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Computerized tomography for diagnosis of biliary tract diseases

The article was professionally consulted by Specialist Doctor I Tran Cong Trinh - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has many years of experience in the field of diagnostic imaging.
Computed tomography (CT) is a modern imaging technique that allows viewing of organs in the body, including bones, blood vessels, and soft tissues. Computed tomography (CT) of the biliary tree plays an important role in the diagnosis of biliary tract diseases and appropriate treatment.

1. Diagnosis of gallstones

1.1 What are gallstones? According to statistics, gallstones are a fairly common disease in Vietnam, in which gallstones are more common than gallstones (due to infectious factors, parasitic infections of the biliary tract).
The cause is determined to be due to the increased amount of cholesterol secreted in the bile, combined with a decrease in bile salts, making it unable to dissolve, so it is deposited into stones. Stones can form in the intrahepatic, extrahepatic, or both.
Patients with gallstones often have the following symptoms:
Gallstones will feel pain in the right lower quadrant. Gallstones in the liver or common bile duct cause pain in the epigastrium, right shoulder, or back. The pain often occurs after meals, especially greasy meals or eating at night. Frequent gas, bloating, indigestion. 1.2 Methods of diagnosing gallstones In addition to routine tests such as liver function assessment, blood cholesterol testing, imaging methods such as X-ray, ultrasound, regional computed tomography Abdomen will be ordered by the doctor to examine the lesions in the gallbladder, ducts and liver.
Especially indicated for biliary computed tomography when:
The process of performing ultrasound is difficult such as: patients with large organs, abdominal distention, small stones in the lower common bile duct. Gallstones with complications. It is necessary to evaluate in detail the state of stones and liver parenchyma to guide treatment. Image features
When computed tomography of the bile, if the patient has gallstones, the following signs will be seen:
Increased density of stones in the biliary tract. Dilatation of the biliary tree anterior to the stone. Cholesterol stones are often co-densified with bile. May be missed on computed tomography due to small stones or no hyperattenuation.
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2. Diagnosis of cholecystitis

2.1 What is cholecystitis? Cholecystitis is considered a complication of gallstones. When gallstones form in the gallbladder, they block the flow of bile, causing bile to stagnate, accumulate bacteria and cause inflammation. In addition, foci of inflammation can also form due to tumors or other diseases.
People with cholecystitis often have the following symptoms:
There are sudden pain in the right or middle abdomen. Combined with fever, vomiting. Often severe pain after meals, the pain is intermittent, dull. There are signs of jaundice when the disease is advanced. Chronic cholecystitis can cause the gallbladder to swell, thicken, and gradually lose its ability to store and release bile.
2.2 Diagnostic method of cholecystitis With cholecystitis, abdominal computed tomography will provide the most accurate and true images of the lesions in the gallbladder, the degree of inflammation, the location of the inflammation. ...as well as help survey surrounding organs such as liver, intestines, pancreas. When computed tomography of the gallbladder, if the patient has cholecystitis, the following signs will be seen:
Thickness of the gallbladder wall (>4mm), strong contrast enhancement after injection. Enlarged gallbladder (horizontal diameter >40mm) Fluid and infiltration of fatty tissue around the gallbladder and liver parenchyma. Peri-gallbladder fluid may be confined to the gallbladder bed with a thin layer. Gas-producing cholecystitis: gas appears in the gallbladder. Necrotizing cholecystitis: thickened gallbladder wall, small abscesses can be seen, air can be seen in the wall.
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3. Diagnosis of Gallbladder Polyps

Gallbladder polyps are tumors in the lining of the gallbladder. Many theories suggest that gallbladder tumors are caused by endothelial cell proliferation or mucosal damage.
Currently, abdominal ultrasound can diagnose gallbladder mucosal tumor. However, abdominal computed tomography provides sharper and clearer images, helping doctors determine the extent of tumor invasion. Bile computed tomography is especially useful for cases that have progressed to cancer, thereby orienting treatment as well as helping to monitor drug response.

4. Gallbladder Cancer Diagnosis

Gallbladder cancer is more common in women than in men, often accompanied by gallstones or porcelain gallbladder. There are two types: nodules and infiltrates. When computed tomography of the gallbladder, if the patient has gallbladder cancer, the following signs will be seen:
The gallbladder wall is irregularly thick, the bud is in the gallbladder lumen. The size of the gallbladder and the liver is not clear, there are many lobes, and the density is reduced compared to the liver parenchyma before and after drug injection. In the late stages, biliary computed tomography will show the tumor growing or spreading rapidly into the hilar nodes, liver parenchyma in the subsegment IV or V.
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5. Diagnosis of cholangiocarcinoma

Cholangiocarcinoma is more common in men than women, 95% is adenocarcinoma. Tumors are usually located in the hilum or extrahepatic biliary tract. When computed tomography of the bile ducts, if the patient has cholangiocarcinoma, the following signs will be seen:
Tumor is in the biliary lumen, possibly invading the parenchyma of the liver hilum or surrounding tissues. liver. The tumor decreased in density before injection, and the contrast was weak and uneven after injection. Dilatation of the upper biliary tract. There may be portal vein thrombosis, liver metastases, hepatic hilar nodes... Computed tomography is widely used in detecting and diagnosing lesions in most soft tissues, bones and blood vessels by imaging. show clearly, accurately, high resolution, time and operation performed quickly and easily.
Currently, CT is the imaging method performed routinely at Vinmec International General Hospital. The computerized tomography procedure at Vinmec is carried out methodically under the guidance of the medical team of the Department of Diagnostic Imaging. In addition, Vinmec is now equipped with the most modern CT scanner, meeting international standards for true and clear images, helping doctors to accurately diagnose the disease and the stage of the disease, thereby effective treatment, creating a sense of safety for the patient.

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