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Diagnostic Radiology: Gastrointestinal and Hepatobiliary Imaging
Niranjan Khandelwal, Veena Chowdhury, Arun Kumar Gupta, Deep Narayan Srivastava
PART ONE: GASTROINTESTINAL IMAGING: IMAGING TECHNIQUES
CHAPTER ONE:
Current Status of Conventional Techniques and Advances in GIT Imaging
INTRODUCTION
Development of Gastrointestinal Radiology
Conventional Techniques: Present Scenario
Advances in GIT Imaging
Ultrasonography (US) in GIT
CT Enteroclysis (Fig. 1.2)
Technique of CT Enteroclysis
Indications
CT Enterography
MRI and MR Enteroclysis (MRE)
PET-CT Enteroclysis and PET CT Colonography
NUCLEAR SCINTIGRAPHY
Tuberculosis
Crohn's Disease
Imaging in Small Bowel Obstruction
Mesenteric Ischemia
Neoplasms Malignant
CONCLUSIONS
CHAPTER TWO:
Non traumatic Acute Abdomen
MISCELLANEOUS
Diverticulitis
Toxic Megacolon
Acute Pyelonephritis
Acute Urinary Colic
Acute Epiploic Appendagitis, Omental Infarction
CHAPTER THREE:
Imaging in Abdominal Trauma
INTRODUCTION
DIAGNOSTIC IMAGING
Plain Radiography
Ultrasonography (US)
Radionuclide Scanning
Magnetic Resonance Imaging (MRI)
Angiography
Computed Tomography (CT)
CT Technique
CT Signs in Blunt Abdominal Trauma10
Water Density Fluid Collection
Interloop Fluid
Hemodynamic Status
Active Arterial Contrast Extravasation
CT Staging of Abdominal Injuries
ORGAN TRAUMA
Peritoneal Cavity
Pneumoperitoneum
Hemoperitoneum
SPLEEN
LIVER AND BILIARY TRACT
PANCREAS
URINARY TRACT
ADRENAL
HOLLOW VISCUS, OMENTAL AND MESENTERIC INJURY
DIAPHRAGM
RETROPERITONEUM
ABDOMINAL WALL INJURY
PENETRATING ABDOMINAL TRAUMA
CONCLUSION
CHAPTER FOUR:
Imaging of the Esophagus
INTRODUCTION
Pharyngeal and Esophageal Anatomy
Physiology of Swallowing
Clinical Perspective
Investigation of Dysphagia
Examination Technique
Barium Studies
Cross-sectional Studies
Pharynx
Esophagus
Endoscopic Ultrasound
Others Techniques for Evaluation of Esophagus
Videoendoscopic Swallowing Study
Esophageal Scintigraphy
Esophageal Manometry
Ambulatory pH Monitoring
Oropharyngeal Lesions
Neuromuscular Disease
Cricopharyngeal Prominence
Cricopharyngeal Webs
Pharyngeal Diverticula and Pouches
Pharyngeal Tumors
Pharyngeal Foreign Bodies
Esophageal Motility Disorders
Primary
Nonspecific Esophageal Motility Disorder
Diffuse Esophageal Spasm
Achalasia
Nutcracker Esophagus
Secondary Motility Disorders
ESOPHAGITIS
Gastroesophageal Reflux Disease and Barrett's Esophagus
Infectious Esophagitis
Candida Esophagitis
Viral Esophagitis
Tuberculosis
Caustic Esophagitis
Drug-induced Esophagitis
Radiation-induced Esophagitis
Miscellaneous Causes
ESOPHAGEAL DIVERTICULA
Intramural Pseudodiverticulosis
ESOPHAGEAL VARICES
TRAUMATIC LESIONS
Foreign Bodies
MISCELLANEOUS LESIONS
ESOPHAGEAL TUMORS
Benign Tumors
Malignant Tumors
Carcinoma
Metastases
INDENTATIONS AND DISPLACEMENT
Recent Advances and Future Directions
CHAPTER FIVE:
Benign Lesions of Stomach and Small Intestine
INTRODUCTION
Techniques of Examination
Hypotonic Duodenography
MDCT and 3D Imaging Techniques
