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Kumar A, Mohanty NR, Mohanty M, Dash S. Comparison of MRCP and ERCP in the evaluation of common bile duct and pancreatic duct pathologies. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:946555. [PMID: 37521722 PMCID: PMC10374843 DOI: 10.3389/fmedt.2023.946555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging modality that has high diagnostic accuracy for a wide range of bile duct and pancreatic duct pathologies. Endoscopic retrograde cholangiopancreatography (ERCP) is still the gold standard for the exploration of the biliopancreatic region. Aim The aim of the study was to compare the diagnostic accuracy of MRCP with that of ERCP in the diagnosis of bile duct and pancreatic duct pathologies. Material and methods A total of 60 patients with common bile duct (CBD) and pancreatic duct pathologies detected on MRCP were subsequently evaluated by ERCP in this observational study. A comparison of MRCP findings with ERCP was made. Results MRCP had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.1%, 94.4%, 97.3%, 72.7%, and 90%, respectively, in diagnosing choledocholithiasis in comparison to ERCP. For CBD dilation, the sensitivity was 90.91%, specificity was 93.75% and the PPV, NPV, and accuracy were 97.56%, 78.95%, and 91.67%, respectively, for MRCP. In CBD stricture, MRCP showed a sensitivity, specificity, PPV, NPV, and accuracy of 83.33%, 97.92%, 90.91%, 95.92%, and 95%, respectively. In pancreatic duct dilatation, the sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Pancreatic duct stricture showed a sensitivity, specificity, PPV, NPV, and accuracy of 80%, 98%, 88.89%, 96.08%, and 95%, respectively. For the diagnosis of periampullary carcinoma, the sensitivity, specificity, PPV, NPV, and accuracy rate of MRCP were 80%, 98%, 88.89%, 96.08%, and 95%, respectively. Conclusion No significant difference was found between MRCP and ERCP in diagnosing those six pathologies.
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Affiliation(s)
- Anand Kumar
- Department of Radiodiagnosis, Apollo Hospitals, Bhubaneswar, India
| | - Nihar Ranjan Mohanty
- Department of Radiodiagnosis, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India
| | - Madhusmita Mohanty
- Department of Pathology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India
| | - Sashibhusan Dash
- Department of Oncopathology, Acharya Harihar Postgraduate Institute of Cancer (AHPGIC), Cuttack, India
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Rosen SJ, Beier MA, Parikh M, Kim S, Hindman N. Accuracy of Ultrasound Imaging for Etiology of New-Onset Painless Jaundice. J Comput Assist Tomogr 2023; Publish Ahead of Print:00004728-990000000-00172. [PMID: 37205734 DOI: 10.1097/rct.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE Ultrasound (US) is considered a first-line study for painless jaundice. However, in our hospital system, patients with new-onset painless jaundice often have a contrast-enhanced computed tomography (CECT) or magnetic resonance cholangiopancreatography (MRCP) regardless of the sonographic findings. Thus, we investigated the accuracy of US for detection of biliary dilatation in patients with new-onset painless jaundice. METHODS Our electronic medical record was searched from January 1, 2012, to January 1, 2020, for adult patients with new-onset painless jaundice. Presenting complaint/setting, laboratory values, imaging studies/findings, and final diagnoses were recorded. Patients with pain or known liver disease were excluded. A gastrointestinal physician reviewed the laboratory values/chart to classify the type of suspected obstruction. Two radiologists blindly re-reviewed the US scans, and κ between the radiologists was calculated. Fisher exact test and the 2-sample t test were used for statistical analysis. RESULTS Three hundred sixty patients presented with jaundice (>3 mg/dL), of whom 68 met the inclusion criteria (no pain and no known liver disease). Laboratory values had an overall accuracy of 54%, but were accurate in 87.5% and 85% for obstructing stones/pancreaticobiliary cancer. Ultrasound demonstrated overall accuracy of 78%, but only 69% for pancreaticobiliary cancer and 12.5% for common bile duct stone. Seventy-five percent of the patients underwent follow-up CECT or MRCP regardless of presenting setting. In the emergency department or inpatient setting, 92% of the patients underwent CECT or MRCP regardless of US, and 81% had follow-up CECT or MRCP within 24 hours. CONCLUSION A US-first strategy in the setting of new-onset painless jaundice is accurate only 78% of the time. In practice, US was almost never a stand-alone imaging examination in patients presenting to the emergency department or inpatient setting with new-onset painless jaundice, no matter the suspected diagnosis based on clinical and laboratory grounds or on the US findings themselves. However, for milder elevations of unconjugated bilirubin (suspicious for Gilbert disease) in the outpatient setting, a US demonstrating lack of biliary dilatation was often a definitive study for exclusion of pathology.
