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Fujiwara R, Yamamoto K, Yamasaki M, Ohno K. Magnetic Resonance Cholangiopancreatography for Cholangiopancreatic Duct Imaging in Dogs. Vet Radiol Ultrasound 2025; 66:e70008. [PMID: 39826111 PMCID: PMC11742707 DOI: 10.1111/vru.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/10/2024] [Accepted: 01/02/2025] [Indexed: 01/22/2025] Open
Abstract
Ultrasonography is often used to diagnose biliary diseases in dogs; however, it is difficult to delineate the entire bile and pancreatic ducts. Various imaging techniques for bile and pancreatic ducts have been attempted to overcome this problem. Magnetic resonance cholangiopancreatography (MRCP) is often used to evaluate the bile and pancreatic ducts in humans with obstructive jaundice, but very few reports exist on its usage in dogs. This study was designed as a prospective observational study to assess the feasibility and effectiveness of MRCP for visualizing the bile and pancreatic ducts in nondiseased dogs. Therefore, this study aimed to evaluate the visibility of the bile and pancreatic ducts through MRCP imaging using a 3.0 T-MRI system in dogs with no signs of hepatic, biliary, and pancreatic diseases. The detection rate for each anatomical structure was evaluated, with the highest observed in the gallbladder (100%), followed by the common bile duct (80%), cystic duct (70%), pancreatic ducts in the left and right lobe of the pancreas (70%), left and right hepatic ducts (60%), accessory pancreatic ducts (60%), and major pancreatic duct (40%). MRCP is a promising noninvasive imaging technique that can promptly and accurately visualize bile and pancreatic ducts in dogs without being influenced by the skill of the operator.
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Affiliation(s)
- Reina Fujiwara
- Division of Companion Animal Internal Medicine, Veterinary Teaching Hospital, Faculty of AgricultureIwate UniversityMoriokaJapan
| | - Kie Yamamoto
- Veterinary Medical CenterGraduate School of Agricultural and Life SciencesThe University of TokyoTokyoJapan
| | - Masahiro Yamasaki
- Laboratory of Veterinary Small Animal Internal MedicineDepartment of Veterinary Medicine Faculty of AgricultureIwate UniversityMoriokaJapan
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Cavalcanti Neto AJ, Lustosa SAS, Casazza G, Reis C, Gomes MP, Do Carmo ACF, D'Ippolito G, Matos D. Combination of magnetic resonance cholangiopancreatography and conventional magnetic resonance imaging for the diagnosis of bile duct stenosis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Suzana AS Lustosa
- Hospital Municipal Dr. Munir Rafful; Extension, Research, Teaching Unit - UEPE; Avenida Jaraguá 1020 Volta Redonda, RJ Sao Paolo Brazil 2727130
| | - Giovanni Casazza
- Università degli Studi di Milano; Dipartimento di Scienze Biomediche e Cliniche "L. Sacco"; via GB Grassi 74 Milan Italy 20157
| | - Carolina Reis
- UniFOA; School of Medical Sciences of Volta Redonda; 103 Eight street, Barreira Cravo Volta Redonda Rio de Janeiro Brazil 27285-510
| | - Marcelle Procopio Gomes
- UniFOA; Escola de Ciências Médicas de Volta Redonda; Rua 80 No 46 Rústico Volta Redonda RJ Brazil 27262-470
| | - Andreia Cristina Feitosa Do Carmo
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Central Library; Rua Botucatu, 862 São Paulo São Paulo Brazil 04023-060
| | - Giuseppe D'Ippolito
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Departamento de Diagnóstico por Imagem; Rua Napoleão de Barros, 800. 1º subsolo São Paulo São Paulo Brazil
| | - Delcio Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Gastroenterological Surgery; Rua Edison 278, Apto 61 Campo Belo São Paulo São Paulo Brazil 04618-031
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Sirinek KR, Schwesinger WH. Has intraoperative cholangiography during laparoscopic cholecystectomy become obsolete in the era of preoperative endoscopic retrograde and magnetic resonance cholangiopancreatography? J Am Coll Surg 2015; 220:522-8. [PMID: 25724609 DOI: 10.1016/j.jamcollsurg.2014.12.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preoperative ERCP, magnetic resonance cholangiopancreatography (MRCP), and intraoperative cholangiography (IOC) are standard procedures in evaluating patients with suspected choledocholithiasis. This study evaluates the changing practice patterns over time of these 3 procedures in a large cohort of patients undergoing laparoscopic cholecystectomy (LC) at a single tertiary care center. STUDY DESIGN Data from all patients undergoing an LC with or without preoperative ERCP, MRCP, or an IOC from January 1, 2004 to December 31, 2013 were retrospectively reviewed from billing data obtained by CPT code and analyzed by chi-square testing. RESULTS During 10 years, 7,427 patients underwent successful LC. The number of patients undergoing successful IOC (11.9% to 7.6%) or preoperative ERCP (7.2% to 1.5%) decreased significantly during that time interval (p < 0.01). In the last 6 years, 4,506 patients underwent successful LC. The number of patients from this group undergoing a preoperative MRCP (0.9% to 8.6%) or MRCP and ERCP (0.4% to 3.6%) increased significantly (p < 0.001). CONCLUSIONS Despite a shift from IOC and preoperative ERCP to preoperative MRCP alone or with ERCP, a significant percentage (7.6%) of patients still underwent IOC in 2013. Use of IOC during LC has decreased but is not considered obsolete, rather, it remains a valuable tool for the evaluation of bile duct anatomy, bile duct injury, or suspected choledocholithiasis. Intraoperative cholangiography during uncomplicated LC should be emphasized in teaching programs to insure general surgery resident competency with the procedure.
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Affiliation(s)
- Kenneth R Sirinek
- Divisions of General and Minimally Invasive Surgery and Surgical Education, Department of Surgery, University of Texas Health Science Center at San Antonia, San Antonio, TX.
| | - Wayne H Schwesinger
- Divisions of General and Minimally Invasive Surgery and Surgical Education, Department of Surgery, University of Texas Health Science Center at San Antonia, San Antonio, TX
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Liu B, Cai J, Xu Y, Peng X, Zheng H, Huang K, Yang J. Three-dimensional magnetic resonance cholangiopancreatography for the diagnosis of biliary atresia in infants and neonates. PLoS One 2014; 9:e88268. [PMID: 24505457 PMCID: PMC3914942 DOI: 10.1371/journal.pone.0088268] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/08/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance cholangiopancreatography (MRCP) is widely accepted for visualization of the biliary system. However, the sensitivity and specificity of MRCP for the diagnosis of biliary atresia (BA) are still not fully elucidated. This study aimed to investigate the diagnostic value of three-dimensional MRCP (3D-MRCP) for BA in a large cohort of cholestatic infants and neonates. METHODS One hundred ninety patients with infant jaundice underwent 3D-MRCP and one or more of the following: (1) intraoperative cholangiography, (2) laparoscopic exploration and pathological examination, or/and (3) clinical therapy. Statistical analyses were performed to determine the diagnostic accuracy of 3D-MRCP for BA. RESULTS Our study demonstrated that 158 of 190 patients were interpreted as having BA by 3D-MRCP; of those, 103 patients were confirmed as having BA, whereas 55 patients did not have BA. Of the 32 patients interpreted as non-BA cases by 3D-MRCP, one patient was misdiagnosed. The diagnostic accuracy for 3D-MRCP was 70.53% (134 of 190), the sensitivity was 99.04% (103 of 104), the specificity was 36.05% (31 of 86), the negative predictive value was 96.88% (31 of 32), the positive predictive value was 65.19% (103 of 158), the positive likelihood ratio was 2.7473, the negative likelihood ratio was 0.0267, and the Youden index was 0.3509. CONCLUSIONS The sensitivity of 3D-MRCP in diagnosing BA was excellent, but the specificity was not as high as described in previous reports. 3D-MRCP can be an effective screening method but should be combined with other modalities to identify BA and distinguish it from other causes of infant jaundice.
