Cholangiography. Preparing the patient for cholecysto and cholangiography, the method of conducting What is cholangiography and urography

The rapid development of medicine allows patients to use new types of diagnostic studies, one of which is the MRI cholangiography mode. What is it, how safe and effective is it? Perhaps the most frequently asked questions from patients.

The essence of the procedure

- this is a fairly young, but accurate diagnostic technique, which is much more effective and safer than traditional methods for examining the abdominal cavity.

In the process of MR-scanning, a series of layer-by-layer images is created, with the help of which the doctor receives comprehensive information about the state of some components of the abdominal organs and the pathological processes occurring in them. MR cholangiography also makes it possible to build a 3D model of the organs, which allows you to further study them from all sides and collect additional information.

When is cholangiography indicated for MRI?

It is prescribed by a doctor in cases where: inflammatory processes or circulatory disorders are observed, the liver is enlarged or there are stones in the biliary tract, there are abnormal changes in organs or defects. Also, this study makes it possible to distinguish a benign neoplasm from a malignant one, to detect metastases and the boundaries of the tumor. With the help of MR cholangiography, you can accurately determine the type and stage of cancer.

MR cholangiography

MR cholangiography is performed as prescribed by the attending physician on the basis of identified medical indications to clarify or confirm the diagnosis.

MRI in the cholangiography mode shows (what was the reason, the attending physician determines):

  • constriction areas;
  • detailed condition of the bile ducts, pancreatic, pancreatic ducts;
  • dyskinesia;
  • inflammation;
  • stones of different sizes and composition;
  • condition of the gallbladder;
  • kinks;
  • and etc.
MR cholangiography makes it possible to study not only the contours of organs and blood vessels, but the state of tissues located next to them.

MRI of the biliary tract: cholangiography

MRI of the biliary tract and cholangiography allow the specialist to obtain data on what changes take place in the gallbladder and biliary tract. During the study, the doctor can examine the structures of these organs, see polyps. Also in the cholangiography mode, it is possible to obtain data on the state of blood vessels, lymph nodes and tissue structures.

The programs and settings of the magnetic resonance tomograph make it possible to study the gallbladder and all ducts using the bile of the patient himself and without the introduction of contrast agents. This study is prescribed by the attending physician in cases where there is a need to clarify or confirm the diagnosis.

Benefits of cholangiography with MRI

If we compare this type of study of internal organs with other methods, we can identify a number of characteristic advantages:

  • safety achieved due to the absence of radiation exposure;
  • accuracy and high detail of images of the organs under study;
  • non-invasiveness.

Indications

MR cholangiography is prescribed by the attending physician in cases where the patient has identified or only suspects the following problems:

  • stones in the gallbladder, in its ducts or pancreatic ducts;
  • narrowing of the gallbladder ducts;
  • abnormalities in the development of gallbladder vessels;
  • stenoses, polyps or tumors;
  • biliary tract injury;
  • various pathologies of the liver (hepatitis, cirrhosis);
  • oncological diseases.
This list is not exhaustive, and MR cholangiography can help diagnose other problems accurately. Also, this procedure is often prescribed when preparing the patient for surgery.

Contraindications

MR examinations are completely safe, but they may be contraindicated for some patients:

  • who has metal objects in the body;
  • pregnant women in the early stages;
  • patients with claustrophobia;
  • patients with severe tremor or pain syndrome.

How is the procedure?

MRI cholangiography and preparation for this type of study begins with the fact that the patient removes all metal objects from himself. After that, he lies down on the retractable table of the tomograph. Then the table will be pushed inside the annular part of the apparatus. During the entire procedure, the patient must remain completely still. The procedure itself is performed on an empty stomach using contrast and lasts 20 minutes.

Contrast enhancement

For clearer visualization, MRI cholangiography with contrast is used. Contrast is a variety of gadolinium-based preparations that allow MRI to examine blood vessels and soft tissues in more detail. The scanning procedure begins immediately after intravenous administration of the drug.

MR cholangiography with contrast has a number of contraindications:

  • pregnancy and lactation;
  • kidney failure;
  • allergy to the contrast agent.

