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Imaging of benign biliary pathologies

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Abstract

Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.

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Abbreviations

CBD:

Common bile duct

CECT:

Contrast-enhanced computed tomography

CHD:

Common hepatic duct

DC:

Direct cholangiography

ERCP:

Endoscopic retrograde cholangiopancreatography

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitis

SOD:

Sphincter of Oddi

SSC:

Secondary sclerosing cholangitis

US:

Ultrasound

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  1. Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA

    Karthik M. Sundaram & Matthew A. Morgan

  2. Mallinkckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA

    Malak Itani

  3. Department of Radiology, University of New Mexico, Albuquerque, USA

    William Thompson

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Sundaram, K.M., Morgan, M.A., Itani, M. et al. Imaging of benign biliary pathologies. Abdom Radiol 48, 106–126 (2023). https://doi.org/10.1007/s00261-022-03440-5

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