64-Detector Row Computed Tomography: An Improved Tool for Evaluating the Biliary and Pancreatic Ducts?

The imaging evaluation of patients with suspected pancre-aticobiliary abnormality includes noninvasive imaging modalities such as sonography and MRI. The use of computed tomography (CT) has typically been limited to the evaluation and staging of malignancy affecting the pancreas and biliary tree. With the increasing use of CT in abdominal imaging for patients with a wide variety of indications, biliary and pancreatic abnormalities are being initially identified with increasing frequency on CT. The evolution of CT technology to multi-detector channel row (MDCT) scanners, currently culminating in use of 64-detector-row MDCT scanners, has provided unprecedented image quality. We have recently installed three 64-MDCT scanners in our institution and, in this article, we describe our experience in their application to imaging of the pancreatic and biliary ducts. Our current protocols for imaging the biliary tree and pancreatic duct using this technology are discussed. Additionally, the advantages of novel interpretation techniques including multi-planar and minimum intensity projection reformations are detailed. Various diseases affecting the pancreaticobiliary tree are briefly discussed along with their typical imaging evaluation. The application of 64-MDCT technology to these abnormalities is described along with expected imaging findings on CT. The imaging findings of various pancreaticobiliary abnormalities using 64-MDCT scanner technology encountered at our institution are illustrated. In summary, 64-MDCT technology offers several technical advances which may increase utilization of CT in the evaluation and diagnosis of pancreaticobiliary abnormalities.