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Affiliation(s)
- Sarah J Rosen
- From the Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Matthew A Beier
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Manish Parikh
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Sooah Kim
- From the Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Nicole Hindman
- From the Department of Radiology, NYU Grossman School of Medicine, New York, NY
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Rahmani V, Peltonen J, Amarilla SP, Spillmann T, Ruohoniemi M. Cholangiopancreatography in cats: a post-mortem comparison of MRI with fluoroscopy, corrosion casting and histopathology. Vet Radiol Ultrasound 2023. [PMID: 37133979 DOI: 10.1111/vru.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 05/04/2023] Open
Abstract
In human medicine, magnetic resonance cholangiopancreatography (MRCP) is a valuable diagnostic tool for hepatobiliary and pancreatic diseases. In veterinary medicine, however, data evaluating the diagnostic value of MRCP are limited. The primary objectives of this prospective, observational, analytical investigation were to assess whether MRCP reliably visualizes the biliary tract and pancreatic ducts in cats without and with related disorders, and whether MRCP images and measurements of the ducts agree with those of fluoroscopic retrograde cholangiopancreatography (FRCP), corrosion casting and histopathology. A secondary objective was to provide MRCP reference diameters for bile ducts, GB, and pancreatic ducts. Donated bodies of 12 euthanized adult cats underwent MRCP, FRCP, and autopsy with corrosion casting of the biliary tract and pancreatic ducts using vinyl polysiloxane. Diameters of the biliary ducts, gallbladder (GB), and pancreatic ducts were measured using MRCP, FRCP, corrosion casts and histopathologic slides. There was an agreement between MRCP and FRCP in measuring diameters of the GB body, GB neck, cystic duct, and common bile duct (CBD) at papilla. Strong positive correlations existed between MRCP and corrosion casting for measuring GB body and neck, cystic duct, and CBD at the extrahepatic ducts' junction. In contrast to the reference methods, post-mortem MRCP did not visualize right and left extrahepatic ducts, and pancreatic ducts in most cats. Based on this study, MRCP with 1.5 Tesla can be regarded as a contributory method to improve the assessment of feline biliary tract and pancreatic ducts when their diameter is >1 mm.
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Affiliation(s)
- Vahideh Rahmani
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Peltonen
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Shyrley Paola Amarilla
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Pathological Sciences, Faculty of Veterinary Sciences, National University of Asuncion, San Lorenzo, Paraguay
| | - Thomas Spillmann
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Mirja Ruohoniemi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Xu X, Guan L, Wu Y, Ke H, Zhao Y, Liu P. One hundred most cited articles related to Endoscopic retrograde cholangiopancreatography: A bibliometric analysis. Front Surg 2022; 9:1005771. [PMID: 36439532 PMCID: PMC9681810 DOI: 10.3389/fsurg.2022.1005771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) has developed over the past few decades into a reliable technology for diagnostic and therapeutic purposes. Through a bibliometric analysis, this research attempted to evaluate the characteristics of the top 100 articles on ERCP that had the most citations. Methods We extracted pertinent publications from the Web of Science Core Collection (WoSCC) on July 9, 2022. The top 100 ERCP articles with the most citations were identified and analyzed. The following data were extracted: publication year, country/region, organization, total citation times, annual citation times, research type and research field, etc. To implement the network’s visual analysis, a bibliographic coupling network based on keywords was built using the VOSviewer 1.6.17 program. Results The journal with the most publications were GASTROINTESTINAL ENDOSCOPY, with 45 articles. Most of the top 100 articles came from the United States (n = 47) and Italy (n = 14). Indiana University and the University of Amsterdam were among the most important institutions in ERCP research. ML Freeman of the University of Minnesota contributed the highest number (n = 9) and the most highly cited paper. The age of the paper and article type is closely related to citation frequency. Of the 100 most-cited articles, clinical application in the field of ERCP has focused on three aspects: diagnosis, treatment, and complications. Clinical use of ERCP has shifted from diagnosis to treatment. Post-ERCP pancreatitis is the focus of attention, and the clinical application of technically complex therapeutic ERCP is the future development trend. Conclusion This study lists the most influential articles in ERCP by exposing the current state of the field, and showing the evolution of research trends to provide perspective for the future development of ERCP.
