Noninvasive Imaging Methods for Bile Duct and Gallbladder Pathology: An Overview

Abstract Evaluation of the gallbladder and biliary system with noninvasive imaging modalities is essential for pathology characterization as well as for guidance of additional diagnostic and therapeutic intervention. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are the mainstream modalities encountered in the workup of gallbladder and biliary pathology and can be used alone or in combination. US is the modality of choice for initial workup of abnormal liver function tests and is excellent at evaluating gallbladder and bile duct pathology such as choledocholithiasis or cholecystitis. It is widely available, cost-effective, and portable. CT is a common modality for the evaluation of abdominal pain and may demonstrate biliary dilatation or other processes such as infection or neoplasms involving the biliary system, gallbladder, and involved adjacent liver parenchyma. MRI, and more specifically MR cholangiopancreatography, is the modality of choice for detailed evaluation of the intrahepatic and extrahepatic ducts. It can accurately depict biliary anatomic variants for presurgical planning, postprocedural complications, intraductal processes, and other biliary-related pathologies. MRI can also assess for bile leaks and fistulas with the use of hepatobiliary contrast agents. All these modalities provide important diagnostic information, facilitate interventional approaches, and guide clinical treatment algorithms. We review the advantages and limitations of each to help guide the provider to the modality of choice for the optimal assessment of specific gallbladder and biliary pathologies and treatment planning needs.