HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chopra, S. Articles by Dodd, G. D. Search for Related Content PubMed PubMed Citation Articles by Chopra, S. Articles by Dodd, G. D., III

Helical CT Cholangiography with Oral Cholecystographic Contrast Material¹

¹ From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284-7800. Received March 5, 1999; revision requested April 27; revision received May 19; accepted August 30. Address reprint requests to S.C. (e-mail: chopra@uthscsa.edu).

	Abstract

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Twenty asymptomatic volunteers underwent helical computed tomographic (CT) cholangiography 10–12 hours after ingesting iopanoic acid. Three observers assessed the images for the extent of bile duct visualization and image quality. The common bile duct and common hepatic duct were adequately visualized in 19 (95%) subjects. Helical CT cholangiography with oral cholecystographic contrast material is feasible and deserves further clinical studies.

Index terms: Bile duct radiography, technology, 76.12115, 76.1221 • Bile ducts, CT, 76.12115, 76.1221

	Introduction

TOP Abstract Introduction Materials and Methods Results Discussion References

 
A number of invasive and noninvasive modalities are available for imaging of the biliary tract. Of those available currently, endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used invasive technique. However, ERCP may not be possible in all patients and has its own attendant complications. Magnetic resonance (MR) cholangiopancreatography (MRCP) is gaining increased importance for noninvasive biliary imaging. Although MRCP has been shown to be quick and fairly accurate (1), it is not universally available and cannot be carried out in patients with claustrophobia or other contraindications to MR imaging.

The use of helical computed tomography (CT) in obtaining cholangiographic images of opacified and unopacified biliary tract has been described extensively (2–11). Helical CT of the unopacified biliary tract is possible only in the presence of biliary dilatation. However, biliary disease and anatomic anomalies of the biliary tract do not always manifest as biliary dilatation. Therefore, except in the presence of calcified biliary stones, opacification of the biliary tract for helical CT cholangiography is desirable. So far, only intravenous cholangiographic contrast materials have been used to opacify the biliary tract for the purpose of helical CT cholangiography. Although CT with intravenous cholangiographic contrast material has been shown to provide diagnostic-quality images with relative safety in recent clinical studies (3,6,8), there have been concerns regarding the safety of such agents in the past (12).

Oral cholecystography was universally used in the past to assess the gallbladder, and in general oral cholecystographic contrast materials are considered relatively safer than intravenous cholangiographic contrast media. Reports of transverse CT of the biliary tract opacified with the oral cholecystographic contrast material calcium ipodate and its combination with iopanoic acid appeared in the literature as early as 1982 (13,14), but to our knowledge there are no published reports of helical CT cholangiography with oral cholecystographic contrast media. Also, to our knowledge, there have been no reports of the ability of the widely used oral cholecystographic contrast material iopanoic acid alone to opacify the bile ducts at CT cholangiography. Therefore, we conducted this study with iopanoic acid to determine the feasibility of obtaining helical CT cholangiographic images in subjects with and those without a gallbladder.

	Materials and Methods

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Subject Recruitment
With use of a protocol and advertising materials approved by our institutional review board, we recruited a study population of 20 subjects made of two groups of 10 subjects each. One group had not undergone cholecystectomy (gallbladder group, seven men and three women; age range, 28–61 years; mean age, 46 years), and the other group had (cholecystectomy group, nine women and one man; age range, 34–69 years; mean age, 48 years). Informed consent was obtained from all subjects. All subjects were free of hepatobiliary symptoms; had normal serum bilirubin, creatinine, alanine transaminase, aspartate transaminase, and alkaline phosphatase levels; and showed no evidence of biliary disease at ultrasonography (US) performed at the time of recruitment. All subjects were weighed at the time of recruitment (weight range, 53–109 kg; mean weight, 75 kg).

Contrast Material Administration
All subjects ingested 6 g (12 500-mg tablets) of the oral cholecystographic contrast agent iopanoic acid (Telepaque; Nycomed Amersham, Princeton, NJ) 30 minutes after their usual evening supper on the night before the CT examination. The next morning when the subjects came for their CT appointment, they were questioned regarding the occurrence of known side effects, specifically, nausea, vomiting, diarrhea, burning on urination, and any allergic phenomena.