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Affiliation(s)
- Bo Liu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhua Cai
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Xu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuehua Peng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Helin Zheng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kaiping Huang
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Yang
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
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Choi IY, Yeom SK, Cha SH, Lee SH, Chung HH, Hyun JJ, Kim BH. Diagnosis of biliary stone disease: T1-weighted magnetic resonance cholangiography with Gd-EOB-DTPA versus T2-weighted magnetic resonance cholangiography. Clin Imaging 2013; 38:164-9. [PMID: 24359645 DOI: 10.1016/j.clinimag.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/08/2013] [Accepted: 11/04/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to compare diagnostic performance of gadoxetic-acid-enhanced-T1-weighted-MR cholangiography (MRC) with that of conventional T2-weighted-MRC in diagnosing biliary stone disease. MATERIALS AND METHODS Ninety patients who underwent MRC for evaluation of biliary disease were included. Presence of stones in extrahepatic duct, gallbladder and intrahepatic duct, and presence of acute cholecystitis were evaluated. Sensitivity, specificity, and accuracy of biliary stone disease diagnosis in each biliary duct location according to each image sets were measured. RESULTS There was no significant difference in diagnostic performance between two sets of MRC in diagnosing biliary stone disease. CONCLUSIONS Diagnostic performance of T1-MRC with gadoxetic-acid in diagnosing biliary stone disease is comparable to that of T2-MRC.
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Affiliation(s)
- In Young Choi
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea.
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Jong Jin Hyun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
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Bile duct confluence: anatomic variations and its classification. Surg Radiol Anat 2013; 36:105-9. [PMID: 23817807 DOI: 10.1007/s00276-013-1157-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Accurate knowledge of the anatomy of the bile ducts is critical for successfully hepato-biliary surgery. We describe the anatomical variations of the confluence of the bile ducts, their branches patterns, frequency and classification. From 1996 to 2011, we have collected data of the bile duct confluence. 2,032 and 1,014 anatomical variations of right and left bile ducts, respectively, were reviewed and classified according to the branching pattern. The frequencies of each type of the right hepatic duct (RHD) were as follows: Type A1-1,247 (61.3%); Type A2-296 (14.5%); Type A3-272 (13.3%); Type A4-124 (6.1%); Type A5-21 (1%) and others-72 (3.5%) and, for the left hepatic duct (LHD) was as follows: Type B1-773 (76.2%); Type B2-153 (15%); Type B3-38 (3.7%); Type B4-9 (0.8%); Type B5-29 (2.8%) and others-12 (1.1%). Atypical branching patterns of both the right and left hepatic ducts were found in 14 and 8%, respectively. The two most common variations of the RHD were right anterior and posterior hepatic ducts join together to form the RHD and trifurcation where the RHD is absent and right anterior and posterior hepatic ducts join directly to the confluence with the LHD to form the common hepatic duct. The two most common variations in the LHD were segment IV drainage to the left and right hepatic ducts.
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Soga K, Ochiai J, Kassai K, Miyajima T, Itani K, Yagi N, Naito Y. Development of a novel fusion imaging technique in the diagnosis of hepatobiliary-pancreatic lesions. J Med Imaging Radiat Oncol 2013; 57:306-13. [PMID: 23721139 DOI: 10.1111/1754-9485.12032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/02/2012] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Multi-row detector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) play an important role in the imaging diagnosis of hepatobiliary-pancreatic lesions. Here we investigated whether unifying the MDCT and MRCP images onto the same screen using fusion imaging could overcome the limitations of each technique, while still maintaining their benefits. Moreover, because reports of fusion imaging using MDCT and MRCP are rare, we assessed the benefits and limitations of this method for its potential application in a clinical setting. METHODS The patient group included 9 men and 11 women. Among the 20 patients, the final diagnoses were as follows: 10 intraductal papillary mucinous neoplasms, 5 biliary system carcinomas, 1 pancreatic adenocarcinoma and 5 non-neoplastic lesions. After transmitting the Digital Imaging and Communication in Medicine data of the MDCT and MRCP images to a workstation, we performed a 3-D organisation of both sets of images using volume rendering for the image fusion. RESULTS Fusion imaging enabled clear identification of the spatial relationship between a hepatobiliary-pancreatic lesion and the solid viscera and/or vessels. Further, this method facilitated the determination of the relationship between the anatomical position of the lesion and its surroundings more easily than either MDCT or MRCP alone. CONCLUSION Fusion imaging is an easy technique to perform and may be a useful tool for planning treatment strategies and for examining pathological changes in hepatobiliary-pancreatic lesions. Additionally, the ease of obtaining the 3-D images suggests the possibility of using these images to plan intervention strategies.
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Affiliation(s)
- Koichi Soga
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Abstract
GOALS Endoscopic retrograde pancreatography is the gold standard diagnostic study for pancreatic duct (PD) pathology but carries significant risks. Our aim was to assess the ability of magnetic resonance cholangiopancreatography (MRCP) to delineate PD disruption. BACKGROUND PD disruption is a significant clinical event and portends a more severe clinical course after acute pancreatitis or other pancreatic injury. Knowledge of such a disruption can direct a more aggressive medical therapy early in the disease course and might also select those patients likely to benefit from early endoscopic intervention. MRCP has been evaluated abundantly in the context of biliary disease. Conversely, the role of MRCP in the investigation of PD pathology has been little studied. STUDY A retrospective analysis identified consecutive patients between 2000 and 2008 undergoing endoscopic retrograde cholangiopancreatography (ERCP) for the indication of pancreatitis. Records were then reviewed to subselect only those patients with proximate ERCP and MRCP. The radiologist reviewing the MRCP was blinded to all clinical and imaging data except a brief clinical synopsis provided by the other authors. RESULTS Thirty-one patients had MRCP within 7 days of the ERCP. MRCP preceded ERCP in 84% (26/31) patients, with ERCP performed a median 2.2 (range, 0 to 7) days after MRCP. PD disruption was found at ERCP in 74% (23/31) of patients; MRCP confirmed 91% (21/23) of the duct disruptions. In the 8 patients with intact PD at ERCP, MRCP correctly reported an intact PD. CONCLUSIONS MRCP performed for a suspected PD fistula is highly accurate in assessing the integrity of the PD.
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Valero V, Cosgrove D, Herman JM, Pawlik TM. Management of perihilar cholangiocarcinoma in the era of multimodal therapy. Expert Rev Gastroenterol Hepatol 2012; 6:481-95. [PMID: 22928900 PMCID: PMC3538366 DOI: 10.1586/egh.12.20] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perihilar cholangiocarcinoma (CCA) is the second most common primary malignant tumor of the liver. In the USA, there are approximately 3000 cases of CCA diagnosed annually, with approximately 50-70% of these tumors arising at the hilar plate of the biliary tree. Risk factors include advanced age, male gender, primary sclerosing cholangitis, choledochal cysts, cholelithiasis, parasitic infection, inflammatory bowel disease, cirrhosis and chronic pancreatitis. Patients typically present with jaundice, abdominal pain, pruritus and weight loss. The mainstays of treatment include surgery, chemotherapy, radiation therapy and photodynamic therapy. Specific preoperative interventions for patients with perihilar CCA include endoscopic retrograde cholangiopancreatography, percutanteous transhepatic cholangiography and portal vein embolization. Surgical resection offers the only chance for curative therapy in perihilar CCA. R0 resection is of utmost importance and has been linked to improved survival. Major hepatic resection is needed to achieve both longitudinal and radial margins negative for tumor. Fractionated stereotactic body radiotherapy has shown promising results in CCA. Perihilar CCA typically presents with advanced disease, and many patients receive systemic therapy; however, the response to current regimens is limited. Orthotopic liver transplantation offers complete resection of locally advanced tumors in select patient groups.
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Affiliation(s)
- Vicente Valero
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - David Cosgrove
- Division of Surgical Oncology, Department of Medical Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Respiratory variation of the extrahepatic bile duct: evaluation with deep inspiratory and expiratory MRCP. Magn Reson Imaging 2012; 30:579-82. [PMID: 22387023 DOI: 10.1016/j.mri.2011.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/11/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the respiratory variation of the extrahepatic bile duct in morphology including shape, length and duct diameter on the breath-hold magnetic resonance cholangiopancreatography (MRCP) obtained during deep inspiration and deep expiration in patients with or without biliary diseases. MATERIALS AND METHODS This study included 102 patients with or without biliary diseases. Breath-hold MRCP was obtained twice during the end-inspiration and the end-expiration. MRCP images were evaluated for the length, maximal diameter and "bowing" of the extrahepatic bile duct. RESULTS In the normal group, the mean maximal diameter of the extrahepatic bile duct was significantly larger on the end-inspiratory MRCP (8.0 ± 2.0 mm) than on the end-expiratory MRCP (7.3 ± 1.8 mm) (P<.0001), while it was not significantly different in the dilated group. In the normal group, 25 (39%) of 65 patients had an increase in the mean maximal diameter of more than 1 mm at the end-inspiration, whereas 4 (11%) of 37 patients in the dilated group had it. The bowing of the extrahepatic bile duct on the end-inspiratory MRCP was observed in 60 (92%) of 65 normal patients, while it was seen in 22 (60%) of 37 patients with biliary dilatation (P<.0001). CONCLUSION Deep inspiratory and expiratory MRCP demonstrated the respiratory variations of the extrahepatic bile duct in the shape (bowing), length and maximal duct diameter in patients with nondilated bile ducts. Awareness of this normal phenomenon will be important for the correct interpretation of MRCP in patients with or without biliary diseases.
