Biliary Papillomatosis and New Ultrasound Imaging Modalities

Abstract

Biliary papillomatosis (BP) is a rare disorder of the biliary tract with a significant risk of malignant transformation and a high recurrence rate after operation due to the diffuse distribution of the disease. Preoperative diagnosis is difficult also by reason of the low sensitivity and specificity of conventional ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiography (ERC) and positron emission tomography (PET). Therefore, the introduction of new diagnostic imaging methods is of importance to improve the preoperative diagnosis of this originally as benign described disease which is reflected in the term of “benign papillomatosis of the biliary tree”. The present review summarizes the literature and discusses new sonographic imaging techniques including contrast-enhanced ultrasound (CEUS), contrast-enhanced low mechanical endoscopic ultrasound (CELMI-EUS) and endoscopic ultrasound elastography.

Zusammenfassung

Die biliäre Papillomatose ist eine selten diagnostizierte Erkrankung der Gallenwege, die mit dem Risiko einer malignen Transformation behaftet ist. Die präoperative Diagnose ist schwierig, da die Veränderungen mittels konventioneller Ultraschalltechnik, Computertomografie, Magnetresonanztomografie und endoskopischer retrograder Cholangiografie unspezifisch sind und wegweisende Befunde selten erhoben werden. Durch die Einführung neuer bildgebender Methoden, wie die kontrastverstärkte Sonografie, kontrastverstärkte Endosonografie und Elastografie erscheint es möglich, neoplastisches Gewebe von Sludge, Schleim und nicht verkalkten Konkrementen zu differenzieren. Die Elastografie ermöglicht insbesondere die Wandanalyse und kann somit frühzeitige Wandinfiltrationen des härteren Tumorgewebes im Vergleich zur relativ weicheren Wand dokumentieren. Neben der Einführung und Diskussion dieser neuen bildgebenden Methoden erfolgt ein Literaturreview.

Key words

biliary papillomatosis - cholangiocellular adenoma - cholangiocellular carcinoma - contrast-enhanced ultrasound - endoscopic ultrasound - elastography

Schlüsselwörter

biliäre Papillomatose - cholangiozelluläres Karzinom - cholangiozelluläres Adenom - Cholezystolithiasis - kontrastverstärkter Ultraschall - endoskopischer Ultraschall - Elastografie

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