Alternative Methods

Demonstrates the greatest efficiency in comparison with other methods, but today there are alternatives:

  • research using an x-ray machine;
  • ultrasound;
  • CT scan.

Magnetic resonance cholangiography makes it possible to obtain detailed information about the state of the intrahepatic and extrahepatic bile ducts, the gallbladder, and the main pancreatic duct. Thanks to this method, doctors can detect the occurrence of pathological processes in the early stages and prescribe the correct treatment. X-rays are not used for diagnostics, so the method is absolutely harmless.

You can do MR cholangiography at Ramsey Diagnostics centers.

When appointed

  • pain in the right hypochondrium and upper abdomen
  • nausea, vomiting
  • jaundice, pruritus and other symptoms indicating a violation of the secretion of bile and pancreatic juice
  • suspicion of the presence of mechanical obstructions in the ducts, the need for their differential diagnosis
  • surgery on the abdominal organs with damage to the biliary tract
  • doubtful, requiring clarification of the results of other studies, and so on

Also, an MRI may be required for preparation for surgery, or for postoperative control.

What does MR cholangiography show?

  • oncological diseases of the biliary tract
  • liver cirrhosis, hepatitis
  • liver damage
  • stones in the extrahepatic and intrahepatic ducts, in the ducts of the pancreas
  • cholelithiasis
  • obstructive jaundice, the causes of which are not known
  • narrowing (stricture) of the ducts
  • polyps and anomalies of the gallbladder, bile ducts

Treatment with contrast

In most cases, cholangiography does not require the use of contrast to improve visualization. This procedure compares favorably with many other studies that are not carried out without contrast. In addition, MR-pancreatocholangiography perfectly replaces the ERCP procedure, which is unpleasant for the patient, which involves the introduction of a probe. If necessary, the study can be carried out with the introduction of a contrast agent Primovista.

The standard limitation is the presence of metal grafts in the body, as well as other factors. More information about them can be found on the website in the section General contraindications for MRI.

In addition to cholangiography at the Ramsey Diagnosis Centers, patients are given the opportunity to have a CT scan of the abdominal cavity and retroperitoneal space.

This method was first proposed by Mirizzi in 1930.

Cholangiography during surgery will help clarify 4 questions:

  • the presence of stones in the ducts
  • scarring of the bile ducts
  • duct patency
  • width (caliber) of the common bile and extra- and intrahepatic ducts.

Cholangiography can be performed by injecting a contrast agent through the gallbladder and through the common bile duct by puncturing them with a needle, as well as through the cystic duct after cholecystectomy or through inserted into the common bile duct during surgery.

Cholangiography when filling the biliary tract through the bladder is performed when there are large adhesions around the common bile duct, it is difficult to understand their anatomical relationships.

Cholangiography through a needle puncture of the common bile duct is carried out mainly during repeated operations, after a previously performed cholecystectomy, and by infusion of a contrast fluid through the cystic duct - for control immediately after removal of the bladder. Finally, cholangiography through the drain is done to monitor the patency of the duct after surgery.

For cholangiography, various contrast agents are used, mainly containing iodine - these are lipoidol, diodrast and its analogue cardiotrast, torotrast, iodomethane, sergosin. Oil solutions are less suitable than water solutions. The use of Sergosin is undesirable, since patients experience vomiting after surgery. It is most advantageous to use 20-30 ml of 50% or 70% cardiotrast solution. Before the introduction of a contrast solution, a soft clamp is applied to the choledoch near its confluence with the duodenum or an assistant presses it with a gauze ball by hand.

The picture must be taken immediately after the introduction of contrast and removal of the clamp from the common bile duct. Serial images within the first 5 minutes better allow you to assess the condition of the liver ducts.

After puncture of the duct with a needle and after its removal, bile is usually secreted, and therefore it is advisable to apply a ligature to the injection site. If there is doubt about the complete tightness of the duct, a swab is brought to the site of its puncture and left for 2 days.

Most often, cholangiography is used in patients when, after cholecystectomy, there is doubt about the patency of the ducts.

Intravenous cholangiography with biligrafin

The first studies on the clinical use of biligrafin were made in Germany by Fromhold and Pyushell (Fromchold, Puschell) in 1953. They immediately showed the high efficiency of intravenous cholangiography.