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Collettini F, Kroencke TJ, Heidenhain C, de Bucourt M, Renz D, Schott E, Neuhaus P, Hamm B, Poellinger A. Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography. Transplant Proc 2012; 43:2660-3. [PMID: 21911142 DOI: 10.1016/j.transproceed.2011.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/18/2011] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the accuracy of magnetic resonance (MR) cholangiography for detection of ischemic-type biliary lesions (ITBL) following orthotropic liver transplantation (OLT). MATERIALS AND METHODS MR cholangiography was performed in 16 patients with established diagnosis of ITBL following OLT. Two blinded observers reviewed all images in consensus and recorded diagnostic features including presence of intrahepatic and extrahepatic biliary strictures, dilatations, beading, pruning, and filling defects. Sensitivity, specificity, positive predictive value, and accuracy of MR cholangiography were calculated. Final diagnosis was established at endoscopic retrograde cholangiography. RESULTS MR cholangiography proved to be a valuable tool for the detection of stenoses and dilatations in patients with ITBL following OLT. Sensitivity of the different diagnostic features ranged between 71% and 100%, specificity between 50% and 100%, accuracy between 81% and 100%, and positive predictive value between 87% and 100%. CONCLUSION MR cholangiography proved to be an accurate imaging technique to noninvasively detect biliary complications in patients with ITBL after OLT.
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Affiliation(s)
- F Collettini
- Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
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Watanabe Y, Dohke M, Ishimori T, Amoh Y, Oda K, Okumura A, Mitsudo K, Dodo Y. High-Resolution MR Cholangiopancreatography. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379891244181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim JH, Hong SS, Eun HW, Han JK, Choi BI. Clinical usefulness of free-breathing navigator-triggered 3D MRCP in non-cooperative patients: comparison with conventional breath-hold 2D MRCP. Eur J Radiol 2011; 81:e513-8. [PMID: 21700409 DOI: 10.1016/j.ejrad.2011.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 06/01/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE To assess the clinical usefulness of free-breathing 3D MRCP in non-cooperative patients compared conventional breath-hold 2D MRCP. MATERIALS AND METHODS We performed FB navigator-triggered 3D MRCP using prospective acquisition correction and BH 2D MRCP in 48 consecutive, non-cooperative patients among 772 patients. Thirteen patients had malignant obstruction. Two radiologists independently graded the likelihood of a malignant obstruction, the overall image quality, and the visibility of ten, individual anatomic segments of both the biliary and pancreatic duct in each sequence. The area under the ROC curve and the repeated measures analyses of variance with multiple comparisons were used for the comparison. The κ statistics were used for interobserver agreement. RESULT The diagnostic performance for detecting malignancy was significantly higher on FB MRCP (A(z)=0.962) than on either BH SS-RARE (A(z)=0.820, P<0.0185) or MS-HASTE MRCP (A(z)=0.816, P<0.0067). Interobserver agreement was excellent for FB MRCP (κ=0.889) and fair for both BH SS-RARE (κ=0.578) and MS-HASTE MRCP (κ=0.49). FB MRCP had a significantly higher technical quality than BH MRCP (P<0.001). FB MRCP was seen to have statistically better visibility of peripheral IHD, right main IHD, CHD, cystic duct, and CBD than BH MRCP (P<0.001). FB MRCP and BH SS-RARE MRCP had statistically better visibility of both the left main IHD and pancreatic duct than did BH MS-HASTE MRCP (P<0.001). CONCLUSION FB 3D MRCP is useful for non-cooperative patients in whom conventional BH 2D methods cannot be used successfully.
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Affiliation(s)
- Jung Hoon Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul 110-744, Republic of Korea.
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Chen CW, Liu YS, Chen CY, Tsai HM, Chen SC, Chuang MT. Use of carbon dioxide as negative contrast agent for magnetic resonance cholangiopancreatography. World J Radiol 2011; 3:47-50. [PMID: 21390193 PMCID: PMC3051110 DOI: 10.4329/wjr.v3.i2.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 12/28/2010] [Accepted: 01/04/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effects of using CO2 as negative contrast agent in decreasing the overlapping on the pancreaticobiliary system from intestinal fluids.
METHODS: We evaluated the magnetic resonance cholangiopancreatography (MRCP) images in 117 patients divided into two groups (group 1, without taking gas producing crystals to produce CO2, n = 64; group 2, with CO2, n = 53) in a 1.5T unit using MRCP sequence. Anatomic locations of intestinal fluids distribution, overlapping with common bile duct (CBD) and pancreatic duct (PD), were evaluated.
RESULTS: In the group with CO2, the decrease in distribution of intestinal fluids was significant in the gastric antrum (P = 0.001) and duodenal bulb (P < 0.001), but not in the gastric fundus and body and in the second portion of the duodenum (P = 1.000, P = 0.171, and P = 0.584 respectively). In the group with CO2, the decrease in overlapping with CBD was significant (P < 0.001), but the decrease in overlapping with PD was not (P = 0.106).
CONCLUSION: MRCP with carbon dioxide as negative contrast agent would decrease intestinal fluids in the gastric antrum and duodenal bulb, thereby decreasing overlapping with the CBD.
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Magnetic resonance cholangiopancreatography in conjunction with 3D for assessment of different biliary obstruction causes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2010. [DOI: 10.1016/j.ejrnm.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Kinner S, Dechêne A, Ladd SC, Zöpf T, de Dechêne EM, Gerken G, Lauenstein TC. Comparison of different MRCP techniques for the depiction of biliary complications after liver transplantation. Eur Radiol 2010; 20:1749-56. [PMID: 20157816 DOI: 10.1007/s00330-010-1714-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/15/2009] [Accepted: 11/28/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Biliary strictures after liver transplantation are common. We aimed to compare different magnetic resonance cholangiopancreatography (MRCP) sequences with regard to their diagnostic accuracy in depicting anastomotic stenoses (AST), ischaemic-type biliary lesions (ITBL) and cholelithiasis. METHODS In patients with clinically suspected biliary obstruction after liver transplantation, MRCP was performed at 1.5 T using two-dimensional (2D) single-shot RARE, 2D T2-weighted (T2w) HASTE, 2D TrueFISP and 3D T2w TSE RESTORE sequences. The presence and localisation of lesions were assessed for each sequence independently and all sequences together. Endoscopic retrograde cholangiopancreatography (ERCP) served as the "gold standard". RESULTS Biliary strictures were detected with a sensitivity of 96% by MRCP and most accurately depicted when all sequences were analysed together. AST was visualised with highest sensitivity on TrueFISP and 3D T2w TSE sequences (79%). For ITBL highest sensitivity was found with the HASTE sequence (81%). Highest sensitivity for filling defects was revealed by the 3D T2w TSE sequence (54%). Receiver operating characteristic (ROC) curve/area under the curve (AUC) analysis revealed the best results for the 3D T2w TSE sequence. CONCLUSION Our results underline the value of different MRCP sequence types for the depiction of biliary lesions. A clinical protocol consisting of different sequences may be helpful depending on the clinical question and the likely underlying abnormality.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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Akpinar E, Turkbey B, Karcaaltincaba M, Balli O, Akkapulu N, Balas S, Tirnaksiz B, Akata D, Akhan O. Initial experience on utility of gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted MR cholangiography in diagnosis of acute cholecystitis. J Magn Reson Imaging 2009; 30:578-85. [PMID: 19711404 DOI: 10.1002/jmri.21887] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the feasibility of the use of gadobenate dimeglumine (also known as Gd-BOPTA) -enhanced T1-weighted MR cholangiography in diagnosis of acute cholecystitis. MATERIALS AND METHODS This prospectively designed institutional review board-approved HIPAA-compliant study was done between January and November 2007. We included 11 consecutive patients (7 male, mean age 59 years) who presented to the emergency room with acute right upper quadrant pain and with equivocal physical examination and/or ultrasound findings. The control group included 15 patients who underwent liver MRI with Gd-BOPTA. All patients underwent contrast-enhanced (CE) MR cholangiography examinations. CE-MR cholangiography was performed on a 1.5 Tesla magnet using 3D T1-weighted high resolution isotrophic volume examination (THRIVE) obtained at the 90th min after intravenous injection of Gd-BOPTA. Imaging features detected on CE-MR cholangiography were correlated with operative and histopathologic findings. RESULTS In the control group, GD-BOPTA was visualized within the gallbladder in all subjects. For the study group, gallstones were present in nine patients (n = 7 both in gallbladder and cystic duct, n = 1 only in gallbladder, n = 1 only in cystic duct) on MRCP. Hydropic gallbladder was detected in seven patients, significant wall thickening in seven patients, and pericholecystic free fluid in 6 patients. On delayed phase CE cholangiography, significant enhancement of gallbladder wall was seen in 10 patients, and contrast agent excretion into gallbladder was absent in all patients. Surgery was performed in 10 patients, and cholecystostomy was done in 1 patient. Surgery and histopathology findings were consistent with cholecystitis in all patients. CONCLUSION In addition to anatomical assessment, Gd-BOPTA-enhanced MR cholangiography can provide functional evaluation similar to HIDA scintigraphy in diagnosing acute cholecystitis in patients with acute right upper quadrant pain and equivocal findings.