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Affiliation(s)
- Xuan Xu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- First Clinical Medical College, Nanchang University, Nanchang, China
| | - Lulu Guan
- First Clinical Medical College, Nanchang University, Nanchang, China
| | - Yao Wu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huajing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanbin Zhao
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Pi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Gastroenterology, The People’s Hospital of Longhua, Shenzhen, China
- Correspondence: Pi Liu
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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Alsaigh S, Aldhubayb MA, Alobaid AS, Alhajjaj AH, Alharbi BA, Alsudais DM, Alhothail HA, AlSaykhan MA. Diagnostic Reliability of Ultrasound Compared to Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography in the Detection of Obstructive Jaundice: A Retrospective Medical Records Review. Cureus 2020; 12:e10987. [PMID: 33209543 PMCID: PMC7667715 DOI: 10.7759/cureus.10987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Challenges in the diagnosis of obstructive jaundice include locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. Imaging plays a significant role in detecting the causes of obstruction. Radiologists aim to diagnose biliary obstruction, its level, extent, and probable causes to determine the appropriate treatment for each case. Methods Our study is a retrospective medical record review study. It included 150 patients who had ultrasound (US) diagnosis of biliary obstruction and underwent magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in King Fahad Specialist Hospital, Buraidah. The patients’ medical records have been reviewed to measure the sensitivity and specificity of US, MRCP, and ERCP. Results Statistical analysis of the data showed that the sensitivity of US in detecting the most common cause of biliary obstruction, common bile duct (CBD) stone, was 26.6%, while the specificity was 100%. Comparing this sensitivity of US in detecting CBD stones to that of MRCP and ERCP, we obtained the following: US, 26.6%; MRCP, 62.9%; and ERCP, 62.4%. Although US was the least sensitive for detecting CBD stones, its specificity in this detection was 100%, while MRCP was 63.6%, and ERCP was 55.2%. Conclusion US is the best initial step for the diagnosis of biliary obstruction. However, MRCP and ERCP are more sensitive in detecting CBD stones compared to US. Also, compared to US, they have shown higher percentages in all aspects of detection: level, cause, and extent of biliary obstruction.
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Affiliation(s)
- Sultan Alsaigh
- General Surgery, King Fahad Specialist Hospital, Buraidah, SAU
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Maruta A, Iwashita T, Uemura S, Yoshida K, Yasuda I, Shimizu M. Efficacy of the Endoscopic Ultrasound-first Approach in Patients with Suspected Common Bile Duct Stone to Avoid Unnecessary Endoscopic Retrograde Cholangiopancreatography. Intern Med 2019; 58:1673-1679. [PMID: 30799342 PMCID: PMC6630128 DOI: 10.2169/internalmedicine.2047-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective Endoscopic ultrasound (EUS) is a safe and accurate examination for evaluating the presence of common bile duct stones (CBDSs). The EUS-first approach, where EUS is performed before endoscopic retrograde cholangiopancreatography (ERCP) for patients suspected of having CBDSs, may help reduce the risk of ERCP-related adverse events and save manpower by avoiding unnecessary ERCP. To evaluate the efficacy of the EUS-first approach in patients with suspected CBDSs. Methods Between April 2012 and March 2016, 104 patients who underwent the EUS-first approach for suspected CBDSs were retrospectively evaluated. The relevant outcomes were the short- and long-term adverse event rates and the ERCP avoidance rate. Results EUS findings were positive for CBDSs in 52 patients, showed sludge formation or possible CBDSs in 4 patients, and were negative for CBDSs in 42 patients (but positive for other diseases in 6). Sixty-two patients (62/104, 59.6%) underwent ERCP, and proper treatments were successfully performed in all but 1 who underwent only cholangiography. In the remaining 42 patients (42/104, 40.4%), ERCP was omitted based on the EUS findings. Early adverse events were recognized in 0% of the EUS-only group and 8 patients (12.9%) in the EUS+ERCP group (p=0.02). Regarding late adverse events, recurrent CBDSs occurred in 1 patient (2.3%) in the EUS-only group and 2 (3.2%) in the EUS+ERCP group (p=1.0). Conclusion The EUS-first approach in patients with suspected CBDSs was useful for reducing early adverse events associated with ERCP without increasing the late adverse event rate, as EUS enabled the avoidance of unnecessary ERCP.
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Affiliation(s)
- Akinori Maruta
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Kensaku Yoshida
- First Department of Internal Medicine, Gifu University Hospital, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Japan
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The Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients With Acute Pancreatitis After Negative Computed Tomography Findings of the Etiology. Pancreas 2018; 47:1165-1171. [PMID: 30142119 DOI: 10.1097/mpa.0000000000001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to investigate the roles of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in detecting the causes of acute pancreatitis after negative computed tomography (CT) findings. METHODS Demographic characteristics, blood test results, the severity of pancreatitis, and definite or possible etiology of pancreatitis by EUS and MRCP were evaluated prospectively in 65 consecutively admitted patients after negative CT findings. RESULTS Endoscopic ultrasonography and/or MRCP confirmed the definite causes of pancreatitis in 47.7% (31/65) (choledocholithiasis, 25; pancreatic divisum, 3; pancreatic cancer, 1; and pancreatic intraductal papillary mucinous neoplasm, 1). The possible causes were cholelithiasis in 75.4%, pancreaticobiliary common channel (PBCC) in 70.8%, and both in 89.2%. The diagnostic values of EUS were higher than MRCP for choledocholithiasis (35.4% vs 12.3%, P < 0.05). Cholelithiasis and the common bile duct diameter were independent factors for the definite etiology of acute pancreatitis. Choledocholithiasis was inversely associated with PBCC, and the common bile duct diameter was the only independent factor associated with PBCC. CONCLUSIONS Endoscopic ultrasonography is a useful imaging modality for detecting definite or possible causes of acute pancreatitis. A PBCC as well as biliary lithiasis could be not uncommon causes of acute pancreatitis after negative CT findings.
