PTCD. The biliary tract system was arrested as a transmission bile duct image through the negative contrasting effect of the CO2, and of blood vessels of a range of circumferences down to and including microvessels can be depicted faithfully at the same time by fusion with contrast enhanced MDCT angiography (the fusion CMCPA technique). It is a new diagnostic tool enabling on-site, quick, accurate and objective emergency evaluation of biliary tract stricture and confinement, the local existence and diagnosis of expansion and vascular invasion.