Biligrafin contains 64.32% iodine and is used in a 20% aqueous solution, which is almost isotonic. The drug is packaged in ampoules of 20.0 ml. To determine individual sensitivity, special test ampoules are made containing 1 ml of a 20% solution. The intravenously administered drug is excreted mainly through the liver (90%), and then through the intestinal tract, and only a small amount is excreted through the kidneys (10%). No special preparation of the patient before intravenous cholangiography is required. An hour before the injection of biligrafin, a cleansing enema is given. A test for individual sensitivity before cholangiography is carried out by intradermal administration of biligrafin from a test ampoule. In the absence of local changes, intravenous administration of the entire portion of the drug is started. 20 ml of the solution is injected into a vein over 3 minutes. A patient weighing more than 70 kg is administered 30-40 ml in 5-6 minutes. Sometimes after the introduction of biligrafin (in 6% of cases) there are side effects - sensations of heat, nausea, pressure in the upper abdomen, sweating, dizziness.

This method of cholangiography is applicable to the study of the extrahepatic biliary tract, especially for the study of the bile ducts in those who underwent cholecystectomy. Currently, biligrafin is the most reliable drug for examining such patients. In addition, it can be used to study the function of the liver, as it removes the drug. With impaired liver function, biligrafin is found not in the biliary tract, but in the pelvis, since in this case it is excreted by the kidneys.

In severe processes in the liver parenchyma, intravenous biligraphy causes an exacerbation of liver disease, and therefore it should not be used in such patients. There are no other contraindications for this method of cholangiography. After the introduction of biligrafin, x-rays, in the prone position with the right half of the body elevated by 35 °, are taken after 20, 40 and 90 minutes. The first of these pictures usually shows the intrahepatic ducts, the second shows the ducts, and the third shows the gallbladder. Then the patient is given tomorrow to (fatty food or 2 yolks) and the next pictures are taken after 20 and 40 minutes. At the same time, the nature and speed of emptying the ducts and bladder are determined. With a stone in the common bile duct, the picture shows a break in the shadow of the duct. This method of cholangiography has advantages over all other methods. It does not require special preparation of the patient, and therefore is suitable for outpatient practice. Positive cholecystocholangiography with biligrafin is achieved much more often (up to 90%) than with oral cholecystography.

Cholangiography is a method of X-ray examination of the bile ducts by direct introduction into the bile ducts (before surgery - by percutaneous or transhepatic puncture, on - through a catheter inserted into the common bile duct, after surgery - through a drainage tube left in the bile ducts) followed by. According to cholangiograms, stones in the bile ducts, their compression by a tumor and other changes are detected. Cholangiography is performed jointly by a surgeon and a radiologist. See also .

Cholangiography (from the Greek chole - bile, angeion - a vessel and grapho - I write, depict) is an X-ray method for examining the bile ducts by direct injection of a contrast agent into the bile ducts, followed by radiography or X-ray cinematography. Depending on the route and method of administration of the contrast agent, there are several main options for cholangiography.

Transhepatic cholangiography. The contrast medium is injected directly into one of the large intrahepatic bile ducts by means of a puncture of the abdominal wall. This technique is mainly used in patients with jaundice to determine its cause and establish the location and nature of biliary tract obstruction (blockage with a stone or tumor, cicatricial stricture, stenosis of the Vater nipple, etc.).

Transhepatic cholangiography can be complicated by needle bleeding, hemobilia, and bile secretion into the abdominal cavity. This intervention is usually performed before the operation.

Percutaneous cholangiography (with laparoscopy). The introduction of a contrast agent into the bile ducts is carried out through the gallbladder. The bubble is punctured through the abdominal wall after the imposition of pneumoperitoneum under the control of a laparoscope. Due to the danger of bile leakage through the puncture hole, the study is recommended to be performed before the operation. It is used primarily for the differential diagnosis of jaundice and the preoperative diagnosis of primary stenosing papillitis.

