DIAGNOSTIC RADIOLOGY Gastrointestinal and Hepatobiliary Imaging
PIONEERS OF AIIMS-MAMC-PGI IMAGING COURSE SERIES
PAST EDITORS
AIIMS-MAMC-PGI IMAGING COURSE SERIES
DIAGNOSTIC RADIOLOGY Gastrointestinal and Hepatobiliary Imaging
Fourth Edition
Jaypee Brothers Medical Publishers (P) Ltd.
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd.
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
E-mail: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd.
83, Victoria Street, London
SW1H 0HW (UK)
Phone: +44-20 3170 8910
Fax: +44(0) 20 3008 6180
E-mail: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 235, 2nd Floor, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
E-mail: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd.
17/1-B, Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
E-mail: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd.
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
E-mail: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2017, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any has been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Diagnostic Radiology: Gastrointestinal and Hepatobiliary Imaging
First Edition: 1997
Second Edition: 2004
Third Edition: 2009
Fourth Edition: 2017
9789386261977
Printed at
- Ajay Gulati MD MAMS
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Alpana Manchanda MD
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Anindita Sinha MD
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Anjali Prakash DMRD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Anju Garg MD
- Director–Professor and Head
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Ankur Goyal MD DNB MNAMS
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences New Delhi, India
- Anmol Bhatia MD
- Assistant Professor
- Department of Gastroenterology (Radiodiagnosis)
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Anupam Lal MD
- Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Arun Kumar Gupta MD FAMS
- Professor and Head
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Ashu Seith Bhalla MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Atin Kumar MD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Jai Prakash Narayan Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
- Chandan J Das MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Chandrashekhara SH MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- (BRA Institute Rotary Cancer Hospital)
- All India Institute of Medical Sciences
- New Delhi, India
- Deep Narayan Srivastava
- MD MBA FAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Devasenathipathy Kandasamy
- MD DNB FRCR
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Ekta Dhamija MD
- Assistant Professor
- Department of Radiodiagnosis
- (BRA Institute Rotary Cancer Hospital)
- All India Institute of Medical Sciences
- New Delhi, India
- Gaurav S Pradhan DMRD DNB
- Director–Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Jyoti Kumar MD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Kumble S Madhusudhan
- MD FRCR MAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Mahesh Prakash MD MAMS FICR
- Additional Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mandeep Garg MD FRCR
- Additional Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mandeep Kang MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Sciences
- Chandigarh, India
- Manisha Jana MD DNB FRCR
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Manphool Singhal MD DNB MAMS
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mukesh Kumar Yadav MD
- Assistant Professor
- Department of Radiodiagnosis
- (BRA Institute Rotary Cancer Hospital)
- All India Institute of Medical Sciences
- New Delhi, India
- Naveen Kalra
- MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Niranjan Khandelwal
- MD DNB FAMS FICR
- Professor and Head
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Priyanka Naranje
- MD DNB
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Raju Sharma
- MD MAMS
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Rashmi Dixit MD
- Director–Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Sapna Singh MD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Shashi Bala Paul MBBS MAMS PhD
- Senior Scientist
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Shivanand Gamanagatti MD MNAMS
- Professor
- Department of Radiodiagnosis
- Jai Prakash Narayan Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
- Smita Manchanda MD DNB
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Smriti Hari MD MAMS
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Subrat Kumar Acharya
- DM FnASc FASc FNA JC Bose Fellow
- Former Professor and Head
- Department of Gastroenterology
- All India Institute of Medical Sciences
- New Delhi, India
- Surabhi Vyas MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Ujjwal Gorsi MD
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Uma Debi MD
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Virendra Jain MD FRCR
- Senior Resident
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
The first edition of Diagnostic Radiology: Gastrointestinal and Hepatobiliary Imaging was published in 1997, followed by the second edition in 2004, and third edition in 2009, in the respective series of AIIMS-MAMC-PGI Imaging courses held over the past two decades.
Encouraged by the overwhelming response to the previous editions and to keep pace with advances in gastrointestinal imaging, we decided to update the third edition with appropriate additions and a few deletions. The chapters have been updated to incorporate the new modalities and concepts and, we hope, the fourth edition will be a comprehensive, updated reference book for the postgraduates, practicing radiologists, gastroenterologists and gastrointestinal 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 the All India Institute of Medical Sciences (AIIMS), Maulana Azad Medical College (MAMC), New Delhi, India, and Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, for their active contribution and support, without which, this endeavor would not have been possible. Their hard work and dedication is much appreciated.
We would also like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and other staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, for their professional help and cooperation in publishing this book in a very short time.
Editors
Arun Kumar Gupta
Niranjan Khandelwal
Anju Garg
Associate Editors
Deep Narayan Srivastava
Raju Sharma
Preface 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 gastrointestinal and hepatobiliary system as one of the most interesting and challenging specialties to the radiologists. New imaging and therapeutic techniques that have revolutionized 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, Maulana Azad Medical College, New Delhi, India, and Postgraduate Institute of Medical Education and Research, Chandigarh, India, present this third book in the series of Diagnostic Radiology, devoted to gastrointestinal and hepatobiliary imaging.
The book comprises 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, color 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, cooperation 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