Helical CT
All CT examinations were performed with a helical scanner (PQ 5000; Picker International, Cleveland, Ohio) 10–12 hours after contrast material ingestion. All patients in the gallbladder group were offered a fatty meal in keeping with the recommendations for increasing the probability of visualization of the bile ducts at conventional oral cystography (14) (manufacturer's recommendation, Nycomed Amersham). One subject refused the fatty meal, and nine ingested the fatty meal, which contained approximately 50 g of fat, 30 minutes before the CT examination. Because the fatty meal acts by inducing gallbladder contraction, it was considered superfluous and not offered to the patients in the cholecystectomy group. All subjects drank 200 mL of of water prior to scanning.

To determine the location of the lower end of the common bile duct (CBD), a series of five 10-mm-thick contiguous transverse scans were obtained with a low-dose technique (100 mA, 100 kV) through the second lumbar vertebra. Starting 1 cm caudad to the lower end of the CBD, a single-breath–hold, 35-second helical acquisition was performed in a caudocranial direction with 2-mm collimation, a pitch of 1.25–1.50, 120 kV, and 200–250 mA. In one subject in whom the upper end of the initial acquisition was not well above the confluence of the right and left hepatic ducts, an additional 10-second acquisition was performed to cover the intrahepatic ducts.

Image Processing
The acquired CT data were reprocessed to obtain 225–240 2-mm-thick overlapping transverse source images at 0.5-mm intervals with a field of view 15–17 cm in diameter centered at the level of the opacified CBD. The transverse source images were transferred to the workstation (Voxel Q; Picker International) and used to produce multiplanar reformation images, maximum intensity projection images, and shaded surface display images of the biliary tract. All reconstructions were performed by one operator (S.C.).

Image and Data Analysis
Three radiologists (S.C., K.R., H.R.) reviewed the images on the workstation at the same time and rendered a consensus opinion about the visualization of the CBD, common hepatic duct (CHD), right and left hepatic ducts, and second and third order biliary branches. In instances of disagreement, the majority opinion prevailed. Each segment of the biliary tree was evaluated as either adequately or inadequately visualized. Segments were labeled adequately visualized if contrast material was present throughout the segment and inadequately visualized if the segment was partially or completely unopacified. In the gallbladder group, visualization or nonvisualization of the gallbladder and cystic duct were assessed. In the cholecystectomy group, visualization or nonvisualization of the cystic duct stump was noted. The reconstruction method that depicted the cystic duct and stump anatomy most clearly was noted.

All images were assessed for the presence and severity of image artifacts. The severity of the artifacts was defined as not clinically important if they did not interfere with the image interpretation and clinically important if they interfered with image interpretation. The CT attenuation values in Hounsfield units were measured with use of a 2-mm² circular region of interest placed in the CBD, CHD, and liver in all subjects and additionally in the gallbladder in the gallbladder group. Conspicuity of the intrahepatic bile duct was defined as the difference between the CT attenuation values of the CHD and liver and was calculated in all subjects.

All statistical analysis was performed by a professional statistician by using a commercially available statistical software package (SAS Institute, Cary, NC). The CT attenuation values of the CBD, CHD, and liver in the gallbladder group were compared with those in the cholecystectomy group by means of the Student t test. The dose of iopanoic acid administered per unit body weight to each subject was determined by dividing the total individual dose of 6,000 mg by the subject's body weight in kilograms. The CT attenuation values of the CHD were plotted against the dose per unit body weight, and the Pearson coefficient of correlation was determined.

	Results

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Representative images obtained at CT cholangiography are shown in Figure 1 in a patient in the gallbladder group and in Figure 2 in a patient in the cholecystectomy group. Gallbladder opacification was noted in all patients in the gallbladder group. The CBD and CHD were judged to be adequately visualized in 19 (95%) subjects. The lower end of the CBD was sharply tapering in 15 (75%) and bluntly tapering in four (20%) subjects. The intramural portion of the CBD that extends to the papilla was not seen in any subject. Excreted contrast material in the duodenal lumen was seen in 12 (60%) subjects. The one patient with inadequate opacification of the ducts was in the cholecystectomy group and had unabsorbed contrast material in the stomach. The right and left hepatic ducts were opacified in 16 (80%) and 14 (70%) subjects, respectively. The second and third order branches were opacified in 14 (70%) and nine (45%) subjects, respectively.

