Abstract
Biliary strictures and masses are commonly a result of cholangiocarcinoma. However, there are several congenital, infectious, inflammatory, autoimmune, iatrogenic, and neoplastic etiologies that should also be considered in the differential diagnosis. Knowledge of the key imaging and clinical findings will aid in facilitating the diagnosis and treatment.
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Harvey RT, Miller WT Jr (1999) Acute biliary disease: initial CT and follow-up US versus initial US and follow-up CT. Radiology 213(3):831–836. doi:10.1148/radiology.213.3.r99dc17831
O’Connor OJ, O’Neill S, Maher MM (2011) Imaging of biliary tract disease. AJR Am J Roentgenol 197(4):W551–W558. doi:10.2214/AJR.10.4341
Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HK (2009) MR imaging and CT of the biliary tract. Radiographics 29(6):1669–1688. doi:10.1148/rg.296095514
Park MS, Kim TK, Kim KW, et al. (2004) Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 233(1):234–240. doi:10.1148/radiol.2331031446
Yam BL, Siegelman ES (2014) MR imaging of the biliary system. Radiol Clin North Am 52(4):725–755. doi:10.1016/j.rcl.2014.02.011
Summerfield JA, Nagafuchi Y, Sherlock S, Cadafalch J, Scheuer PJ (1986) Hepatobiliary fibropolycystic diseases. A clinical and histological review of 51 patients. J Hepatol 2(2):141–156
Todani T, Watanabe Y, Toki A, Morotomi Y (2003) Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepato-Biliary-Pancreatic Surg 10(5):340–344. doi:10.1007/s00534-002-0733-7
Lee HK, Park SJ, Yi BH, et al. (2009) Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 10(1):71–80. doi:10.3348/kjr.2009.10.1.71
Visser BC, Suh I, Way LW, Kang SM (2004) Congenital choledochal cysts in adults. Arch Surg 139(8):855–860; discussion 860–852. doi:10.1001/archsurg.139.8.855
Levy AD, Rohrmann CA Jr, Murakata LA, Lonergan GJ (2002) Caroli’s disease: radiologic spectrum with pathologic correlation. AJR Am J Roentgenol 179(4):1053–1057. doi:10.2214/ajr.179.4.1791053
Brancatelli G, Federle MP, Vilgrain V, et al. (2005) Fibropolycystic liver disease: CT and MR imaging findings. Radiographics 25(3):659–670. doi:10.1148/rg.253045114
Lefere M, Thijs M, De Hertogh G, et al. (2011) Caroli disease: review of eight cases with emphasis on magnetic resonance imaging features. Eur J Gastroenterol Hepatol 23(7):578–585. doi:10.1097/MEG.0b013e3283470fcd
Venkatanarasimha N, Thomas R, Armstrong EM, et al. (2011) Imaging features of ductal plate malformations in adults. Clin Radiol 66(11):1086–1093. doi:10.1016/j.crad.2011.05.008
Ananthakrishnan AN, Saeian K (2007) Caroli’s disease: identification and treatment strategy. Curr Gastroenterol Rep 9(2):151–155
Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 52(5):434–440
de Vries JS, de Vries S, Aronson DC, et al. (2002) Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification. J Pediatr Surg 37(11):1568–1573
Kim OH, Chung HJ, Choi BG (1995) Imaging of the choledochal cyst. Radiographics 15(1):69–88. doi:10.1148/radiographics.15.1.7899614
Soreide K, Soreide JA (2007) Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol 14(3):1200–1211. doi:10.1245/s10434-006-9294-3
Ducreux M, Buffet C, Lamy P, et al. (1995) Diagnosis and prognosis of AIDS-related cholangitis. Aids 9(8):875–880
Bilgin M, Balci NC, Erdogan A, et al. (2008) Hepatobiliary and pancreatic MRI and MRCP findings in patients with HIV infection. AJR Am J Roentgenol 191(1):228–232. doi:10.2214/AJR.07.3197
Devarbhavi H, Sebastian T, Seetharamu SM, Karanth D (2010) HIV/AIDS cholangiopathy: clinical spectrum, cholangiographic features and outcome in 30 patients. J Gastroenterol Hepatol 25(10):1656–1660. doi:10.1111/j.1440-1746.2010.06336.x
Heffernan EJ, Geoghegan T, Munk PL, Ho SG, Harris AC (2009) Recurrent pyogenic cholangitis: from imaging to intervention. AJR Am J Roentgenol 192(1):W28–W35. doi:10.2214/AJR.08.1104
Jan YY, Chen MF, Wang CS, et al. (1996) Surgical treatment of hepatolithiasis: long-term results. Surgery 120(3):509–514
Ohara H, Okazaki K, Tsubouchi H, et al. (2012) Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepato-Biliary-Pancreat Sci 19(5):536–542. doi:10.1007/s00534-012-0521-y
Okazaki K, Uchida K, Koyabu M, et al. (2014) IgG4 cholangiopathy: current concept, diagnosis, and pathogenesis. J Hepatol 61(3):690–695. doi:10.1016/j.jhep.2014.04.016
Vlachou PA, Khalili K, Jang HJ, et al. (2011) IgG4-related sclerosing disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiographics 31(5):1379–1402. doi:10.1148/rg.315105735
Nakazawa T, Ohara H, Sano H, Ando T, Joh T (2006) Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas 32(2):229. doi:10.1097/01.mpa.0000202941.85955.07