MR Imaging
Erosive and Ulcerative Lesions of Stomach and Duodenum
NARROWING OF STOMACH
THICKENED GASTRIC FOLDS AND FILLING DEFECTS
REDUCED OR ABSENT RUGAL FOLDS
GAS IN WALL OF STOMACH
GASTRIC OUTLET OBSTRUCTION
GASTRIC DILATATION WITHOUT OBSTRUCTION
POSITIONAL ABNORMALITIES
THICKENING OF DUODENAL FOLDS
DUODENAL FILLING DEFECTS
DUODENAL NARROWING OR OBSTRUCTION
EXTRINSIC IMPRESSION ON BULB
WIDENING OF DUODENAL SWEEP
MISCELLANEOUS ABNORMALITIES
CONCLUSION
CHAPTER SIX:
Malignant Lesions of the Stomach and Small Intestine
INTRODUCTION
CARCINOMA OF THE STOMACH
Risk Factors for Gastric Cancer
Clinical Features
Pathology
Diagnosis
Barium UGI Series Features of Gastric Cancer
Staging
CT Features of Gastric Cancer
Limitations of CT
Other Investigations for Preoperative Staging of Gastric Cancer
Treatment and Prognosis
CARCINOMA OF THE SMALL BOWEL
Adenocarcinoma of the Small Bowel
Clinical Features
Barium Studies of the Small Bowel
Barium Study Features of Carcinoma of the Small Bowel
CT of the Small Bowel
CT Features of Adenocarcinoma of the Small Bowel
MRI of the Small Bowel
Staging
Treatment and Prognosis
Follow-up
CARCINOID
Carcinoids of the Stomach and Duodenum
Imaging Features of Gastric and Duodenal Carcinoids
Small Bowel Carcinoids
Imaging Features of Small Bowel Carcinoids
Differential Diagnosis of Carcinoids
Treatment and Prognosis
GASTROINTESTINAL STROMAL TUMORS (GIST)
Imaging Features of GIST
Treatment of GIST
METASTASES TO THE STOMACH AND SMALL BOWEL
MISCELLANEOUS MALIGNANT TUMORS OF STOMACH AND SMALL BOWEL
CHAPTER SEVEN:
Abdominal Tuberculosis
TUBERCULOUS PERITONITIS
Peritoneum
Omentum
Small Bowel Mesentery
TUBERCULAR LYMPHADENITIS
GASTROINTESTINAL TUBERCULOSIS
OESOPHAGEAL TUBERCULOSIS
GASTRIC TUBERCULOSIS
DUODENAL TUBERCULOSIS
TUBERCULOSIS ENTERITIS
First Stage
Second Stage
Third Stage
ILEOCAECAL TUBERCULOSIS
Group 1
Group 2
Group 3
Group 4
APPENDICEAL TUBERCULOSIS41
COLONIC TUBERCULOSIS
ANORECTAL TUBERCULOSIS29
Enterolithiasis
VISCERAL TUBERCULOSIS
Liver and Spleen
Pancreas
Vascular Involvement in Gastrointestinal Tuberculosis
AIDS AND TUBERCULOSIS
Percutaneous Biopsy in the Diagnosis of Abdominal Tuberculosis
NUCLEAR IMAGING
CONCLUSION
CHAPTER EIGHT:
Non Tubercular Inflammatory Bowel Diseases
INFLAMMATORY BOWEL DISEASES
RADIOLOGY
ULCERATIVE COLITIS
CROHN'S DISEASE
Complications of IBD
Extra Intestinal Complications
Ulcerative Colitis vs Crohn's Disease
Crohn's Disease Vs Tuberculosis
Distribution of Disease
Barium Findings
CT Findings
OTHER INFLAMMATORY BOWEL DISEASES
Ischemic Bowel Disease
Appendicitis
Epiploic Appendagitis
Diverticulitis
Radiation Colitis
Pseudomembranous Colitis
Amebic Colitis
Typhilitis
Celiac disease
Eosinophilic Enteritis
Amyloidosis
CHAPTER NINE:
Colorectal Malignancies
CONCLUSION
CHAPTER TEN:
Lymphoma of the Gastrointestinal Tract
INTRODUCTION
Pathology
Staging
Paris staging system for primary gastrointestinal lymphomas*†
Clinical Presentation
Imaging Modalities
Barium Studies and Computed Tomography (CT)
CT Enteroclysis