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Affiliation(s)
- Erhan Akpinar
- Hacettepe University School of Medicine, Department of Radiology, Ankara, Turkey
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18
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Patel HT, Shah AJ, Khandelwal SR, Patel HF, Patel MD. MR Cholangiopancreatography at 3.0 T. Radiographics 2009; 29:1689-706. [DOI: 10.1148/rg.296095505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Peddu P, Quaglia A, Kane PA, Karani JB. Role of imaging in the management of pancreatic mass. Crit Rev Oncol Hematol 2008; 70:12-23. [PMID: 18951813 DOI: 10.1016/j.critrevonc.2008.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 08/15/2008] [Accepted: 09/10/2008] [Indexed: 11/26/2022] Open
Abstract
Pancreatic cancer is the second commonest malignant gastrointestinal neoplasm. Modern imaging techniques have greatly increased sensitivity in diagnosing and staging pancreatic cancers. Multidetector CT in particular, plays a critical role in local staging and determining the resectability of pancreatic tumours. MR and endoscopic ultrasound are valuable in those groups of patients in whom CT findings alone are inconclusive in tumour characterisation and local staging, particularly vascular involvement. In this article we review the current established concepts and the role of imaging in the multidisciplinary management of pancreatic tumours together with a comprehensive review of the literature.
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Affiliation(s)
- P Peddu
- Department of Radiology, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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20
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Aufort S, Molina E, Assenat E, Rigole H, Bauret P, Calvet C, Navarro F, Fabre JM, Blanc P, Taourel P, Larrey D, Bruel JM, Pageaux GP, Gallix BP. [Value of MRCP for diagnosis of biliary complications after liver transplantation]. ACTA ACUST UNITED AC 2008; 89:221-7. [PMID: 18354352 DOI: 10.1016/s0221-0363(08)70397-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation. MATERIALS AND METHODS 27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography. RESULTS 216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris. CONCLUSION MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.
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Affiliation(s)
- S Aufort
- Service d'Imagerie Médicale, CHU Montpellier, Hôpital Saint-Eloi, 80, rue Augustin Fliche, 34295 Montpellier Cedex 5
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2D Thick-Slab MR Cholangiopancreatography: Does Parallel Imaging with Sensitivity Encoding Improve Image Quality and Duct Visualization? AJR Am J Roentgenol 2008; 190:W327-34. [DOI: 10.2214/ajr.07.2854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Park MS, Kim BC, Kim TI, Kim MJ, Kim KW. Double common bile duct: curved-planar reformatted computed tomography (CT) and gadobenate dimeglumine-enhanced MR cholangiography. J Magn Reson Imaging 2008; 27:209-11. [PMID: 18157896 DOI: 10.1002/jmri.21195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We present the case of a 61-year-old female with double common bile duct (CBD) with an opening into the lesser curvature of the stomach. We discuss the role of curved-planar reformatted computed tomography (CT) and gadobenate dimeglumine (Gd-BOPTA)-enhanced T1-weighted MRI in confirming the diagnosis of this uncommon disease.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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23
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Kim HJ, Lee JM, Kim SH, Han JK, Lee JY, Choi JY, Kim KH, Kim JY, Lee MW, Kim SJ, Choi BI. Evaluation of the longitudinal tumor extent of bile duct cancer: value of adding gadolinium-enhanced dynamic imaging to unenhanced images and magnetic resonance cholangiography. J Comput Assist Tomogr 2007; 31:469-74. [PMID: 17538298 DOI: 10.1097/01.rct.0000238011.42060.b5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the added value of gadolinium-enhanced dynamic magnetic resonance (MR) images compared with unenhanced and MR cholangiography (MRC) images, to evaluate the longitudinal extension of bile duct cancer. MATERIALS AND METHOD Thirty-three patients with hilar cholangiocarcinoma or common duct cancer who had undergone MRC, unenhanced, and gadolinium-enhanced dynamic MR images and surgery were included in this study. Two experienced radiologists independently reviewed 2 image sets in 2 steps, that is, the MRC set (unenhanced and MRC) and the combined image set (MRC set with dynamic images). At each step, the readers determined the tumor status according to the Bismuth-Corlette classification. The readers assigned their confidence levels on a 5-point scale regarding whether the tumor involved the secondary confluence of the bile duct and the intrapancreatic common bile duct. The radiologists' diagnostic confidence of the 2 image sets was analyzed using receiver operating characteristic analysis. RESULTS Receiver operating characteristic analysis showed higher areas under the curve values when the combined image set was interpreted (0.990 +/- 0.017 for reader 1 and 0.951 +/- 0.027 for reader 2) than when the MRC set was interpreted (0.982 +/- 0.017 for reader 1 and 0.902 +/- 0.038 for reader 2); however, the difference was not statistically significant for either reader (P > 0.05). In addition, regarding evaluation of the tumor status according to the Bismuth-Corlette classification, the overall accuracy was higher for the combined image set than for the MRC set alone, but the difference was not significant (P > 0.05). When dynamic images were added to the MRC images, interobserver agreement improved from 0.72 to 0.84. CONCLUSIONS The addition of contrast-enhanced dynamic images to unenhanced and MRC images did not significantly improve the diagnostic accuracy for assessment of the longitudinal extent of bile duct cancer.
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Affiliation(s)
- Hyuk Jung Kim
- Department of Radiology, Seoul Medical Center, Seoul, Korea
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24
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Isoda H, Kataoka M, Maetani Y, Kido A, Umeoka S, Tamai K, Koyama T, Nakamoto Y, Miki Y, Saga T, Togashi K. MRCP imaging at 3.0 T vs. 1.5 T: preliminary experience in healthy volunteers. J Magn Reson Imaging 2007; 25:1000-6. [PMID: 17410562 DOI: 10.1002/jmri.20892] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the impact of magnetic resonance cholangiopancreatography (MRCP) imaging at 1.5T and 3.0T on image quality. MATERIALS AND METHODS Fourteen volunteers were examined at both 1.5T and 3.0T using MRCP imaging performed with a breath-held two-dimensional (2D) half-Fourier acquired single-shot turbo spin-echo (HASTE) thick-slab sequence, a free-breathing navigator-triggered three-dimensional (3D) turbo spin-echo (TSE) sequence with prospective acquisition correction, and a heavily T2-weighted (T2W) sequence with breath-held multislice HASTE. All images were scored for visualization of the biliary and pancreatic ducts, severity of artifacts, image noise, and overall image quality. RESULTS MRCP imaging at 3.0T yielded a significant improvement in overall image quality compared to 1.5T. We found a trend for superior visualization of the biliary and pancreatic ducts at 3.0T. Heavily T2W imaging with thin sections (1.4 mm) at 3.0T provided diagnostic images and better visualization of the biliary and pancreatic ducts than heavily T2W imaging with standard sections (2.8 mm) at 3.0T. CONCLUSION Our experience suggests that MRCP imaging at 3.0T has the potential to provide excellent images. High-resolution heavily T2W imaging with a small voxel size (1.3 x 1.3 x 1.4 mm) at 3.0T can provide diagnostic images and allow evaluation of small pathologies of the bile and pancreatic ducts, which 1.5T MRI cannot sufficiently visualize.