View larger version (182K): [in this window] [in a new window]   Figure 1a. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the gallbladder group: (a) transverse source images, (b) multiplanar reformation images, and (c) maximum intensity projection (left) and shaded surface display (right) images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), CBD (wide straight arrows), and gallbladder (open arrows) are identified. The shaded surface display image, which has been optimized to show the cystic duct, shows the origin and course of the cystic duct to the best advantage.

View larger version (187K): [in this window] [in a new window]   Figure 1b. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the gallbladder group: (a) transverse source images, (b) multiplanar reformation images, and (c) maximum intensity projection (left) and shaded surface display (right) images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), CBD (wide straight arrows), and gallbladder (open arrows) are identified. The shaded surface display image, which has been optimized to show the cystic duct, shows the origin and course of the cystic duct to the best advantage.

View larger version (100K): [in this window] [in a new window]   Figure 1c. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the gallbladder group: (a) transverse source images, (b) multiplanar reformation images, and (c) maximum intensity projection (left) and shaded surface display (right) images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), CBD (wide straight arrows), and gallbladder (open arrows) are identified. The shaded surface display image, which has been optimized to show the cystic duct, shows the origin and course of the cystic duct to the best advantage.

View larger version (178K): [in this window] [in a new window]   Figure 2a. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the cholecystectomy group: (a) transverse source images, (b) multiplanar reformation images, (c) maximum intensity projection image, and (d) shaded surface display images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), and CBD (wide straight arrows) are identified. The papilla (longest straight arrow in a) is outlined by the water in the duodenum on the last transverse image. Note the corduroy artifact in the background of c and the clear depiction of the anatomy of the long, low-inserting cystic duct remnant in d.

View larger version (167K): [in this window] [in a new window]   Figure 2b. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the cholecystectomy group: (a) transverse source images, (b) multiplanar reformation images, (c) maximum intensity projection image, and (d) shaded surface display images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), and CBD (wide straight arrows) are identified. The papilla (longest straight arrow in a) is outlined by the water in the duodenum on the last transverse image. Note the corduroy artifact in the background of c and the clear depiction of the anatomy of the long, low-inserting cystic duct remnant in d.

View larger version (140K): [in this window] [in a new window]   Figure 2c. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the cholecystectomy group: (a) transverse source images, (b) multiplanar reformation images, (c) maximum intensity projection image, and (d) shaded surface display images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), and CBD (wide straight arrows) are identified. The papilla (longest straight arrow in a) is outlined by the water in the duodenum on the last transverse image. Note the corduroy artifact in the background of c and the clear depiction of the anatomy of the long, low-inserting cystic duct remnant in d.

View larger version (112K): [in this window] [in a new window]   Figure 2d. Helical CT cholangiography with oral cholecystographic contrast material in a patient in the cholecystectomy group: (a) transverse source images, (b) multiplanar reformation images, (c) maximum intensity projection image, and (d) shaded surface display images. The right and left hepatic ducts (short straight arrows), CHD (long straight arrows), cystic duct (curved arrows), and CBD (wide straight arrows) are identified. The papilla (longest straight arrow in a) is outlined by the water in the duodenum on the last transverse image. Note the corduroy artifact in the background of c and the clear depiction of the anatomy of the long, low-inserting cystic duct remnant in d.

In the cholecystectomy group, cystic duct remnants were seen in seven (70%) of the 10 patients. In one of these, the cystic duct remnant was long with a low insertion (Fig 2d). Although the cystic duct and remnant anatomy could be easily deduced on the transverse source and multiplanar reformation images, it was depicted in its entirety most clearly on the shaded surface display images (Figs 1c, 2d).