MRI
Radionuclide Imaging
Radiological Findings
Esophagus
Stomach
Small Intestine
Appendix
Colon and Rectum
Lymphoma Variants
Burkitt's Lymphoma
Mediterranean Lymphoma
Multiple Lymphomatous Polyposis
CHAPTER ELEVEN:
Imaging of Appendix
NORMAL IMAGING APPEARANCE
ACUTE APPENDICITIS
Pathophysiology
Clinical Picture
IMAGING
Conventional radiography
Ultrasonography
US Technique
Sonographic Findings
Doppler Imaging
Pitfalls in Sonographic Diagnosis
Computed Tomography
CT Technique
CT Findings in Acute Appendicitis
Magnetic Resonance Imaging (MRI)
WHICH MODALITY AND WHEN
MUCOCELE OF APPENDIX
PRIMARY APPENDICEAL INTUSSUSCEPTION (PAI)
POSTOPERATIVE APPENDICEAL DEFECTS
TUMORS OF THE APPENDIX
PART TWO: HEPATOBILIARY AND PANCREATIC IMAGING: LIVER AND BILIARY TRACT
CHAPTER TWELVE:
Liver Anatomy and Techniques of Imaging
INTRODUCTION
NORMAL ANATOMY
BISMUTH AND COUINAUD'S SEGMENTAL NOMENCLATURE
ULTRASONOGRAPHY (US)
Technique
Ultrasound Contrast Agents
Sonographic Anatomy
Intraoperative Ultrasonography (IOUS)
Computed Tomography
CT Anatomy
Magnetic Resonance Imaging
Technique
MR Imaging Contrast Agents
MR Anatomy
ANGIOGRAPHY
Technique
Anatomy
PET
CHAPTER THIRTEEN:
Benign Focal Lesions of Liver
IMAGING FEATURES
US
CT
Nuclear Scintigrams
Angiogram
MRI
Congenital Hepatic Fibrosis and Polycystic Liver Disease
Imaging Features
Biliary Cystadenoma
IMAGING FEATURES
Bile Duct Hamartoma
Hemangioma
Pathology
IMAGING FEATURES OF CAVERNOUS HEMANGIOMAS
Plain Film Findings
US and CT
Microbubble Enhanced US
Multiple Phase Imaging
MR Imaging
MR Imaging Characteristics in Giant Hemangioma of the Liver
Red Blood Cell Scintigraphy
Angiographic Findings
Hepatocellular Adenoma (HA)
Imaging Features
CT
Triphasic Study
Radionuclide Scintigraphy
MRI
Angiograms
Focal Nodular Hyperplasia (FNH)
Pathology
IMAGING FEATURES
US
Color Doppler
Contrast Enhanced US
Focal Nodular Hyperplasia and Hepatic Adenoma: Differentiation with Low Index Contrast Enhanced Sonography
CT
Hemodynamic Characterization of Focal Nodular Hyperplasia
Nuclear Scintigraphy
Hepatic Adenoma and Focal Nodular Hyperplasia: MR Findings with Superparamagnetic Iron Oxide Enhanced MRI (SPIO)
Nodular Regenerative Hyperplasia (NRH)
Adenomatous Hyperplastic Nodule (AHN)
Lipomatous Tumors
CT
MRI
Pediatric Liver Tumors
Mesenchymal Hamartoma
US
CT
MRI
Infantile Hemangioendothelioma (IHE)
US
CT
MR
Hepatic Arteriography
Focal Inflammatory Lesions of Liver
Bacterial (Pyogenic) Liver Abscess
Pathology
IMAGING FEATURES
Plain Film Findings
US
ERCP
CT and MR Imaging
Amoebic Abscess
Pathology
IMAGING FEATURES
Plain Film Findings
Nuclear Scintigrams
US
CT
MRI
Complications
Fungal Hepatic Abscesses
Imaging Features
Hydatid Disease
Hydatid Cyst Structure
Hepatic Hydatid Disease
Imaging Features
Plain Film Findings\
Nuclear Scintigraphy
CT
MRI
Local Complications Intrahepatic Complications
Exophytic Growth
Transdiaphragmatic Thoracic Involvement
Perforation into Hollow Viscera
Peritoneal Seeding
Biliary Communication
Portal Vein Involvement