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Affiliation(s)
- Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan.
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25
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Singh saluja S, Sharma R, Pal S, Sahni P, Kanti Chattopadhyay T. Differentiation between benign and malignant hilar obstructions using laboratory and radiological investigations: a prospective study. HPB (Oxford) 2007; 9:373-82. [PMID: 18345322 PMCID: PMC2225516 DOI: 10.1080/13651820701504207] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative determination of the aetiology of bile duct strictures at the hilum is difficult. We evaluated the diagnostic accuracy of laboratory parameters and imaging modalities in differentiating between benign and malignant causes of hilar biliary obstruction. PATIENTS AND METHODS Fifty-eight patients (26 men) with a history of obstructive jaundice and liver function tests (LFTs) and ultrasound suggestive of biliary obstruction at the hilum were studied. They were evaluated by tumour marker assay (CA19-9), CT and MRI/MRCP. A single experienced radiologist, blinded to the results of other tests, evaluated the imaging. The final diagnosis was made either from histology of the resected specimen, operative findings or image-guided biopsy in inoperable patients. A receiver operator characteristic (ROC) curve was constructed for each laboratory parameter to determine optimal diagnostic cut-off to predict malignant biliary stricture (MBS). RESULTS In all, 34 patients had a benign and 24 had malignant aetiology. The mean age of benign patients was 38 years compared with 54 years for MBS. Forty-seven patients were treated with surgery while 11 had ERCP/PTC and stenting. The ROC curve showed that preoperative bilirubin level >8.4 mg/dl (sensitivity 83.3%, specificity 70%), alkaline phosphatase level >478 IU (sensitivity 63%, specificity 49%) and CA19-9 levels >100 U/L (sensitivity 45.8%, specificity 88.2%) for predicting MBS. The sensitivity, specificity and diagnostic accuracy of MRI/MRCP (87.5%, 85.3%, 82.7%, respectively) was marginally superior to CT (79.2%, 79.4%, 79.3%, respectively). CONCLUSIONS Patients with a bilirubin level of >8.4 mg% and CA19-9 level >100 U/L were more likely to have malignant aetiology. MRI/MRCP was a better imaging modality than CT.
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Affiliation(s)
- Sundeep Singh saluja
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari NagarNew DelhiIndia
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, Ansari NagarNew DelhiIndia
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari NagarNew DelhiIndia
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari NagarNew DelhiIndia
| | - Tushar Kanti Chattopadhyay
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari NagarNew DelhiIndia
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Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. ACTA ACUST UNITED AC 2006; 13:487-96. [PMID: 17139421 DOI: 10.1007/s00534-005-1083-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 11/25/2005] [Indexed: 12/29/2022]
Abstract
A wide range of potential biliary complications can occur after orthotopic liver transplantation (OLT). The most common biliary complications are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dyfunction, which may occur in up to 20%-40% of OLT recipients. Leaks predominate in the early posttransplant period; stricture formation typically develops gradually over time. However, with the advent of new techniques, such as split-liver, reduced-size, and living-donor liver transplantation, the spectrum of biliary complications has changed. Risk factors for biliary complications comprise technical failure; T-tube or stent-related complications; hepatic artery thrombosis; bleeding; ischemia/reperfusion injury; and other immunological, nonimmunological, and infectious complications. Noninvasive diagnostic methods have been established and treatment modalities have been modified towards a primarily nonoperative, endoscopy-based strategy. Besides, the management of biliary complications after OLT requires a multidisciplinary approach, in which interventional and endoscopic treatment options have to be weighed up against surgical treatment options. The etiology and spectrum of bile duct complications, their diagnosis, and their treatment will be reviewed in this article.
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Affiliation(s)
- Andreas Pascher
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow, Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany
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27
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Vogl TJ, Schwarz WO, Heller M, Herzog C, Zangos S, Hintze RE, Neuhaus P, Hammerstingl RM. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol 2006; 16:2317-25. [PMID: 16622690 DOI: 10.1007/s00330-005-0139-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 12/16/2005] [Indexed: 12/11/2022]
Abstract
The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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28
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Lee HY, Kim SH, Lee JM, Kim SW, Jang JY, Han JK, Choi BI. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology 2006; 239:113-21. [PMID: 16467211 DOI: 10.1148/radiol.2383050419] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively assess the accuracy of combined multiphasic computed tomography (CT) and direct cholangiography for evaluation of the resectability of hilar cholangiocarcinoma, on the basis of revised criteria for unresectability, by using surgery as the reference standard. MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was waived. From 1998 to 2003, 55 patients (37 men, 18 women; mean age +/- standard deviation, 59 years +/- 12) with surgically proved hilar cholangiocarcinomas who underwent preoperative CT (single-detector row CT, n = 26; multi-detector row CT, n = 29) and cholangiography were included for study. The authors' revised criteria for unresectable tumor were contralateral hepatic artery invasion; main or contralateral portal vein invasion longer than 2 cm; biliary extension to the contralateral secondary confluence, farther than 2 cm from hepatic hilum; enlarged lymph nodes at the celiac, portacaval, and paraaortic area; and other ancillary findings. Tumor resectability based on these parameters was determined at imaging by two radiologists in consensus. Mann-Whitney U test and weighted kappa coefficient of agreement were used for accuracy determination. RESULTS For depiction of portal vein invasion (in 26 patients), CT yielded an accuracy of 85.5%. Arterial invasion was found at surgery in 19 patients, with CT providing an accuracy of 92.7%. For prediction of node involvement (15 patients, 27%), CT yielded an accuracy of 83.6%. The extent of ductal involvement could be accurately predicted in 46 patients (84%) (weighted kappa = 0.767). In 30 of 42 patients with disease classified as resectable according to revised criteria, disease was found to be resectable at surgery (71.4% positive predictive value). In 11 of 13 patients with disease classified as unresectable according to revised criteria, unresectable disease was confirmed (84.6% negative predictive value). Overall accuracy of resectability was 74.5%. CONCLUSION Combined interpretation of CT and direct cholangiographic images by using our revised criteria resulted in overall accuracy of 74.5% for prediction of resectability for hilar cholangiocarcinoma.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, Korea
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Tamura R, Ishibashi T, Takahashi S. Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology 2006; 238:920-8. [PMID: 16424235 DOI: 10.1148/radiol.2382041527] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively compare-in patients with chronic pancreatitis-magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for measurement of main pancreatic duct (MPD) diameter by using area intensity measurement (AIM) at MRCP and full width at half maximum (FWHM) at ERCP and to retrospectively determine the accuracy of MRCP for depiction of pathologic changes by using ERCP as the reference standard. MATERIALS AND METHODS The institutional review board approved this study and waived the need to obtain informed consent. Both MRCP and ERCP were performed in 24 patients with chronic pancreatitis (21 men, three women; mean age, 54 years +/- 14 [standard deviation]). The diameter of the MPD was determined by using both methods at the same sites in the head, body, and tail of the pancreas. MRCP and ERCP measurements involved AIM and FWHM techniques, respectively. For qualitative evaluation, visualization of the MPD and pathologic findings was also examined by using both methods. Paired t and Wilcoxon matched-pair signed rank tests were performed for the quantitative and qualitative evaluations, respectively. RESULTS The mean diameter of the MPD at ERCP was 1.5 times larger, on average, than that at MRCP; differences were statistically significant for each segment, as well as for the entire duct system. For qualitative evaluation, MRCP tended to be superior to ERCP for delineation of the MPD. Overall sensitivity, specificity, and accuracy values of MRCP for delineating pathologic pancreatic changes were 88% (87 of 99), 98% (44 of 45), and 91% (131 of 144), respectively. CONCLUSION Use of ERCP tends to result in overestimation of the caliber of the MPD. MRCP can enable accurate evaluation of the condition of the pancreatic duct and its changes in patients with chronic pancreatitis.