Cholangiography on the operating table is performed by the surgeon after opening the abdominal cavity and examining the liver and extrahepatic biliary tract before surgical manipulations on these organs. The best method for surgical cholangiography is the introduction of a contrast agent through a catheter passed through the cystic duct into the common bile duct. In addition, a contrast agent can be injected through the gallbladder, the stump of the cystic duct, directly into the bile duct, through the opening of the Vater nipple with the duodenum open. Radiographs are taken on the operating table using a mobile unit and are interpreted jointly by the surgeon and radiologist. Often, cholangiography is accompanied by a measurement of pressure in the biliary tract, which makes it possible to more accurately judge the function of the sphincter of Oddi. At the end of the operation, cholangiography is usually repeated to determine if there are any remaining stones in the ducts and how well the ducts or anastomoses have been created.

Postoperative cholangiography is performed by introducing a contrast agent through a drainage tube or catheter left in the biliary tract.

The main task of the study is to establish the patency of the bile ducts and the function of the sphincter of Oddi.

Cholangiography through a fistula (fistulacholangiography) is performed to assess
patency of artificially created anastomoses between the biliary tract and the alimentary canal or for the study of spontaneous external and
internal biliary fistulas. The contrast agent is injected through the external fistulous opening or through the fistula with the gastrointestinal tract (after the patient has taken a suspension of barium sulfate).

All types of cholangiography give an idea of ​​the morphological and functional state of the bile ducts. According to cholangiograms, one can judge the patency of the ducts, their location, caliber, shape, pathological changes (Fig. 1 - 3). The introduction of a contrast agent into the biliary tract is recommended to be carried out under the control of transillumination (the most promising for this are electron-optical X-ray image intensifiers and X-ray television). This allows you to adjust the amount of injected drug and choose the optimal timing of shooting.

Normally, the contrast agent moves freely through the bile ducts and passes into the duodenum. On sighting pictures and on film frames, you can reflect the various phases of the activity of the sphincter of Oddi. With his hypertension, a moderate expansion of the bile ducts and a slowdown in the transition of the contrast agent into the intestine are detected. A very similar picture is sometimes given by stenosing papillitis. To distinguish between these conditions, pharmacological tests are used, for example, 0.25 mg of atropine sulfate is administered intravenously. If at the same time the contrast agent quickly passes into the intestine, then the functional nature of the obstacle is evident. With hypotension of the sphincter, the extrahepatic ducts are also dilated, but the contrast agent flows into the intestine quickly and in large quantities.

Cholangiography allows diagnosing various variants and anomalies in the development of the biliary tract, their kinks and strictures, compression of the ducts by the tumor. All types of cholangiography are of particular importance in the detection of stones in the bile ducts (Fig. 2 and 3).

Rice. 1. Cholangiography on the operating table. The bile ducts are evenly filled with a contrast agent, slightly dilated, do not contain stones. The contrast medium passes freely into the duodenum.
Rice. 2. Cholangiography on the operating table. The bile ducts are greatly dilated. In the common bile duct, there are two stones that cause filling defects in the shadow of the duct. Part of the contrast agent passed into the duodenum.
Rice. 3. Postoperative cholangiography through a drainage tube. The bile ducts are dilated. Cicatricial deformity of the common bile duct, in the lumen of which there are stones that cause filling defects. Due to spasm of the sphincter of Oddi, the contrast agent does not enter the duodenum.

The liver (exocrine glands), intrahepatic and extrahepatic ducts, and the gallbladder constitute the hepatobiliary system of the human body. To diagnose diseases and identify pathologies of this system, laboratory and hardware research methods are used.

The former include: clinical and biochemical blood tests, general urinalysis, coprogram (general fecal analysis). Of the hardware techniques, most often, duodenal sounding is used (diagnosis with parenteral administration of an irritant), x-ray or x-ray cholangiography, ultrasound examination (ultrasound). If the above methods do not make it possible to establish a reliable diagnosis, the patient is assigned a detailed examination of the hepatobiliary system - MRI cholangiography.

Purpose of the survey

In patients with severe disorders of the gallbladder and liver, magnetic resonance imaging with cholangiography is prescribed to control the therapy of previously diagnosed diseases.