Abdominal Wall Invasion
HEPATIC TUBERCULOSIS
Pathology
IMAGING FEATURES
Plain Film Findings
Nuclear Scintigraphy
US
CT
HEPATIC SCHISTOSOMIASIS
IMAGING FEATURES
Plain Film Findings
US
CT
MRI
HEPATIC PNEUMOCYSTIS CARINII INFECTION
Miscellaneous Lesions
Fatty Infiltration
Hematoma
Biloma
CHAPTER FOURTEEN:
Malignant Focal Lesions of the Liver
INTRODUCTION
Primary
Hepatocellular Tumors
Cholangiocellular Tumors
Mesenchymal Tumors
Secondary
PRIMARY MALIGNANT FOCAL LESIONS
Hepatocellular Carcinoma (HCC)
Clinical Presentation
IMAGING IN HCC
Ultrasonography (USG)
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
ANGIOGRAPHY
FIBROLAMELLAR HEPATOCELLULAR CARCINOMA (FLC)
Interventional Techniques
INTRAHEPATIC CHOLANGIOCARCINOMA (ICCA)
IMAGING
HEPATOBLASTOMA
IMAGING
EPITHELIOID HEMANGIOENDOTHELIOMA
IMAGING
ANGIOSARCOMA
SECONDARY MALIGNANCIES
Metastatic Disease
Ultrasonography
Computed Tomography
MAGNETIC RESONANCE IMAGING
IMAGE GUIDED BIOPSY
LYMPHOMA
CHAPTER FIFTEEN:
Diffuse Liver Diseases
INTRODUCTION
FATTY LIVER (HEPATIC STEATOSIS)
Ultrasonography (US)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
VIRAL HEPATITIS
US
CT
MRI
ALCOHOLIC HEPATITIS
RADIATION HEPATITIS
HEMOCHROMATOSIS AND HEMOSIDEROSIS
US
CT
MRI
AMYLOIDOSIS
WILSON'S DISEASE
GRANULOMATOUS DISEASES
CIRRHOSIS
US
CT
MRI
MALIGNANT DIFFUSE LIVER DISEASES
CHAPTER SIXTEEN:
Imaging of Obstructive Biliopathy
INTRODUCTION
ULTRASONOGRAPHY
ENDOSCOPIC ULTRASONOGRAPHY (EUS)
COMPUTED TOMOGRAPHY
HEPATOBILIARY SCINTIGRAPHY
MAGNETIC RESONANCE IMAGING
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
BENIGN LESIONS CAUSING OBSTRUCTIVE BILIOPATHY
CHOLEDOCHOLITHIASIS
BENIGN STRICTURES
POSTOPERATIVE BILIARY STRICTURES
POST-INFLAMMATORY STRICTURES
BILE DUCT FISTULA
MIRIZZI SYNDROME
CHOLEDOCHAL CYSTS
PRIMARY SCLEROSING CHOLANGITIS
PRIMARY BILIARY CIRRHOSIS
RECURRENT PYOGENIC CHOLANGITIS
BACTERIAL CHOLANGITIS AND AIDS RELATED BILIARY ABNORMALITIES
PARASITIC DISEASES
RARE INFECTIONS
AMPULLARY STENOSIS
PORTAL BILIOPATHY
HEMOBILIA
BENIGN TUMORS OF THE BILE DUCT
MALIGNANT LESIONS CAUSING OBSTRUCTIVE BILIOPATHY
Carcinoma Gallbladder
Cholangiocarcinoma
Intrahepatic (Peripheral) Cholangiocarcinoma
Hilar Cholangiocarcinoma (Klatskin Tumor)
Hilar Cholangiocarcinoma are Graded according to Bismuth Classification.49
Extrahepatic Cholangiocarcinoma
Carcinoma Head of the Pancreas
OTHER MALIGNANT TUMORS OF BILIARY TRACT
CHAPTER SEVENTEEN:
Clinical Aspects of Liver Cirrhosis: A Perspective for the Radiologist
INTRODUCTION
Epidemiology
Pathology
Causes and Risk Factors of Cirrhosis
Natural History and Prognosis
Severity of Cirrhosis
Types of Cirrhosis
Diagnosis of Cirrhosis
Endoscopy
Liver Biopsy
Imaging in Cirrhosis
Complications of Cirrhosis
Cirrhosis and HCC
Screening Tests
Surveillance Intervals
Protocol for HCC Surveillance
Cost Effectiveness
Treatment of Cirrhosis
Treatment of Complications
CONCLUSION
CHAPTER EIGHTEEN:
Imaging and Interventions in Pancreatitis
ACUTE PANCREATITIS
Classification
Assessment of Severity