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EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65:146-181. [PMID: 27085810 DOI: 10.1016/j.jhep.2016.03.005] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
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Tamir S, Braun M, Issachar A, Bachar GN, Benjaminov O. Yield of magnetic resonance cholangiopancreatography for the investigation of bile duct dilatation in asymptomatic patients. United European Gastroenterol J 2016; 5:408-414. [PMID: 28507753 DOI: 10.1177/2050640616652317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Biliary dilatation in the asymptomatic patient is a frequent incidental finding in the work-up for which there are no current guidelines. OBJECTIVES The purpose of this study was to determine the yield of magnetic resonance cholangiopancreatography (MRCP) in asymptomatic patients with an incidental finding of biliary duct dilatation. METHODS The study included 68 consecutive patients for evaluation of biliary duct dilatation found incidentally on computed tomography (CT) or ultrasound (US). MRCP scans were reviewed, and data were retrospectively collected on demographics and laboratory work-up. Patients were divided by the presence of a significant or non-significant MRCP findings explaining the biliary duct dilatation and compared for normal or abnormal liver function. RESULTS Liver function was normal in 47 patients and abnormal in 21 patients. MRCP identified the cause of the bile duct dilatation in 41 patients (60.3%). Rates of insignificant causes were 51% in the normal-liver-function group and 7% in the abnormal-function group. Corresponding rates of significant causes were 27.7% and 61.9% (p = 0.007). CONCLUSIONS MRCP is a valuable tool in the work-up of biliary duct dilatation. Although significantly more significant causes of bile dilatation are identified in patients with abnormal liver function, almost one-third of patients with normal liver function need further work-up. This has important implications for establishing criteria for the use of MRCP in asymptomatic patients with biliary dilatation.
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De Castro VL, Moura EG, Chaves DM, Bernardo WM, Matuguma SE, Artifon EL. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: A systematic review. Endosc Ultrasound 2016; 5:118-28. [PMID: 27080611 PMCID: PMC4850791 DOI: 10.4103/2303-9027.180476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/02/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of consensus about the optimal noninvasive strategy for patients with suspected choledocholithiasis. Two previous systematic reviews used different methodologies not based on pretest probabilities that demonstrated no statistically significant difference between Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) for the detection of choledocholithiasis. In this article, we made a comparison of the diagnostic ability of EUS and MRCP to detect choledocholithiasis in suspected patients. METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations with all published randomized prospective trials. We performed the systemic review using MedLine, EMBASE, Cochrane, LILACS, and Scopus reviews through May 2015. We identified eight randomized, prospective, blinded trials comparing EUS and MRCP. All the patients were submitted to a gold standard method. We calculated the study-specific variables and performed analyses using aggregated variables such as sensitivity, specificity, prevalence, positive predictive value (PPV) and negative predictive value (NPV), and accuracy. RESULTS Five hundred and thirty eight patients were included in the analysis. The pretest probability for choledocholithiasis was 38.7. The mean sensitivity of EUS and MRCP for detection of choledocholithiasis was 93.7 and 83.5, respectively; the specificity was 88.5 and 91.5, respectively. Regarding EUS and MRCP, PPV was 89 and 87.8, respectively, and NPV was 96.9 and 87.8, respectively. The accuracy of EUS and MRCP was 93.3 and 89.7, respectively. CONCLUSIONS For the same pretest probability of choledocholithiasis, EUS has higher posttest probability when the result is positive and a lower posttest probability when the result is negative compared with MRCP.
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Affiliation(s)
| | - Eduardo G.H. Moura
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Dalton M. Chaves
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | | | - Sergio E. Matuguma
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
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Chen W, Mo JJ, Lin L, Li CQ, Zhang JF. Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis. World J Gastroenterol 2015; 21:3351-3360. [PMID: 25805944 PMCID: PMC4363767 DOI: 10.3748/wjg.v21.i11.3351] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/26/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in patients with choledocholithiasis.
METHODS: We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane databases for studies reporting on the sensitivity, specificity and other accuracy measures of diagnostic effectiveness of MRCP for detection of common bile duct (CBD) stones. Pooled analysis was performed using random effects models, and receiver operating characteristic curves were generated to summarize overall test performance. Two reviewers independently assessed the methodological quality of studies using standards for reporting diagnostic accuracy and quality assessment for studies of diagnostic accuracy tools.