The mean CT attenuation values for the gallbladder in the gallbladder group and for the CBD, CHD, and liver in the gallbladder and cholecystectomy groups are shown in graph form in Figure 3. The attenuation values of the CBD ranged from 159 to 824 HU (mean, 339 HU) in the gallbladder group and from 114 to 232 HU (mean, 176 HU) in the cholecystectomy group. The attenuation values for the CHD ranged from 66 to 283 HU (mean, 152 HU) in the gallbladder group and from 98 to 232 HU (mean, 169 HU) in the cholecystectomy group. In the gallbladder group, the attenuation values for the gallbladder ranged from 236 to 1,116 HU (mean, 558 HU). The attenuation values in the liver ranged from 68 to 81 HU (mean, 72 HU) in the gallbladder group and from 48 to 80 HU (mean, 67 HU) in the cholecystectomy group. The conspicuity of the biliary system, defined as the difference between the attenuation values of the CHD and the liver ranged from 27 to 210 HU (mean, 98 HU).

View larger version (9K): [in this window] [in a new window]   Figure 3. Bar graph shows the mean CT attenuation values of the gallbladder in the gallbladder group (black bars) and of the CBD, CHD, and liver in the gallbladder group and cholecystectomy group (white bars).

View larger version (10K): [in this window] [in a new window]   Figure 4. Scattergram with trend line shows the linear correlation between the dose of iopanoic acid per unit body weight and the CT attenuation values obtained in the CHD.

Of the expected side effects, diarrhea was reported by 19 (95%) subjects, with the number of loose stools fewer than three in 17 subjects, five in one, and seven in one. One subject reported nausea, and one stinging on urination. No serious, allergic, or unexpected side effects were reported.

	Discussion

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Until the application of US to diagnose gallbladder disease, oral cholecystography was the only noninvasive method available to study the gallbladder. The key factor that makes oral cystography feasible is the concentrating action of the gallbladder on the conjugated contrast material excreted into the bile by the liver. Although the gallbladder can be routinely visualized, the bile ducts are rarely seen at conventional radiography. On the other hand, because of its high contrast resolution, CT has the potential to enable visualization of the bile ducts opacified with oral cholecystographic contrast material. Pretorius et al (13) reported in 1982 that opacified bile ducts could be visualized after the administration of calcium ipodate. However, these authors did not have the advantage of the recent advances in CT technology such as thin-section, single-breath-hold helical CT and three-dimensional and multiplanar reformation reconstruction techniques. Although there are many publications about three-dimensional cholangiography with helical CT with use of intravenous cholangiographic contrast material (2–4,6–10), helical CT cholangiography with use of oral cholecystographic contrast material has not been described in the literature, to our knowledge. We undertook this study to demonstrate the feasibility of obtaining helical CT cholangiographic images in asymptomatic volunteers with a normal hepatobiliary US scan and serum bilirubin and liver enzyme levels.

Our results suggest that the degree of opacification of bile ducts after ingestion of oral cholecystographic contrast material is adequate for reasonable visualization of the biliary tree at helical CT cholangiography. Because the CHD contains bile that has not been concentrated by the gallbladder, the attenuation values of the opacified CHD represent the minimum degree of ductal opacification that can be expected from the use of oral cholecystographic contrast material irrespective of the presence of the gallbladder. The mean attenuation value of the CHD in our study population was 152 HU in the gallbladder group and 169 HU in the cholecystectomy group. This degree of opacification is comparable to the 180 HU reported by Stockberger et al (4) in the CBD at CT cholangiography with intravenous cholangiographic contrast material. The mean attenuation value of the CBD in our study depended on the presence or absence of the gallbladder. In the cholecystectomy group, the attenuation value of the CBD was not significantly different from that of the CHD. In the patients in the gallbladder group who had a fatty meal, the attenuation value of the CBD was significantly higher than that of the CHD. In these subjects, the mean attenuation value of the CBD was between the values of the CHD and the gallbladder. On the other hand, the CT attenuation value of the CBD was lower than that of the CHD in the patient in the gallbladder group who refused the fatty meal.

