Choledocholithiasis causing intrahepatic biliary duct dilation
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Coronal T2 weighted images show well defined hypointense areas of various sizes in the dependent portion of the body of the gallbladder. There is obstruction at the distal CBD with dilatation of the proximal CBD and intrahepatic biliary system. The hyperintense bile produces a "convex margin" at the site of obstruction which is fairly specific for "meniscus sign of choledocholithiasis".
Axial T2 weighted images show “target sign” in the distal CBD, representing a central hypointense filling defect surrounded by hyperintense bile.
Choledocholithiasis can be differentiated from a tumor in most cases, as the calculi may have angulated contours depending on the location in the bile duct and they are almost completely surrounded by high-signal-intensity bile (target sign) 1. Whereas abrupt termination of the bile duct and the absence of typical signs of biliary lithiasis have a high correlation with extrahepatic cholangiocarcinoma.
- 1. Manfredi R, Mucelli RP. Magnetic Resonance Cholangiopancreatography (MRCP): Biliary and Pancreatic Ducts. Springer. ISBN:8847028434. Read it at Google Books - Find it at Amazon