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Affiliation(s)
- Ryo Tamura
- Department of Radiology, Northern Fukushima Medical Center, Hakozaki, Date, Japan.
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Luciani A, Kobeiter H, Zegai B, Anglade MC, Deux JF, Malhaire C, Rahmouni A. [Imaging in congenital fibrocystic diseases of the liver]. ACTA ACUST UNITED AC 2005; 29:870-4. [PMID: 16294160 DOI: 10.1016/s0399-8320(05)86362-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The identification of dilatations of the intrahepatic bile ducts in the absence of bile duct obstruction is rare. Imaging techniques, especially MR cholangio-pancreaticography, generally permit the distinction between fibrocystic liver diseases and polycystic liver diseases. The presence of dilated sacciform or tubular bile ducts on cholangio-pancreaticography associated with a centrally located fibrovascular bundle (central dot sign) suggests Caroli's syndrome. The presence of associated signs of liver dysmorphia including right lobe atrophy and hypertrophy of segment IV suggests associated congenital hepatic fibrosis. The findings on cholangio-pancreaticography, computerized tomography or Doppler ultrasonography correlate well with the pathogenesis of fibrocystic liver diseases, linked to an embryologic malformation of the ductal plate.
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Affiliation(s)
- Alain Luciani
- Service d'Imagerie Médicale, Centre hospitalo-universitaire Henri Mondor, Créteil.
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Izuishi K, Toyama Y, Wakabayashi H, Usuki H, Maeta H. Compression of the common hepatic duct by the right hepatic artery. Clin Imaging 2005; 29:342-4. [PMID: 16153541 DOI: 10.1016/j.clinimag.2005.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 01/15/2005] [Accepted: 01/24/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance (MR) cholangiography has been used wildly as preoperative examination before laparoscopic cholecystectomy (LSC). However, cases that suggested the stenotic lesion of extrahepatic bile duct are not so rare in MR cholangiography. When stenosis is found, further examination is needed to avoid the possibility of bile duct cancer. We reported a case in which the stenotic lesion was diagnosed compression of the common hepatic duct by the right hepatic artery by multislice CT (MCT) cholangiography.
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Affiliation(s)
- Kunihiko Izuishi
- First Department of Surgery, Faculty of Medicine, Kagawa University 1750-1, Kagawa 761-0793, Japan.
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Abstract
Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of this technique. Biliary complications have been reported to occur at a relatively constant rate of approximately 10-15% of all deceased donor full size OLTs. There is a wide range of potential biliary complications which can occur after OLT. Their incidence varies according to the type of graft, type of donor, and the type of biliary anastomosis performed. The spectrum of biliary complications has changed over the past decade because of the establishment of split liver, reduced-size, and living donor liver transplantation. Apart from technical developments, novel diagnostic methods have been introduced and evaluated in OLT, the most prominent being magnetic resonance imaging (MRI). Treatment modalities have also changed over the past years towards a primarily nonoperative, endoscopy-based strategy, leaving the surgical intervention for lesions which otherwise are not curable. The management of biliary complications after OLT requires a multidisciplinary approach. Conservative, interventional, and endoscopic treatment options have to be weighed up against surgical re-intervention. In the following the spectrum of specific bile duct complications after OLT and their treatment options will be reviewed.
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Affiliation(s)
- Andreas Pascher
- Department of General, Visceral, and Transplantation Surgery, Universitätsmedizin Berlin, Berlin, Germany.
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33
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Boraschi P, Donati F, Gigoni R, Urbani L, Femia M, Cossu MC, Filipponi F, Falaschi F. Ischemic-type biliary lesions in liver transplant recipients: evaluation with magnetic resonance cholangiography. Transplant Proc 2005; 36:2744-7. [PMID: 15621138 DOI: 10.1016/j.transproceed.2004.09.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We assessed the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating ischemic-type biliary lesions in the follow-up of liver transplant patients. We retrospectively reviewed magnetic resonance imaging and MRC of 28 liver transplant recipients with ischemic changes of the biliary tree. The MR examinations were performed at 1.5 T. After the acquisition of axial T1w and T2w sequences, MRC involved a coronal respiratory-triggered, fat-suppressed, two-dimensional, thin-slab, heavily T2w fast spin-echo sequence, and/or a coronal breath-hold, thin- and thick-slab, single-shot T2w sequence. Eleven patients underwent either surgical reconstruction of the biliary system (n = 4) or liver retransplantation (n = 7); the pathologic specimens were employed as standard of reference. The final diagnosis was obtained through direct cholangiography in the remaining cases. Without knowledge of the surgical, pathologic, and cholangiographic findings, two experienced investigators evaluated in conference the MR images to determine the presence of biliary tract abnormalities. MRC demonstrated strictures involving the hepatic bifurcation and the extrahepatic bile duct of the graft in 26 patients; a concomitant thickening of the biliary wall was described in 18 out of these 26 subjects. MRC also showed sludge or stones formation in the donor common bile duct in 16 out of these patients. In conclusion, MRC allows noninvasive, reliable, assessment of ischemic-type biliary lesions in liver transplant recipients.
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Affiliation(s)
- P Boraschi
- 2nd Department of Radiology, Pisa University Hospital, University of Pisa, I-56124 Pisa, Italy.
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34
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Abstract
AIM: To evaluate the clinical value of MR multi-imaging techniques in diagnosing and preoperative assessment of pancreaticobiliary tumor.
METHODS: MR multi-imaging techniques, including MR cross-sectional imaging, MR cholangiopancreatography (MRCP) and 3D dynamic contrast-enhanced MR angiography (3D DCE MRA), were performed to make prospective diagnosis and preoperative evaluation in 28 patients with suspected pancreaticobiliary tumors. There were 17 cases of pancreatic adenocarcinoma, 8 cases of biliary system carcinoma and 3 cases of non-neoplastic lesions.
RESULTS: Using MR multi-imaging techniques, the accuracy in diagnosing the patients with pancreaticobiliary tumors was 89.3% (25/28). The accuracy in detecting the range of tumor invasion was 80.3% (57/71). The sensitivity, specificity, accuracy, positive and negative predictive value of MR multi-imaging techniques in preoperative assessment of the resectability of pancreaticobiliary tumor were 83.3%, 89.5%, 88.0%, 71.4%, and 94.4%, respectively. There was well diagnostic consistency between MR multi-imaging techniques and CT (κ = 0.64, P<0.01). The fusion image could be made from MRCP and 3D DCE MRA images.
CONCLUSION: MR multi-imaging techniques can integrate the advantages of various MR images. The non-invasive “all-in-one” MR imaging protocol is the efficient method in diagnosing, staging and preoperative assessment of pancreaticobiliary tumor.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Second Medical University, 145 Shandong Zhonglu, Shanghai 200001, China.
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35
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Abstract
MR imaging has made significant advances in recent years, with an increasingly important role in the detection, characterization, and staging of pancreatic diseases. MRI is appealing as a noninvasive imaging modality as it can evaluate the pancreas, the vasculature, and the pancreaticobiliary ducts in a single examination. Advantages of MRI include its excellent soft tissue contrast resolution and anatomic detail and absence of ionizing radiation. This article reviews the utility of MRI and its use not only as a problem-solving tool but its potential use as a primary examination (similar to CT) in a wide variety of pancreatic diseases.