RESULTS: A total of 25 studies involving 2310 patients with suspected choledocholithiasis and 738 patients with CBD stones met the inclusion criteria. The average inter-rater agreement on the methodological quality checklists was 0.96. Pooled analysis of the ability of MRCP to detect CBD stones showed the following effect estimates: sensitivity, 0.90 (95%CI: 0.88-0.92, χ2 = 65.80; P < 0.001); specificity, 0.95 (95%CI: 0.93-1.0, χ2 = 110.51; P < 0.001); positive likelihood ratio, 13.28 (95%CI: 8.85-19.94, χ2 = 78.95; P < 0.001); negative likelihood ratio, 0.13 (95%CI: 0.09-0.18, χ2 = 6.27; P < 0.001); and diagnostic odds ratio, 143.82 (95%CI: 82.42-250.95, χ2 = 44.19; P < 0.001). The area under the receiver operating characteristic curve was 0.97. Significant publication bias was not detected (P = 0.266).
CONCLUSION: MRCP has high diagnostic accuracy for the detection of choledocholithiasis. MRCP should be the method of choice for suspected cases of CBD stones.
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Giljaca V, Gurusamy KS, Takwoingi Y, Higgie D, Poropat G, Štimac D, Davidson BR. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev 2015; 2015:CD011549. [PMID: 25719224 PMCID: PMC6464848 DOI: 10.1002/14651858.cd011549] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are tests used in the diagnosis of common bile duct stones in patients suspected of having common bile duct stones prior to undergoing invasive treatment. There has been no systematic review of the accuracy of EUS and MRCP in the diagnosis of common bile duct stones using appropriate reference standards. OBJECTIVES To determine and compare the accuracy of EUS and MRCP for the diagnosis of common bile duct stones. SEARCH METHODS We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and Clinicaltrials.gov until September 2012. We searched the references of included studies to identify further studies and of systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We included studies that provided the number of true positives, false positives, false negatives, and true negatives for EUS or MRCP. We only accepted studies that confirmed the presence of common bile duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of common bile duct stones by surgical or endoscopic negative exploration of the common bile duct or symptom free follow-up for at least six months for a negative test, as the reference standard in people suspected of having common bile duct stones. We included participants with or without prior diagnosis of cholelithiasis; with or without symptoms and complications of common bile duct stones, with or without prior treatment for common bile duct stones; and before or after cholecystectomy. At least two authors independently screened abstracts and selected studies for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently collected the data from each study. We used the bivariate model to obtain pooled estimates of sensitivity and specificity. MAIN RESULTS We included a total of 18 studies involving 2366 participants (976 participants with common bile duct stones and 1390 participants without common bile duct stones). Eleven studies evaluated EUS alone, and five studies evaluated MRCP alone. Two studies evaluated both tests. Most studies included patients who were suspected of having common bile duct stones based on abnormal liver function tests; abnormal transabdominal ultrasound; symptoms such as obstructive jaundice, cholangitis, or pancreatitis; or a combination of the above. The proportion of participants who had undergone cholecystectomy varied across studies. Not one of the studies was of high methodological quality. For EUS, the sensitivities ranged between 0.75 and 1.00 and the specificities ranged between 0.85 and 1.00. The summary sensitivity (95% confidence interval (CI)) and specificity (95% CI) of the 13 studies that evaluated EUS (1537 participants; 686 cases and 851 participants without common bile duct stones) were 0.95 (95% CI 0.91 to 0.97) and 0.97 (95% CI 0.94 to 0.99). For MRCP, the sensitivities ranged between 0.77 and 1.00 and the specificities ranged between 0.73 and 0.99. The summary sensitivity and specificity of the seven studies that evaluated MRCP (996 participants; 361 cases and 635 participants without common bile duct stones) were 0.93 (95% CI 0.87 to 0.96) and 0.96 (95% CI 0.90 to 0.98). There was no evidence of a difference in sensitivity or specificity between EUS and MRCP (P value = 0.5). From the included studies, at the median pre-test probability of common bile duct stones of 41% the post-test probabilities (with 95% CI) associated with positive and negative EUS test results were 0.96 (95% CI 0.92 to 0.98) and 0.03 (95% CI 0.02 to 0.06). At the same pre-test probability, the post-test probabilities associated with positive and negative MRCP test results were 0.94 (95% CI 0.87 to 0.97) and 0.05 (95% CI 0.03 to 0.09). AUTHORS' CONCLUSIONS Both EUS and MRCP have high diagnostic accuracy for detection of common bile duct stones. People with positive EUS or MRCP should undergo endoscopic or surgical extraction of common bile duct stones and those with negative EUS or MRCP do not need further invasive tests. However, if the symptoms persist, further investigations will be indicated. The two tests are similar in terms of diagnostic accuracy and the choice of which test to use will be informed by availability and contra-indications to each test. However, it should be noted that the results are based on studies of poor methodological quality and so the results should be interpreted with caution. Further studies that are of high methodological quality are necessary to determine the diagnostic accuracy of EUS and MRCP for the diagnosis of common bile duct stones.