Although the number of subjects is too small to be certain, we postulate that it was the action of the fatty meal on the gallbladder in the gallbladder group that was responsible for the CT attenuation values of the CBD being significantly higher. This phenomenon is easily explained. The ingestion of a fatty meal leads to gallbladder contraction, which floods the CBD with bile that has a higher concentration of contrast material than that of the bile in the CHD. This observation is an expected finding but, to our knowledge, has never been documented. Notwithstanding the higher CT attenuation values of the CBD in the gallbladder group after a fatty meal, the data from our study suggest that the use of a fatty meal is not essential to obtain adequate visualization of the ducts. Similarly, unlike in conventional oral cholecystography, in which the presence of a functional gallbladder is essential to obtain iodine concentrations high enough to be seen on the conventional radiographs, the presence of a functioning gallbladder is not necessary to obtain high-quality CT cholangiographic images with oral cholecystographic contrast material. This makes CT cholangiography with oral cholecystographic contrast material potentially useful in both patients who have nonfunctioning gallbladders and those in whom the gallbladder has been removed.

On the basis of the results of this study and the existing literature for CT and MR cholangiography with intravenous cholangiographic contrast material, we postulate that the potential clinical applications for CT cholangiography with oral cholecystographic contrast material are similar. It may prove useful in the investigation of biliary obstruction, preoperative demonstration of biliary anatomy, demonstration of the biliary tract in patients with postcholecystectomy syndromes, and as an alternative to ERCP in patients in whom there is a contraindication. In our experience, CT cholangiography with oral cholecystographic contrast material may have a few advantages. Unlike CT cholangiography with intravenous cholangiographic contrast material, it is less invasive, requires no patient monitoring, and has fewer serious side effects, and the time spent in the CT suite is short. It is less expensive and quicker than MRCP.

Our findings also suggest potential limitations for CT cholangiography with oral cholecystographic contrast material. First, although the CBD and CHD were consistently visualized, the intrahepatic ducts were visualized in only 45%–70% of subjects. In our opinion, this is because of their small size, transverse direction, and lower conspicuity due to the surrounding liver parenchyma. Second, although dissolved contrast material was seen in the duodenum in a majority of subjects, the intramural portion of the CBD that extends to the papilla was not visualized in any subject. Some investigators have solved this problem at CT cholangiography with intravenous cholangiographic contrast material by treating the patients with an anticholinergic agent before the procedure (4). It is possible that the same approach may work with this technique. Third, there is a potential for degradation of the CT cholangiographic images by artifacts. The so-called corduroy artifact described at CT cholangiography with intravenous cholangiographic contrast material (4) was commonly seen, and its effect on image quality was more prominent in subjects with common ducts of small caliber. Although in our study this artifact was not severe enough to interfere with the demonstration of the anatomy of the biliary tract, it is possible that it may impair the ability to visualize the radiologic findings of cholangitis. Similarly, local degradation of the images was caused by streak artifacts in some of the patients in the cholecystectomy group with cystic duct clips. The three-dimensional display techniques commonly showed pseudostenoses. All these artifacts are related to CT and are potentially seen in any application of three-dimensional CT including CT cholangiography and CT angiography with intravenous cholangiographic contrast material. Fourth, although we used the recommended 6-g dose of the oral cholecystographic contrast material (14) (manufacturer's recommendation, Nycomed, Amersham), it led to an almost universal incidence of diarrhea.

The higher incidence of side effects with double-dose oral cystography has been described previously. Therefore, oral cystography is often performed with a single dose of 3 g of iopanoic acid, which is repeated on the 2nd day if the gallbladder is not visualized (15). It is possible that the same approach can be used in CT cholangiography, although further studies will be required to establish that. In our study, despite its high incidence, diarrhea was mild in the majority of subjects. The presence of moderate diarrhea did not result in impaired opacification of the biliary system. No serious side effects were expected or seen with the oral cholecystographic contrast material in our subject population. However, there are potential contraindications to this technique in practice, especially high bilirubin levels and poor liver and kidney function. Finally, because our study was performed with healthy volunteers, we have not addressed the issue of the accuracy of this technique in the demonstration of biliary abnormalities.

In conclusion, we have demonstrated the feasibility of helical CT cholangiography with the oral cholecystographic contrast material iopanoic acid in subjects with and those without a gallbladder. Further clinical trials are indicated to determine its accuracy in the evaluation of biliary tract abnormalities.

