Diagnostic Radiology: Gastrointestinal and Hepatobiliary Imaging Niranjan Khandelwal, Veena Chowdhury, Arun Kumar Gupta, Deep Narayan Srivastava
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1DIAGNOSTIC RADIOLOGY: Gastrointestinal and Hepatobiliary Imaging
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PIONEERS OF AIIMS-MAMC-PGI IMAGING COURSE SERIES
Manorama Berry
Sudha Suri
Veena Chowdhury
PAST EDITORS
Sima Mukhopadhyay
Sushma Vashisht
3AIIMS-MAMC-PGI IMAGING COURSE SERIES
DIAGNOSTIC RADIOLOGY: Gastrointestinal and Hepatobiliary Imaging
THIRD EDITION
Editors Arun Kumar Gupta MD MNAMS Professor and Head Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi Veena Chowdhury MD Director Professor and Head Department of Radiodiagnosis Maulana Azad Medical College New Delhi Niranjan Khandelwal MD DNB FICR Professor and Head Department of Radiodiagnosis PGIMER, Chandigarh Associate Editors Deep Narayan Srivastava MD MAMS Professor Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi Raju Sharma MD Additional Professor Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi
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Diagnostic Radiology: Gastrointestinal and Hepatobiliary Imaging
© 2009, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition : 1997
Second Edition : 2004
Third Edition : 2009
9788184484342
Typeset at JPBMP typesetting unit
Printed at
5List of Contributors 7Preface to the Third Edition
The first edition of Diagnostic Radiology on ‘Hepatobiliary and Gastrointestinal Imaging’ was published in 1997. Rapid advances in the field of imaging necessitated revision and therefore the second edition was published in 2004.
Encouraged by the response to the previous editions and to keep up with the pace of advances in imaging we decided to update the second edition, delete some and add few new chapters to make the third edition a very comprehensive, updated reference book for postgraduates, practicing radiologists, gastroenterologists and GI surgeons.
We hope that the readers will find this book informative and that in the long run it will serve to improve patient care.
We wish to take this opportunity to thank our faculty from AIIMS, MAMC and PGIMER for their active contribution and support without which this endeavor would not have been possible.
We would also like to thank Mr. JP Vij, Chairman and Managing Director of M/S Jaypee Brothers Medical Publishers (P) Ltd., Mr. Tarun Duneja, Director Publishing, Ms. Samina Khan and other staff for their professional help and cooperation in publishing this book in a very short time.
Arun Kumar Gupta
Veena Chowdhury
Niranjan Khandelwal
Deep Narayan Srivastava
Raju Sharma
8Preface to the First Edition
There has been a tremendous change in the approach to the diagnosis of abdominal diseases in the last decade, making the imaging of hepatobiliary and gastrointestinal system as one of the most interesting and challenging specialities to the radiologists. New imaging and therapeutic techniques, that have revolutionised the diagnosis and treatment of many abdominal diseases, have also given us the added responsibility of defining the proper role of these techniques, evaluating their efficacy against earlier and more established methods, and providing guidance to clinicians through the judicious use of newer technology.
It is with this goal in mind, the faculty of Departments of Radiodiagnosis at the All India Institute of Medical Sciences, New Delhi, Maulana Azad Medical College, New Delhi and Postgraduate Institute of Medical Education and Research, Chandigarh present this third book in the series of Diagnostic Radiology, devoted to Hepatobiliary and Gastrointestinal Imaging.
The book comprises of twenty-nine chapters covering the radiological and imaging aspects of Hepatobiliary and Gastrointestinal systems in detail. In spite of advancements in various imaging techniques, conventional radiology still remains the mainstay as the initial imaging modality for many abdominal disorders and its interpretation continues to be a great challenge. The importance of plain radiography and barium studies has been described in depth. Techniques of US, CT and the potential role of MRI in evaluation of these disorders have also been explicitly elaborated upon. There are separate sections dedicated to imaging of the liver, biliary tract and pancreas. Clinicopathological aspects with radiological correlation have been discussed in the section on liver with special reference to focal and diffuse, benign and malignant lesions. Biliopathy and pancreatic disorders have been covered at length, with two separate chapters dealing with interventions. Portal hypertension has been discussed in great detail with authors explaining the role of various radiological modalities including US, colour Doppler, angiography and newer imaging techniques. The status of conventional techniques and advances in imaging have been described in an attempt to provide a comprehensive overview of all regions of the GI tract involved by infective, benign, and malignant lesions with special reference to the evaluation of the patients with GI bleed.
We hope the reader shall find this book both instructive and informative for the improved use of imaging resources which will help to serve the common goal of good health care and management of patients everywhere.
We wish to take this opportunity to thank our faculty colleagues from AIIMS, MAMC and PGIMER for their active support, co-operation and timely submission of the manuscripts. We owe immense gratitude to Prof K Subbarao, Prof A Gajaraj, Prof Ratni B Gujral and Prof B Nagi who have been very kind to contribute their experience into this book. We specially like to thank Dr Sumedha Pawa, Dr Mona Bhatia, Dr Anju Garg, Dr Sima Mukhopadhyay and Dr Sushma Vashisht for their help and untiring efforts in bringing out this volume. We also express our sincere thanks to the publishers of the series of these books, M/s Jaypee Brothers for timely publication of this volume, as always, in the present form.
Manorama Berry
Veena Chowdhury
Sudha Suri