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Affiliation(s)
- Vanja Giljaca
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - David Higgie
- North Bristol NHS TrustFrenchay HospitalBristolUKBS16 1LE
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Davor Štimac
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Sohns JM, Staab W, Dabir D, Spiro JE, Bergau L, Schwarz A, Sohns C. Current role and future potential of magnetic resonance cholangiopancreatography with an emphasis on incidental findings. Clin Imaging 2014; 38:35-41. [DOI: 10.1016/j.clinimag.2013.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/28/2013] [Accepted: 08/23/2013] [Indexed: 02/06/2023]
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Abstract
Acute obstruction of the gastrointestinal or biliary tract represents a common problem for acute care surgeons. It is with appropriate clinical evaluation, planning, and physical examination follow-up that acute care surgeons are able to appropriately diagnose, manage, and resolve this difficult group of surgical problems and minimize the morbidity associated with each.
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Affiliation(s)
- Jason Sperry
- University of Pittsburgh Medical Center, Suite F1268 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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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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Sun G, Han L, Yang Y, Linghu E, Li W, Cai F, Kong J, Wang X, Meng J, Du H, Wang H, Huang Q, Hyder Q, Zhang X. Comparison of two editions of Tokyo guidelines for the management of acute cholangitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:113-9. [PMID: 23813895 DOI: 10.1002/jhbp.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gang Sun
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Lu Han
- General Oncology Department; Chinese PLA General Hospital; Beijing China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Wen Li
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Fengchun Cai
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Jinyan Kong
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Xiangdong Wang
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Jiangyun Meng
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Hong Du
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Hongbin Wang
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Qiyang Huang
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
| | - Quratulain Hyder
- Department of Gastroenterology; Pakistan Institute of Medical Sciences; Islamabad Pakistan
| | - Xiuli Zhang
- Department of Gastroenterology and Hepatology; Chinese PLA General Hospital; 28 Fuxing Road Beijing 100853 China
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How reliable is MRCP with an SS-FSE sequence at 3.0 T: comparison between SS-FSE BH and 3D-FSE BH ASSET sequences. Clin Imaging 2013; 37:697-703. [PMID: 23522790 DOI: 10.1016/j.clinimag.2013.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/11/2012] [Accepted: 01/17/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the visibility and the image quality of the biliary and pancreatic duct system on magnetic resonance cholangiopancreatography (MRCP) images based on two breath-hold (BH) methods using array spatial sensitivity technique: a single-shot fast spin-echo (SS-FSE) sequence and a three-dimensional single slab fast spin-echo (3D-FSE) sequence. MATERIALS AND METHODS In the present prospective comparative study, 47 patients (22 male and 25 female, mean age=50 years, age range=22-82 years) that were referred for MRCP during a 12-month period are included. All of them were referred with suspected pancreaticobiliary disease. All patients underwent MRCP with both a SS-FSE BH sequence and a 3D-FSE BH sequence. Qualitative evaluation regarding the depiction of three segments of the pancreaticobiliary tree and the frequency of artifacts was performed. Two radiologists graded each sequence of the obtained studies in a blinded fashion. Quantitative evaluation including calculation of relative signal intensity (rSI) and relative contrast (RC) ratios at seven segments of the pancreaticobiliary tree between fluid-filled ductal structures and organ parenchyma at the same ductal segments was performed. In order to evaluate the parameters' differences of the two sequences, either in qualitative or in quantitative analysis, the Wilcoxon paired signed-rank test was performed. RESULTS On quantitative evaluation, both rSI and RC ratios of all segments of the pancreaticobiliary tree at SS-FSE BH sequence were higher than those at 3D-FSE BH sequences. This finding was statistically significant (P<.01). On qualitative evaluation, the two radiologists found intrahepatic ducts and pancreatic ducts to be better visualized with SS-FSE BH than with 3D-FSE BH sequence. This finding was statistically significant (P<.02). One of them found extrahepatic ducts to be significantly better visualized with SS-FSE BH sequence. Moreover, the frequency of artifacts was lower in the SS-FSE sequence, a finding that was of statistical significance. Interobserver agreement analysis found at least substantial agreement (κ>0.60) between the two radiologists. CONCLUSION The SS-FSE sequence is performed faster and significantly improves image quality; thus, it should be included into the routine MRCP sequence protocol at 3.0 T. Furthermore, we recommended SS-FSE BH MRCP examination to be applied to uncooperative patients or patients in emergency because of its short acquisition time (1 s).