Role of Imaging in Patient Management
Computed Tomography
CT Protocol
CT Findings in Acute Pancreatitis
MILD ACUTE PANCREATITIS OR EDEMATOUS PANCREATITIS
SEVERE ACUTE PANCREATITIS
Acute Fluid Collections
Acute Pseudocyst
Pancreatic Abscess
Pancreatic Necrosis
Vascular Complications
Extrapancreatic Adjacent Organ Involvement
Staging of Acute Pancreatitis
Magnetic Resonance Imaging
Ultrasound
Percutaneous Cross-sectional Image–guided Interventions
CHRONIC PANCREATITIS
Etiology and Pathophysiology
Imaging in Chronic Pancreatitis
Plain Films
Ultrasonography (US)
Endoscopic Ultrasonography (EUS)
CT
Endoscopic Retrograde Pancreatography (ERP)
Magnetic Resonance (MR) Imaging
MR Cholangiopancreatography (MRCP)
Advantages of MRP over ERP
Advantages of ERP over MRP
Positron-emission Tomography (PET)
Imaging in Special Situations and Variants
SUMMARY
CHAPTER NINETEEN:
Tumors of Pancreas
ANATOMY
Topography
Histology
Physiology
MACROANATOMY
Ductal System
Vascular System
PATHOLOGY
Classification of tumors (Based on Predominant Cell Type and Radiological Appearances1)
Epithelial Exocrine
Endocrine Islets Cell Tumors
Other Pancreatic Neoplasms
PANCREATIC ADENOCARCINOMA
PATHOLOGICAL ANATOMY AND BIOLOGICAL BEHAVIOR
Ultrasonography (US)
Color Doppler Flow Imaging (CDFI)
Endoscopic US
Computed Tomography (CT)
Dual Phase Helical CT
MAGNETIC RESONANCE IMAGING (MRI)
MRCP
ERCP
PET
DSA
Tumor Markers in Pancreatic Carcinoma
Laparoscopy
Fine Needle Aspiration (FNA)
STAGING OF PANCREATIC TUMORS
CYSTIC TUMORS
Mucinous Cystic Neoplasms (MCNs)
Microcystic Adenoma (Serous Cystadenoma)
Intraductal Papillary Mucinous Tumors/Neoplasms (IPMT)/(IPMN)
Solid and Papillary Epithelial Tumors/SPT's Neoplasms (SPEN)
UNCOMMON CYSTIC PANCREATIC TUMORS
Cystic Endocrine Tumors
Insulinoma
Gastrinoma
Glucagonoma
Vipoma
Somatostatinoma
Nonfunctioning ICTS
Arteriography and Venous Sampling
Arterial Stimulation and Venous Sampling
Endoscopic US
UNCOMMON SOLID PANCREATIC TUMORS
Pancreatoblastoma
Acinar Cell Carcinomas
Tumors of Neural Origin
Metastasis
Lymphoma
CHAPTER TWENTY:
Imaging in Portal Hypertension
ANATOMY AND COLLATERAL CIRCULATION
Tributary Collaterals (Hepatofugal)
Developed Collaterals (Hepatofugal)
Bridging Collaterals (Hepatopedal)
Etiology of Portal Hypertension
Noninvasive Radiological Evaluation
Investigations include
Sonography and CDFI
Computed Tomographic Imaging
MR Imaging
MR Portography
Pitfalls22
INTRAHEPATIC PORTAL HYPERTENSION
Organ Parameters
Splenomegaly
Ascites
Vascular Evaluation
Portal Vein, Superior Mesenteric Vein and Splenic Vein Diameter
Pitfalls of Portal Flow Assessment
Portosystemic Venous Collaterals12
Assessment of Hepatic Veins
Arterial Evaluation
Extrahepatic Portal Hypertension: Prehepatic
Portal Vein Occlusion
Spleinic Vein Occlusion
SMV Occlusion
Extrahepatic Portal Hypertension: Posthepatic
Hyperkinetic Portal Hypertension6
MEDICAL TREATMENT FOLLOW-UP
Evaluation of Surgical Portosystemic Shunts and Tips
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
CHAPTER TWENTY-ONE:
Hepatic Venous Outflow Tract Obstruction
INTRODUCTION
DIAGNOSTIC TECHNIQUES
EVALUATION OF HEPATIC VEINS IN BCS
EVALUATION OF IVC IN BCS
Five types of Collateral Pathways develop in Budd-Chiari syndrome23
ASSESSMENT OF LIVER PARENCHYMA IN BCS
MANAGEMENT OF BCS
CHAPTER TWENTY-TWO:
Gastrointestinal Hemorrhage
INTRODUCTION
IMAGING MODALITIES
Angiography
Technical Considerations
Angiographic Findings in GIH
Radionuclide Studies
Computed tomography
Barium Studies
CONTROL OF GASTROINTESTINAL HEMORRHAGE
Transcatheter Embolization
SPECIFIC SITUATIONS IN GI HEMORRHAGES
Upper Gastrointestinal Hemorrhage (UGIH)
Hemobilia
Pancreatitis and UGIH
Lower Gastrointestinal Hemorrhage (LGIH)
Colonic Diverticula
Meckel's Diverticulum
Angiodysplasia
Hemangioma and Arteriovenous Malformation
Tumors
Inflammatory Bowel Diseases and Small Bowel or Colonic Ulcers
Others
CONCLUSIONS
CHAPTER TWENTY-THREE:
Interventions in Obstructive Biliopathy
INDICATIONS FOR BILIARY DRAINAGE
Percutaneous Transhepatic Cholangiography (PTC)
Pre-procedure Evaluation and Preparation
Technique
Percutaneous Transhepatic Biliary Drainage (PTBD)
Technique
Fluoroscopic Guidance
Internal and External Drainage
Complications of Biliary Drainage
Follow Up of Biliary Catheters
Biliary Stenting
Intraluminal Brachytherapy with PTBD
Dilatation of Benign Biliary Structures
Percutaneous Cholecystostomy
Technique
Complications
Gallbladder Biopsy
CHAPTER TWENTY-FOUR:
Interventional Treatment of Liver Tumors
INTRODUCTION
TREATMENT OF LIVER TUMORS
Hepatocellular Carcinoma (HCC)
Chemical Ablation
Radiofrequency Ablation (RFA)
Technique
Follow-up
Transcatheter Arterial Chemoembolization (TACE)
Technique
Follow-up
Transcatheter Arterial Embolization (TAE)
Transarterial Radionuclide Therapy (TART)
Right Portal Vein Embolization
Hepatic Vein Stenting
METASTATIC TUMORS OF LIVER
BENIGN TUMORS OF LIVER
CONCLUSION
CHAPTER TWENTY-FIVE:
Percutaneous Non vascular GIT Interventions
GASTRODUODENAL STENTING
Indications
Contraindications
Available Devices
Endoscopic versus Fluoroscopic Placement
Technique (Figs 25.5A to D)
Postprocedure Care
Complications
COLORECTAL STENTING
Indications
Contraindications
Technical Considerations
Postprocedure Follow-up
Complications
Percutaneous Enterocutaneous Fistula Closure with N-butyl-2-Cyanoacrylate
Mechanism of Action of the Glue (N-butyl-2-cyanoacrylate)
Prerequisites
Technical Consideration
Preparation
Technique (Figs 25.6A to D)
CHAPTER TWENTY-SIX:
Interventional Radiology in Portal Hypertension
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
INDICATIONS OF TIPS2
CONTRAINDICATIONS OF TIPS2
COMPLICATIONS OF TIPS2
Revision of Occluded Surgical Shunt
Arterioportal Fistulas
Recanalization of Occluded Portal Vein and its Tributaries
Partial Splenic Embolization
Percutaneous Transhepatic Variceal Embolization
Angiographic Vasopressin Infusion
Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices
Budd-Chiari Syndrome
Recent Advances
INDEX
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