Ducts all in a row

Does anybody know, when they do liver ultra sounds can they see the ducts?

[Ktltel]

I think a MRCP scan is what shows that kind of detail. I was told it's like a MRI but focuses in on one general location.

I had one. They said (at the time back in Nov. 2016) that my bile ducts were unremarkable.

Stella

[Hidden in reply to Ktltel]

Ok thank you

[Ktltel in reply to Hidden]

Found this....

MRCP is a special type of magnetic resonance imaging (MRI). It uses computer software that specifically images pancreatic and bile ducts, which are often the site of tumors. Fluid naturally present in the ducts serves as a contrast substance.

[Hidden in reply to Ktltel]

Thank you!! That's very helpful.

[Ktltel in reply to Hidden]

But there was this too about CT scans...

Computed tomography (CT) scan. ... CT scans can show the organs near the bile duct (especially the liver), as well as lymph nodes and distant organs where cancer might have spread to. A type of CT known as CT angiography can be used to look at the blood vessels around the bile ducts.

[Hidden in reply to Ktltel]

It's all so confusing. My gastro doc says I have autoimmune pbc how does she know without looking at the ducts?

[Ktltel in reply to Hidden]

One is diagnosed by blood work and sometimes a biopsy. An elevated AMA-M2, and a few other liver enzymes tell the story. Have a second opinion by a hepatologist. They should be the experts. 👍

[Hidden in reply to Hidden]

Hello again RebeGarcia10.

When we first start with PBC the bile ducts are normally pretty much intact. It is over time and a progression of PBC that the bile ducts start to disappear. The disappearing and damaged bile ducts are what causes bile to leech into our liver causing it to become inflamed.

I was diagnosed in December 2010 with PBC due to not only having higher than normal liver function test (LFTs) and another used in liver disorders, the GGT blood test (tends to be a guide for liver inflammation) I also had sy,ptons (itching and at the time fatigue) plus I was found to have a high titre (measure) of certain antibodies known as AMAs that gave diagnosis.

[katim]

I think yes, when they use Doppler...

[Hidden]

Hello RebeGarcai10.

Back in 2010 several months after I started itching and continued to have rising abnormal LFTs my GP asked me to go for an ultrasound scan. I had a scan on liver and surrounding organs at the time and then later that year when I had my first hospital consultant appointment (I am in the UK) he said that he could see 'clear bile ducts' on the scan he went through that day as well at the time as my liver and other organs appearing normal. So yes it is possible.

[dianekjs]

Hi, yes, the bile ducts are visible using ultrasound and it is often the initial test ordered to look for problems. My US reports included the actual images and I could see the ducts pretty easily on the printout. PBC diagnosis can be made if two of the following three tests are positive: a blood test detecting AMA/M2 antibodies, a blood test showing elevated liver enzymes, or a positive liver biopsy. Most doctors no longer routinely order a biopsy if labs are confirmatory.

[JaneIng in reply to dianekjs]

Hi Dianekjs, where are you in US? I never got a printout from my ultrasound

[dianekjs in reply to JaneIng]

Hi Jane, I'm in Raleigh, NC. You should be able to request a copy of the full US report from the radiology or diagnostic imaging lab where you had it done. I'm not sure how detailed the US imaging is, but it seems to be an accepted initial screening method. The radiologist actually took me back to his lab/office and put the images up on the screen and explained what he was looking at.

[JaneIng in reply to dianekjs]

Thanks Diane. I have taken images in Northside hospital and Piedmont Hospital in Atlanta, GA. Technicians took the image and sent off to a radiologist. The radiologist write the summary and send it to the doctors. The doctor review the write-up with me. To be honest, I don't even know where are those radiologist. I think the hospital may have them outsourced.

It will be nice to be able to see the pictures, especially I have done so many in the past 4 years. This way I can see the changes throughout the years.

Is US imaging a offside location from the hospital? Is it where you had your image taken? Or is it where your doctor is?

[dianekjs in reply to JaneIng]

My doctor ordered the ultrasound (US) to be done at a local private diagnostic imaging facility. They do MRI, ultrasound, CT scans, etc. The radiologist there came in to talk to me after he had reviewed the images, and then took me back to his office to show me on the screen. The ordering physician is a GI and hepatology specialist in private practice. But your doctor should be able to give you a copy of the actual ultrasound report, even if it was sent out to be read.

[JaneIng in reply to dianekjs]

your imaging center's process make sense and sounds efficient to me. I get the summary only. I will go back and ask for a picture. Thanks so much for responding. Have a great day.

--Jane

[GrittyReads]

I think it may be necessary to check what exactly is meant by 'bile ducts'.

The liver has many, many (thousands ... millions??) of tiny biliary tubules, which collect the bile from the liver cells. It is the cells of the walls of these tubules that are believed to be attacked, and which then causes the breakdown of the tubules and the scarring etc. that is the hallmark of PBC. This then affects the liver's ability to conduct the bile safely away (it's a waste product and the liver needs to get rid of it) from the liver cells to larger and larger bile tubes. These join up to form bigger tubes, which eventually join to form the large, main 'bile duct', which empties the bile into the gall bladder. [It's a bit like a tree: tiny twigs join to form to branchlets, then main branches and then the trunk]

My understanding is that ultrasound scans show the gall bladder and its one main bile duct, and some of the smaller ducts, but not the tiny ones where the damage causes the initial problem. If an ultrasound shows 'mass' scarring of the liver - when cirrhosis is advanced - the general appearance looks different, and this different looking liver tissue would indicate that other investigations should be done. My consultant said that ultrasound cannot be used to diagnose PBC, but that the evidence of mass scarring can indicate if more investigation is needed: eg a biopsy.

You should not be diagnosed from AMAs alone, and as dianekjs has said, 2 out of 3 tests must be satisfied for a diagnosis of PBC: the presence of AMA-M2; and/or abnormal liver function tests that are typical of PBC, over a period of time; and/or a biopsy that shows typical damage to the cells and tiny tubules of the liver.

Hope this makes sense, feel free to ask more. Also checkout the dvd that the British Liver Trust have on PBC.

[Skypony in reply to GrittyReads]

Gritty, you are a fantastic resource for us all, you're so knowledgable, and what you write is always crystal clear. Thank you

[Hidden in reply to GrittyReads]

Thank you! My AMA/M2 came back positive my liver enzymes were all elevated and the Fibroscan showed stage 4 cirrhosis and I have Esophageal varices. My Dr said no biopsy it wouldn't change anything.

[JaneIng]

I had MRCP done and it showed enlarged bile duct of 8mm. Normal size should be 4 - 5 mm.

[iagra]

The liver biopsy is used initially to determine the stage of PBC and set the baseline. After that, the ultrasound with sheer wave elastography, a non-invasive procedure that requires no preparation, is used periodically (approximately, twice a year) to monitor the condition of the liver bile ducts. It is a standard procedure used in the USA. Don't know about other countries. Yes, the doctor will be able to see the ducts on the wave ultrasound image.