	Acknowledgments

 
The authors thank John Schoolfield, MS, for statistical analysis; Cynthia Francis, ARRT, and Lamar Callier, ARRT, for obtaining the CT scans; and Baltazar Farias for photography.

	Footnotes

 
Abbreviations: CBD = common bile duct CHD = common hepatic duct ERCP = endoscopic retrograde cholangiopancreatography MRCP = MR cholangiopancreatography

Author contributions: Guarantor of integrity of entire study, S.C.; study concepts, S.C.; study design, S.C., G.D.D.; definition of intellectual content, S.C.; literature research, S.C.; clinical studies, S.C.; data acquisition, S.C., K.R., H.R.; data analysis, S.C.; manuscript preparation and editing, S.C.; manuscript review, K.N.C., G.D.D., H.R., K.R.

	References

TOP Abstract Introduction Materials and Methods Results Discussion References

 

1. Fulcher AS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. RadioGraphics 1999; 19:25-41.[Abstract/Free Full Text]
2. Klein HM, Wein B, Truong S, Pfingsten FP, Gunther RW. Computed tomographic cholangiography using spiral scanning and 3D image processing. Br J Radiol 1993; 66:762-767.[Abstract]
3. Van Beers BE, Lacrosse M, Trigaux JP, de Canniere L, De Ronde T, Pringot J. Noninvasive imaging of the biliary tree before or after laparoscopic cholecystectomy: use of three dimensional CT cholangiography. AJR Am J Roentgenol 1994; 162:1331-1335.[Abstract/Free Full Text]
4. Stockberger SM, Wass JL, Sherman S, Lehman GA, Kopecky KK. Intravenous cholangiography with helical CT: comparison with endoscopic retrograde cholangiography. Radiology 1994; 192:675-680.[Abstract/Free Full Text]
5. Zeman RK, Berman PM, Silverman PM, et al. Biliary tract: three-dimensional helical CT without cholangiographic contrast material. Radiology 1995; 196:865-867.[Abstract/Free Full Text]
6. Fleischmann D, Ringl H, Schofl R. Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparison with endoscopic retrograde cholangiography. Radiology 1996; 198:861-868.[Abstract/Free Full Text]
7. Galeon M, Deprez P, Van Beers BE, et al. Spiral CT cholangiography of choledochocele. J Comput Assist Tomogr 1996; 20:814-815.[Medline]
8. Stockberger SM, Sherman S, Kopecky KK. Helical CT cholangiography. Abdom Imaging 1996; 21:98-104.[Medline]
9. Nascimento S, Murray W, Wilson P. Computed tomography intravenous cholangiography. Australas Radiol 1997; 41:253-261.[Medline]
10. Stockberger SM, Jr, Johnson MS. Spiral CT cholangiography in complex bile duct injuries after laparoscopic cholecystectomy. J Vasc Interv Radiol 1997; 8:249-252.[Medline]
11. Raptopoulos V, Prassopoulos P, Chuttani R, McNicholas MMJ, McKee JD, Kressel HY. Multiplanar CT pancreatography and distal cholangiography with minimal intensity projections. Radiology 1998; 207:317-324.[Abstract/Free Full Text]
12. Lindsey I, Nottle PD, Sacharias PD. Preoperative screening for common bile duct stones with infusion cholangiography: review of 1000 patients. Ann Surg 1997; 226:174-178.[Medline]
13. Pretorius DH, Gosnik BB, Olson LK. CT of the opacified biliary tract: use of calcium ipodate. AJR Am J Roentgenol 1982; 138:1073-1075.[Free Full Text]
14. Greenberg M, Rubin JM, Greenberg BM. Appearance of gallbladder and biliary tree by CT cholangiography. J Comput Assist Tomogr 1983; 7:788-794.[Medline]
15. Maglinte DDT, Torres WE, Laufer I. Oral cholecystography in contemporary gallstone imaging: a review. Radiology 1991; 178:49-58.[Abstract/Free Full Text]

This Article Abstract Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chopra, S. Articles by Dodd, G. D. Search for Related Content PubMed PubMed Citation Articles by Chopra, S. Articles by Dodd, G. D., III