These are:

  • the presence of calculi (stones) of various sizes and structure;
  • abnormal growth of tissues over the mucous membrane of organs (polyps);
  • narrowing (stenosis) of the ducts;
  • vascular pathologies of the gallbladder;
  • changes in organs due to trauma;
  • malignant lesions of the gland and gallbladder;
  • violation of the allocation of pancreatic (food) juice and secretion of bile;
  • cirrhosis of the liver;
  • severe course of hepatitis;
  • inflammation of the bile ducts due to infection (cholangitis).

The primary diagnostic procedure is performed if other methods have not been effective, and the doctor doubts the correctness of the diagnosis. In this case, the patient has the following symptoms: yellowing of the mucous membranes and epidermis, accompanied by itching, systematic pain in the right hypochondrium, abnormal blood biochemistry.

The doctor can assess the state of the hepatobiliary system

In addition, most medical specialists have recognized that MRI cholangiography is the most effective method for examining those patients who are to undergo surgery on the organs of the hepatobiliary system.

Prerogative aspects of the survey

The main advantage of cholangiography with magnetic resonance imaging is its 100% reliability. Magnetic waves penetrate into the anatomical structures of the examined organs and resonate back in the form of electromagnetic impulses. With the help of a computer program, the response signals are rearranged, and the results are displayed in a three-dimensional projection. This allows you to analyze in detail the state of organ tissues.

Other diagnostic benefits include:

  • harmlessness to the body. MRI tomography does not have a negative effect, and does not pose a health hazard. Unlike X-ray procedures, the multiplicity and frequency of MRI is unlimited. The examination is carried out for women during lactation and pregnancy, for small children. This method also has no age restrictions;
  • the ability to establish the presence of oncological processes and other pathologies at the initial stage of their development. Early diagnosis contributes to the successful outcome of the treatment of diseases of the liver, gallbladder and pancreas;
  • ease of procedure. The side of the examination that is favorable for the patient is the non-invasiveness of the method. With MRI cholangiography, it is not necessary to endure the presence of foreign medical instruments in the body that cause discomfort and sometimes pain. In addition, the procedure in most cases is performed without the use of a contrast agent, which is not well tolerated by all patients;
  • lack of a large number of contraindications.

The disadvantages of cholangiography include the cost of the procedure, which is not always affordable for patients.

Preparation and conduct of MRI cholangiography

Magnetic resonance imaging is performed in the direction of a doctor. Before the procedure, the examined person must observe an 8-hour fasting period. In addition, two days before the scheduled examination, the patient should exclude from the diet foods that cause flatulence (peas, beans, cabbage, etc.).

Refuse fried foods, strong coffee, fast food. The consumption of alcoholic beverages is strictly prohibited. The day before, you can take medicine for gas formation and do an enema. Compliance with these rules is necessary to obtain the most accurate diagnostic results.

Magnetic resonance imaging of the organs of the hepatobiliary system does not differ from other types of MRI. The time range of the procedure is from a quarter of an hour to 40 minutes. A contrast agent is used when malignant neoplasms are suspected. Before cholangiography with contrast, patients prone to allergic reactions should be tested for gadolinium, the basis of the injected contrast.

Contraindications for examination

Prohibitions for MRI of the abdominal organs are classified into absolute and relative (relative). The first category includes: medical implants that cannot be removed during the examination (pacemaker, metal clips installed on vessels, ear implants, the Ilizarov apparatus, metal articular prostheses, fixed braces and crowns); obesity. The subject's body weight should not exceed 130 kg.


Reminder to the patient before MRI cholangiography

Renal decompensation, gadolinium allergy, and pregnancy are complete contraindications for contrast-enhanced MRI cholangiography. Relative prohibitions on the procedure:

  • cardiac decompensation;
  • the initial period of pregnancy (first trimester);
  • mental pathology in the form of a phobia of closed spaces;
  • preschool age of the patient;
  • inability to maintain a static position for the required period of time due to pain or convulsive syndrome.

Some relative contraindications can be eliminated with anesthesia. Anesthesia is used to ensure the immobile state of the patient or to relieve attacks of claustrophobia. The examination takes place in a hospital or a specialized diagnostic clinic. Where to do cholangiography, the patient can choose on their own.

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