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Marolf AJ, Kraft SL, Dunphy TR, Twedt DC. Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis. J Feline Med Surg 2012; 15:285-94. [PMID: 23143839 DOI: 10.1177/1098612x12466084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cholangiohepatitis/cholangitis is second only to hepatic lipidosis as the most common liver disease in cats and is often associated with concurrent pancreatitis. Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) have developed into an accurate, highly sensitive and specific imaging tool for the diagnosis of biliary and pancreatic duct disorders in humans. In this prospective case series, 10 cats with suspected cholangitis and/or pancreatitis were enrolled based on clinical history, physical examination and appropriate diagnostic test results. MRI and MRCP sequences with secretin stimulation of the cranial abdomen were performed, and sonography and laparoscopic biopsies for histologic diagnosis were obtained for comparison. MRI detected pancreatic abnormalities in cats suspected of pancreatitis, including T1 pre-contrast hypointense and T2 hyperintense pancreatic parenchyma and a dilated pancreatic duct. The MRI findings of the liver were non-specific. Nine of 10 cats had biliary abnormalities, including gall bladder wall thickening, gall bladder wall moderate contrast enhancement and/or gall bladder debris. Eight of 10 cats had histologic evidence of pancreatitis, as well as hepatitis or cholangitis, with one cat diagnosed with hepatic lymphoma. The advantages of MRI/MRCP over sonography of these cats included the striking pancreatic signal changes associated with pancreatitis and the ability to comprehensibly assess and measure the pancreas and hepatobiliary structures without operator dependence or interference from bowel gas. MRI/MRCP imaging of the feline abdomen may be beneficial in cases with equivocal ultrasound imaging findings.
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Affiliation(s)
- Angela J Marolf
- Colorado State University, Veterinary Medical Center, Fort Collins, CO 80523, USA.
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Duarte JA, Furtado APA, Marroni CA. Use of pineapple juice with gadopentetate dimeglumine as a negative oral contrast for magnetic resonance cholangiopancreatography: a multicentric study. ACTA ACUST UNITED AC 2012; 37:447-56. [PMID: 21630051 DOI: 10.1007/s00261-011-9761-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the efficacy of pineapple juice with gadopentetate dimeglumine as a negative oral contrast agent for magnetic resonance cholangiopancreatography (MRCP). Images were obtained before and after the intake of a negative oral contrast agent. Images obtained from six different areas of the biliary tree were analyzed by three different radiologists, who were blind to the exams; scores regarding image quality were given to each area. The statistical analysis showed a significant difference between images before and after the use of the contrast agent (P < 0.001) for the three radiologists (R1-R3). Mean scores given by radiologists before the intake of the contrast agent were 2.49 ± 0.42 (R1), 2.62 ± 0.32 (R2), and 2.22 ± 0.46 (R3). After the intake, mean scores were 3.38 ± 0.62 (R1), 3.48 ± 0.55 (R2), and 2.89 ± 0.69 (R3). The ducts that showed the highest scores were the common bile duct and duct of Wirsung, the distal portion of the common bile duct and the cystic duct. We suggest herein that the contrast agent pineapple juice with gadopentate dimeglumine constitutes an efficient negative oral contrast agent for MRCP, for it efficiently eliminates the signal of the digestive tube in MRCP images.
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Affiliation(s)
- Juliana Avila Duarte
- Radiologia - Magnetic Resonance, Hospital de Clínicas de Porto Alegre, RS, Brazil.
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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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Sotoudehmanesh R, Khatibian M, Ghadir MR, Bagheri M, Hashemi-Taheri AP, Sedighi N, Ali-Asgari A, Zeinali F, Shahraeeni S, Kolahdoozan S. Diagnostic accuracy of endoscopic ultrasonography in patients with inconclusive magnetic resonance imaging diagnosis of biliopancreatic abnormalities. Indian J Gastroenterol 2011; 30:156-60. [PMID: 21847603 DOI: 10.1007/s12664-011-0120-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 08/05/2011] [Indexed: 02/04/2023]
Abstract
AIM To determine the sensitivity and specificity of endoscopic ultrasonography (EUS) in patients with inconclusive magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) in pancreatobiliary abnormalities. METHODS During 10 months, patients with pancreatobiliary diseases referred to endoscopic retrograde cholangiopancreatography (ERCP) because of inconclusive MRI/MRCP diagnosis were scheduled to undergo endoscopic ultrasonography. Patients were divided into four major groups: patients with (i) resectable periampullary neoplasms who were referred to a surgeon, (ii) unresectable periampullary cancer who underwent ERCP for biliary stenting, (iii) bile duct stone who were referred to ERCP for stone extraction, and (iv) normal pancreatobiliary tract. Reference standards for comparison were ERCP, surgery, a biopsy confirming malignancy, or the clinical course during follow up (at least 12 months) in cases without evidences of malignancy. RESULTS One hundred and seven patients (51 men; mean [SD] age 60.0 [15.5]) were included in the study. Final diagnoses were common bile duct (CBD) stone (n = 24), periampullary neoplasms (n = 46), others (n = 23) and no pathologic findings (n = 14). EUS determined the staging for clinical decision-making in 47 patients with neoplasms which showed that tumors in 34 patients (79.1%) were unresectable (advanced stage). After EUS, 47 patients (43.9%) did not require ERCP. The accuracy of EUS for the diagnosis of CBD stone and periampullary neoplasms were 96.3% and 99.1%, respectively. CONCLUSIONS EUS is a useful modality in cases of inconclusive MRI/MRCP indicating pancreatobiliary disorders.