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Affiliation(s)
- Ana L Keppke
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University, The Feinberg School of Medicine, Chicago, IL, USA
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36
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Park MS, Kim KW, Yu JS, Kim MJ, Kim KW, Lim JS, Cho ES, Yoon DS, Kim TK, Lee SI, Lee JD, Lee WJ, Ha HK, Lee JT, Yoo HS. Early biliary complications of laparoscopic cholecystectomy: evaluation on T2-weighted MR cholangiography in conjunction with mangafodipir trisodium-enhanced 3D T1-weighted MR cholangiography. AJR Am J Roentgenol 2005; 183:1559-66. [PMID: 15547191 DOI: 10.2214/ajr.183.6.01831559] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Our aim was to assess preliminary experience with combined conventional T2-weighted and mangafodipir trisodium (MnDPDP)-enhanced T1-weighted MR cholangiography in evaluating early biliary complications of laparoscopic cholecystectomy. SUBJECTS AND METHODS Conventional heavily T2-weighted MR cholangiography with MnDPDP-enhanced T1-weighted MR cholangiography and ERCP were performed in seven patients with high clinical suspicion of biliary complications after laparoscopic cholecystectomy. The final diagnoses of complications were classified according to the presence and degree of bile duct injury, bile leakage, and retained stones. RESULTS The diagnoses on MR cholangiography were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 3), partial strictures of the common bile duct with bile leakage (n = 1), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). The final diagnoses at surgery (n = 2) and ERCP (n = 5) were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 2), partial strictures of the common bile duct with bile leakage (n = 2), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). MR cholangiography accurately yielded the same findings as the final diagnoses, except in one case with partial stricture of the bile duct with bile leakage (overdiagnosed as complete occlusion on MR cholangiography). CONCLUSION Combined conventional T2-weighted and MnDPDP-enhanced T1-weighted MR cholangiography may eliminate the use of other studies for the imaging of biliary complications after cholecystectomy if this preliminary data can be verified in a larger study.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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37
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Abstract
The current imaging technique and clinical application of MR cholangiopancreatography (MRCP) is reviewed. MRCP has evolved into a feasible method of non-invasively evaluating the pancreaticobiliary system and has considerable clinical utility. If endoscopic retrograde cholangiopancreatography (ERCP) is incomplete or has failed, or in patients with biliary and gastrointestinal surgical procedures, MRCP is a useful alternative modality. In the near future, MRCP may supplant diagnostic ERCP such that ERCP is reserved primarily for therapeutic interventions. Furthermore, when MRCP is performed in conjunction with abdominal MR and MR angiography, the 'all-in-one' examination can evaluate the solid organs and vessels of the abdomen as well as the ductal systems.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Second Medical University, Shanghai, China
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38
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Abstract
Preoperative imaging with MRI/MRA/MRCP is an accurate non-invasive method for staging cholangiocarcinoma, and determining resectability. It provides information regarding tumor size, extent of bile duct involvement, vascular patency, extrahepatic extension, nodal or distant metastases, and the presence of lobar atrophy. MRCP is better for demonstrating bile ducts distal to the stricture, although with ERCP, therapeutic intervention such as stent placement and biopsy can be performed.
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Affiliation(s)
- Katrina A Vanderveen
- Department of Radiology/MRI B2B311, University of Michigan Hospitals-Ann Arbor, Ann Arbor, MI 48109-0030, USA
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39
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Pilleul F, Courbière M, Henry L, Scoazec JY, Valette PJ. La cholangio-IRM dans le diagnostic étiologique des sténoses biliaires : corrélation anatomopathologique. ACTA ACUST UNITED AC 2004; 85:25-30. [PMID: 15094636 DOI: 10.1016/s0221-0363(04)97541-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the accuracy of MR cholangiography to differentiate between the benign and malignant etiology of biliary strictures, excluding bilioenteric anastomoses. MATERIALS AND METHODS 49 patients (26 males, 23 females) with suspected biliary stricture underwent MR cholangiography at 1.5T (Siemens Symphony). RARE and HASTE sequences were acquired in the coronal, oblique and axial planes. MR cholangiography findings were reviewed by two independent radiologists and correlated with the final histological diagnosis. Sensitivity, specificity, and agreement were calculated with a 95% confidence interval. RESULTS Benign stenosis was identified in 23 patients (47%) and malignant stenosis in 26 (53%). The sensitivity of MR cholangiography was 64% and the specificity was 96%. The agreement between results at MR cholangiography and histology was moderate. The inter-observer agreement for MR cholangiography was good with a Kappa value of 0.61. CONCLUSION MR cholangiography has the potential to replace diagnostic cholangiography in patients with suspected biliary stricture. Direct cholangiography could be reserved for patients where a therapeutic procedure is anticipated.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Bile Ducts, Intrahepatic/pathology
- Bile Ducts, Intrahepatic/surgery
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Cholangiocarcinoma/diagnosis
- Cholangiocarcinoma/pathology
- Cholangiocarcinoma/surgery
- Cholangiography
- Cholangitis/diagnosis
- Cholangitis/pathology
- Cholangitis/surgery
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/pathology
- Cholangitis, Sclerosing/surgery
- Cholestasis, Intrahepatic/diagnosis
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/pathology
- Cholestasis, Intrahepatic/surgery
- Diagnosis, Differential
- Female
- Humans
- Image Processing, Computer-Assisted
- Liver Neoplasms/diagnosis
- Liver Neoplasms/pathology
- Liver Neoplasms/secondary
- Liver Neoplasms/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Postoperative Complications/diagnosis
- Postoperative Complications/pathology
- Postoperative Complications/surgery
- Sensitivity and Specificity
- Statistics as Topic
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Affiliation(s)
- F Pilleul
- Service de Radiologie Digestive, Pavillon H, Hôpital Edouard Herriot, Lyon
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40
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Affiliation(s)
- Thierry Barrioz
- Unité d'endoscopie digestive, pôle médico-chirurgical de pathologie digestive, Hôpital de la Milétrie, CHU de Poitiers.
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41
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Abstract
AIM: To evaluate the clinical value of various imageological methods in diagnosing the pancreato-biliary diseases and to seek the optimal procedure.
METHODS: Eighty-two cases of pancreato-biliary diseases confirmed by surgery and pathology were analyzed. There were 38 cases of cholelithiasis, 34 cases of pancreato-biliary tumors and 10 other cases. The imageological methods included B-US, CT, ERCP, PTC, cross-sectional MRI and MR cholangiopancreatography (MRCP).
RESULTS: The accuracy rate of MRCP in detecting the location of pancreato-biliary obstruction was 100%. In differentiating malignant from benign obstruction, the sensitivity of the combination of MRCP and cross-sectional MRI was 82.3%, the specificity was 93.8%, and the accuracy rate was 89.0%. The accuracy rate for determining the nature of obstruction was 87.8%, which was superior to that of B-US (P = 0.0000) and CT (P = 0.0330), but there was no significant difference between direct cholangiopancreatography and the combination of MRCP and conventional MRI (P = 0.6666).
CONCLUSION: In most cases, MRCP can substitute direct cholangiopancreatography for diagnosis. The combination of MRCP and cross-sectional MRI should be considered as an important means in diagnosing the pancreato-biliary diseases, pre-operative assessment and post-operative follow-ups.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.
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42
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Antón MD, Ortiz I, López A, Delgado F, Barrachina M, Moreno E. [Chronic pancreatitis as the initial presentation of Crohn's disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2003; 26:300-2. [PMID: 12732103 DOI: 10.1016/s0210-5705(03)70361-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It has been suggested that pancreatitis could be an extrahepatic manifestation of inflammatory bowel disease, since its incidence in this disease is greater than that in the general population and in many cases no etiological factor is found. We present a case of chronic idiopathic pancreatitis as the initial presentation of Crohn's disease of the colon.
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Affiliation(s)
- M D Antón
- Servicio de Aparato Digestivo. Hospital Dr. Peset. Valencia. Spain
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43
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Courbière M, Pilleul F, Henry L, Ponchon T, Touzet S, Valette PJ. Value of magnetic resonance cholangiography in benign and malignant biliary stenosis: comparative study with direct cholangiography. J Comput Assist Tomogr 2003; 27:315-20. [PMID: 12794592 DOI: 10.1097/00004728-200305000-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Magnetic resonance cholangiography (MRC) is currently under investigation for imaging of biliary stenosis. The purpose of this study was to evaluate the diagnostic value of MRC compared with direct cholangiography in biliary duct diseases, with the exception of biliary-enteric anastomosis. METHOD Forty-nine patients (26 men, 23 women; median age 60 years) with clinically suspected bile duct stenosis were prospectively included. Magnetic resonance cholangiography was performed within 7 days before direct cholangiography, considered to be the gold standard. Stenosis location, extension, and type according to Bismuth classification as well as diagnostic presumed causes were determined by 2 radiologists and 1 endoscopist. RESULTS Magnetic resonance cholangiography correctly identified the level of biliary ductal obstruction compared with direct cholangiography findings in 96% patients. Excellent agreement between MRC and direct cholangiography was found for the stenosis location (kappa value, 0.89). Sensitivity and specificity of MRC to detect common bile duct stenosis were 88% and 100%, respectively. Sensitivity and specificity of MRC to detect biliary confluence stenosis were 96% and 93%, respectively. Precise location of the lesion according to Bismuth classification was correctly evaluated on MRC in 74% of patients (kappa value, 0.64). The overall interobserver concordance between radiologists for the level of stenosis was good (kappa value, 0.625). In 35 patients with intrahepatic bile ducts dilation identified on direct cholangiography, 97% of patients were identified on MRC. Moderate concordance between MRC and direct cholangiography was confirmed in the evaluation of the surgical management (kappa value, 0.55). CONCLUSION Magnetic resonance cholangiography is able to replace diagnostic direct cholangiography to restrict the use of invasive procedures to cases in which therapeutic procedures are anticipated or MRC findings are equivocal, especially in biliary tract diseases.
