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Volume rendering of three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective study

¹ Center for Medical Image Science and Visualization (CMIV), Linköping University Hospital, Sweden, ² Department of Radiology, Hudiksvall Hospital, Sweden and ³ Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden

View larger version (159K): [in a new window]   Figure 1. No contrast excretion is observed in this case. At the consensus reading, the examination was regarded as not conclusive. One reader described a calcified bile duct stone (arrow), which was verified with endoscopic retrograde cholangiography.

View larger version (53K): [in a new window]   Figure 2. (a, b) Axial 2D images, (c) volume rendering technique (VRT). Three small bile duct stones (arrows) were observed in common bile duct (consensus), no stone was observed at endoscopic retrograde cholangiography.

View larger version (94K): [in a new window]   Figure 3. Axial 2D images. (a) One small stone (arrow) was observed in the common bile duct (consensus), (b) no stone was observed at endoscopic retrograde cholangiography.

View larger version (87K): [in a new window]   Figure 4. This case shows poor excretion of contrast. There is an area with low attenuation (arrow) close to the confluence of the main bile duct, which was proposed by consensus to represent a stricture, but the examination was ranked as inconclusive, requiring further investigation. Final diagnosis at endoscopic retrograde cholangiography confirmed the existence of a total post-operative occlusion of the common bile duct.

View larger version (17K): [in a new window]   Figure 5. Image quality in the 3D volume rendering technique (VRT) display for the 198 assessments (3 observersx66 examinations). The number at the top of each bar denotes the absolute number of assessments, and the bar height represents the percentage.

View larger version (13K): [in a new window]   Figure 6. Estimated diagnostic quality of the 3D drip infusion CT cholangiography (DIC-CT) data sets. The number at the top of each bar denotes the absolute number of assessments, bar height represents the percentage.

View larger version (28K): [in a new window]   Figure 7. Attenuation in the common bile duct and liver parenchyma at drip infusion CT cholangiography (DIC-CT) as a function of serum bilirubin in all individuals with >19 µmol l–1, i.e. in 90 patients out of a consecutive 142 patients.

View larger version (84K): [in a new window]   Figure 8. Volume rendering 3D images with two different transfer functions. (a) A linear ramp transfer function giving high opacity (up to 50%) to all voxels inside the bile duct. (b) Rendered with lower opacity (12%) and a transfer function emphasising attenuation values in a narrow intermediate interval, corresponding to the border between the bile duct lumen and surrounding tissue. A surgically verified stone is observed in the distal bile duct.

View larger version (42K): [in a new window]   Figure 9. Volume rendering 3D images with (a) high (50%) and (b) low opacity (12%). The same transfer functions as in Figure 2a, b have been used. (c) The same data set as in (a) but with an applied multiplanar cut plane in order to omit obscuring parts of the volume. Three stones are visualized in the common bile duct. Two of these were verified at endoscopic retrograde cholangiography.