Nakazawa T, Ohara H, Sano H, et al. (2004) Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc 60(6):937–944
Tokala A, Khalili K, Menezes R, Hirschfield G, Jhaveri KS (2014) Comparative MRI analysis of morphologic patterns of bile duct disease in IgG4-related systemic disease versus primary sclerosing cholangitis. AJR Am J Roentgenol 202(3):536–543. doi:10.2214/AJR.12.10360
Eaton JE, Talwalkar JA (2013) Primary sclerosing cholangitis: current and future management strategies. Curr Hepat Rep 12(1):28–36. doi:10.1007/s11901-012-0155-1
Dave M, Elmunzer BJ, Dwamena BA, Higgins PD (2010) Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography. Radiology 256(2):387–396. doi:10.1148/radiol.10091953
Vitellas KM, Keogan MT, Freed KS, et al. (2000) Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. Radiographics 20(4):959–975; quiz 1108–1109, 1112. doi:10.1148/radiographics.20.4.g00jl04959
Bader TR, Beavers KL, Semelka RC (2003) MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease. Radiology 226(3):675–685. doi:10.1148/radiol.2263011623
Gossard AA, Lindor KD (2014) Hepatocellular carcinoma. Low risk of HCC in patients who have PSC and cirrhosis. Nat Rev Gastroenterol Hepatol 11(5):276–277. doi:10.1038/nrgastro.2014.47
Zenouzi R, Weismuller TJ, Hubener P, et al. (2014) Low risk of hepatocellular carcinoma in patients with primary sclerosing cholangitis with cirrhosis. Clin Gastroenterol Hepatol 12(10):1733–1738. doi:10.1016/j.cgh.2014.02.008
Avila NA, Ling A, Worobec AS, Mican JM, Metcalfe DD (1997) Systemic mastocytosis: CT and US features of abdominal manifestations. Radiology 202(2):367–372. doi:10.1148/radiology.202.2.9015059
Baron RL (1997) Computed tomography of the bile ducts. Semin Roentgenol 32(3):172–187
Cronan JJ, Mueller PR, Simeone JF, et al. (1983) Prospective diagnosis of choledocholithiasis. Radiology 146(2):467–469. doi:10.1148/radiology.146.2.6849096
Anderson SW, Rho E, Soto JA (2008) Detection of biliary duct narrowing and choledocholithiasis: accuracy of portal venous phase multidetector CT. Radiology 247(2):418–427. doi:10.1148/radiol.2472070473
Mandelia A, Gupta AK, Verma DK, Sharma S (2013) The value of magnetic resonance cholangio-pancreatography (MRCP) in the detection of choledocholithiasis. J Clin Diagn Res 7(9):1941–1945. doi:10.7860/JCDR/2013/6158.3365
Aube C, Delorme B, Yzet T, et al. (2005) MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study. AJR Am J Roentgenol 184(1):55–62. doi:10.2214/ajr.184.1.01840055
Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK (1999) CT and MR imaging of benign hepatic and biliary tumors. Radiographics 19(2):431–451. doi:10.1148/radiographics.19.2.g99mr04431
Baheti AD, Tirumani SH, Rosenthal MH, Shinagare AB, Ramaiya NH (2014) Diagnosis and management of intrahepatic cholangiocarcinoma: a comprehensive update for the radiologist. Clin Radiol. doi:10.1016/j.crad.2014.08.003
Itri JN, Heller MT, Tublin ME (2013) Hepatic transplantation: postoperative complications. Abdom Imaging 38(6):1300–1333. doi:10.1007/s00261-013-0002-z
Stewart L (2014) Iatrogenic biliary injuries: identification, classification, and management. Surg Clin N Am 94(2):297–310. doi:10.1016/j.suc.2014.01.008
Shanbhogue AK, Tirumani SH, Prasad SR, Fasih N, McInnes M (2011) Benign biliary strictures: a current comprehensive clinical and imaging review. AJR Am J Roentgenol 197(2):W295–W306. doi:10.2214/AJR.10.6002
Da Ines D, Essamet W, Montoriol PF (2011) Peribiliary cysts. Hepatology 54(6):2271–2272. doi:10.1002/hep.24715
Brancatelli G, Federle MP, Ambrosini R, et al. (2007) Cirrhosis: CT and MR imaging evaluation. Eur J Radiol 61(1):57–69. doi:10.1016/j.ejrad.2006.11.003
Montoriol PF, Poincloux L, Petitcolin V, Da Ines D (2012) Peribiliary cysts mistaken for a biliary dilatation in a cirrhosis patient. Clin Res Hepatol Gastroenterol 36(5):e93–e95. doi:10.1016/j.clinre.2012.03.005
Galia M, Taibbi A, Marin D, et al. (2014) Focal lesions in cirrhotic liver: what else beyond hepatocellular carcinoma? Diagn Interv Radiol 20(3):222–228. doi:10.5152/dir.2014.13184
Bittle MM, Gunn ML, Gross JA, Rohrmann CA (2012) Imaging of duodenal diverticula and their complications. Curr Probl Diagn Radiol 41(1):20–29. doi:10.1067/j.cpradiol.2011.07.001
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Heller, M.T., Borhani, A.A., Furlan, A. et al. Biliary strictures and masses: an expanded differential diagnosis. Abdom Imaging 40, 1944–1960 (2015). https://doi.org/10.1007/s00261-014-0336-1
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DOI: https://doi.org/10.1007/s00261-014-0336-1