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Affiliation(s)
- Marion Courbière
- Déparment de Radiologie Digestive, Hôspita Universitaire Edouard Herriot, Lyon, France
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44
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Schwartz LH, Lefkowitz RA, Panicek DM, Coakley FV, Jarnagin W, Dematteo R, Fong Y, Blumgart L. Breath-hold magnetic resonance cholangiopancreatography in the evaluation of malignant pancreaticobiliary obstruction. J Comput Assist Tomogr 2003; 27:307-14. [PMID: 12794591 DOI: 10.1097/00004728-200305000-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was designed to determine the effectiveness of magnetic resonance cholangiopancreatography (MRCP) using a breath-hold single-shot fast spin echo (SSFSE) technique in imaging patients with malignant biliary and/or pancreatic duct obstruction. METHODS One hundred thirty-one breath-hold MRCP studies in patients with malignant pancreatic and/or biliary obstruction were evaluated. Pathologic diagnoses included pancreatic cancer, biliary malignancy, gallbladder carcinoma, hepatic neoplasms, malignant lymphadenopathy, and ampullary carcinoma. Two observers independently reviewed the images in a blinded fashion to assess the level of obstruction and the site of underlying tumor. RESULTS The level of obstruction was correctly identified in 104 of 131 cases (79%) by observer 1 and in 107 of 131 cases (82%) by observer 2. The site of underlying tumor was correctly identified in 113 of 131 cases (86%) by observer 1 and in 110 of 131 cases (84%) by observer 2. CONCLUSION Magnetic resonance cholangiopancreatography utilizing the SSFSE technique can accurately assess the level of obstruction and the site of underlying tumor in patients with malignant pancreaticobiliary obstruction, without the risks of cholangiography. This MRCP technique allows for visualization of intra- and extraductal anatomy and pathology.
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Affiliation(s)
- Lawrence H Schwartz
- Department of Radiology, Memmorial Sloan - Kettering Cancer Center, and Weill Medical College of Cornell University, New York, NY 10021, USA.
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45
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Kim KW, Park MS, Yu JS, Chung JP, Ryu YH, Lee SI, Lee KS, Yoon SW, Lee KH. Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology 2003; 227:580-4. [PMID: 12637680 DOI: 10.1148/radiol.2272020207] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Twelve patients with symptoms of acute cholecystitis underwent heavily T2-weighted and mangafodipir trisodium-enhanced T1-weighted magnetic resonance (MR) cholangiography and cholescintigraphy before they underwent cholecystectomy. On T2-weighted MR cholangiographic images, morphologic evidence of outflow obstruction of the gallbladder was definitive in seven patients, equivocal in one, and absent in four. In all 12 patients, biliary dynamics depicted at manganese-enhanced T1-weighted MR cholangiography agreed completely with those depicted at hepatobiliary scintigraphy. T2-weighted MR cholangiography combined with manganese-enhanced T1-weighted MR cholangiography provides not only morphologic information but also functional information about the biliary system.
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Affiliation(s)
- Ki Whang Kim
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, Kangnam-Ku, Seoul 135-270, South Korea.
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46
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Aubé C, Hentati N, Tanguy JY, Fournier HD, Papon X, Lebigot J, Mercier P. Radio-anatomic study of the pancreatic duct by MR cholangiopancreatography. Surg Radiol Anat 2003; 25:64-9. [PMID: 12647024 DOI: 10.1007/s00276-002-0082-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2001] [Accepted: 10/17/2002] [Indexed: 10/26/2022]
Abstract
To compare the performance of MR-cholangiopancreatography (MRCP) and that of classical anatomy in the depiction of the main pancreatic duct, 50 MRCP examinations were done in patients free of pancreatic disease. Axial and coronal sections 20 mm thick were obtained in a Single Shot Fast Spin Echo (SSFSE) sequence. The following were analyzed: (1) visibility of pancreatic duct structures, (2) form of the main pancreatic duct, (3) various angulations of the duct and (4) diameter of the duct. Anatomic variants were noted. These findings were compared with anatomic and radio-anatomic (ERCP) data in the literature. The main pancreatic duct was visualized in 100% of cases and the accessory pancreatic duct in 61%. The form, diameter and angulations of the various segments of the pancreatic duct were similar to those reported in the literature. These findings are reported in the axial and coronal planes. Comparison with major anatomic classifications was not possible. MRCP enables in vivo anatomic exploration of the main pancreatic duct. Horizontal sections provided new radio-anatomic information. The technique nevertheless remains limited by poor spatial resolution.
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Affiliation(s)
- C Aubé
- Department of Radiology, University Hospital, 49033 Angers cedex 01, France
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47
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Madura JA, Deziel DJ. The Jaundiced Cancer Patient. Surg Oncol 2003. [DOI: 10.1007/0-387-21701-0_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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Boraschi P, Gigoni R, Braccini G, Lamacchia M, Rossi M, Falaschi F. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography. Acta Radiol 2002. [PMID: 12485257 DOI: 10.1034/j.1600-0455.2002.430610.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). MATERIAL AND METHODS A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size > or = 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. RESULTS CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. CONCLUSION MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.
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Affiliation(s)
- P Boraschi
- Second Department of Radiology, Pisa University Hospital, Pisa, Italy
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49
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Abstract
Many imaging techniques are available for the evaluation of patients with malignant obstructive jaundice. Ultrasonography, in experienced hands, is valuable for evaluating the local extent of the disease, but its usefulness for staging distant metastases is limited. When used properly, CT and MR imaging can provide valuable information about the extent of local tumor involvement and distant metastases. These noninvasive techniques provide images of the bile ducts and vascular images that are comparable in quality to those obtained with more invasive procedures, such as PTC, ERCP, and angiography, and do not have the risk for complications of these invasive techniques.
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Affiliation(s)
- Janio Szklaruk
- Division of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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50
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Hellerhoff KJ, Helmberger H, Rösch T, Settles MR, Link TM, Rummeny EJ. Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracy. AJR Am J Roentgenol 2002; 179:121-9. [PMID: 12076919 DOI: 10.2214/ajr.179.1.1790121] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The objective of our study was to assess the improvement of image quality and diagnostic accuracy of secretin-enhanced MR pancreatography compared with conventional MR pancreatography. SUBJECTS AND METHODS Ninety-five patients were studied with a 1.5-T scanner using a T2-weighted single-slice fast spin-echo sequence. Image quality and diameter of the head, body, and tail portion of the pancreatic main duct, the accessory duct, and the side branches were assessed before and after IV administration of secretin. Diagnoses before and after secretin administration were evaluated in a blinded fashion and correlated to the final diagnoses based on endoscopic retrograde cholangiopancreatography (ERCP), intraoperative results, and clinical follow-up as the reference standard. RESULTS In patients with a normal pancreatic duct, the visualization of all portions of the main pancreatic duct and the accessory duct was significantly improved with dynamic MR pancreatography (p < or = 0.001). In patients with chronic pancreatitis, the visualization of the main duct was also significantly improved with dynamic MR pancreatography (p < or = 0.05). However, the visualization of the minor duct and the side branches was significantly improved only in patients showing no ductal stricture (p < or = 0.05), compared with those with ductal stricture (not significant). The overall sensitivity for the detection of chronic pancreatitis increased from 77% to 89% using secretin-enhanced MR pancreatography. A pancreas divisum was found in eight patients before and 13 patients after secretin administration. The overall negative predictive value of MR pancreatography increased from 84% to 98% after secretin administration. CONCLUSION Improvement in image quality after secretin stimulation increases the diagnostic value of MR pancreatography in patients with a normal or nondilated main pancreatic duct and may obviate invasive procedures such as ERCP.
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Affiliation(s)
- Karin J Hellerhoff
- Department of Diagnostic Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, D-81675 Münich, Germany
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