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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: 0.5] [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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An appraisal of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary disease in children: our institutional experience in 231 cases. Surg Endosc 2011; 25:2536-40. [PMID: 21359895 DOI: 10.1007/s00464-011-1582-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 01/10/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool used by clinicians in the diagnosis and management of pancreaticobiliary disease. The safety and utility of ERCP for adults has been well documented. However, experience with ERCP for pediatric patients remains limited. This study aimed to examine the utility and safety of ERCP for diagnosis and therapy in pediatric surgical conditions. METHODS An institutional review board-approved retrospective chart review of all children younger than 21 years who underwent ERCP at a single children's hospital between 1992 and 2008 was performed. Age, sex, medical history, presenting symptoms, laboratory values, and discharge diagnoses were recorded. The ERCP findings, interventions performed, complications, and associated surgical procedures also were recorded. RESULTS A total of 231 ERCPs were performed for 167 children (98 girls and 69 boys) ages 62 days to 21 years. The mean patient age was 11.4 years, with 11% (n = 18) of the ERCPs performed for children younger than 2 years. Common indications for ERCP included chronic or recurrent pancreatitis (n = 106), acute pancreatitis (n = 42), and choledocholithiasis (n = 26). Additional indications included choledochal cyst (n = 2), congenital biliary obstruction (n = 2), and malignant biliary obstruction (n = 1). Therapeutic interventions were performed in 159 cases (69%) including sphincterotomy (n = 96), stone extraction (n = 55), and stent insertion (n = 52). Complications occurred for only 11 patients (4.76%), including 7 cases of post-ERCP pancreatitis. The use of ERCP for imaging resulted in surgical procedures in 58 cases. CONCLUSION Endoscopic retrograde cholangiopancreatography was used most commonly for children with pancreatitis and gallstone disease. It was used frequently for infants with a low complication rate. The majority of patients required therapeutic intervention, suggesting an important role for ERCP in the management of pancreaticobiliary disease in infants and children.
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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: 2.1] [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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Desai R, Shokouhi BN. Common bile duct stones - their presentation, diagnosis and management. Indian J Surg 2009; 71:229-37. [PMID: 23133165 PMCID: PMC3452785 DOI: 10.1007/s12262-009-0050-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Accepted: 04/11/2009] [Indexed: 12/15/2022] Open
Abstract
Common Bile duct stones (CBD) continue to pose a significant problem both to the patient and the Surgeon. They increase the morbidity of a patient undergoing Cholecystectomy from less than 5% to as much as 20% and almost zero mortality to as high as 30%. Recent times have thrown up a fair share of controversy in the management of this condition both due to technological innovations and costreduction-pressures. The aim in CBD stone disease, as in any benign disease is to discover a therapeutic algorithm with minimal morbidity, no mortality and at reasonable cost. This can be achieved only by a thorough understanding of the disease and also the available diagnostic and treatment modalities.This article dicusses the diagnosis, investigation and therapy of Common Bile Duct Stones (CBD) and gives a therapeutic algorithm.
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Affiliation(s)
- Rajendra Desai
- Department of Surgery, Desai Hospitals, 3-6-274, Himayatnagar, Hyderabad, 500 029 India
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Sakai Y, Tsuyuguchi T, Ishihara T, Yukisawa S, Ohara T, Tsuboi M, Ooka Y, Kato K, Katsuura K, Kimura M, Takahashi M, Nemoto K, Miyazaki M, Yokosuka O. Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones? World J Gastroenterol 2009; 15:3283-7. [PMID: 19598305 PMCID: PMC2710785 DOI: 10.3748/wjg.15.3283] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile duct.
METHODS: Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever, and showed signs of inflammatory reaction and marked rise of hepatobiliary enzymes. These symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on MRCP. All these patients were subjected to ERCP within 3 d of MRCP to check for the presence of stones.
RESULTS: No stones were detected by ERCP in any patient, confirming the results of MRCP.
CONCLUSION: When clinical symptoms improve, blood biochemical parameters have normalized, and MRCP shows there are no stones in the common bile duct, it can be considered the stone has spontaneously passed and thus ERCP is not necessary.
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Patkar NM, Curtis JR, Teng GG, Allison JJ, Saag M, Martin C, Saag KG. Administrative codes combined with medical records based criteria accurately identified bacterial infections among rheumatoid arthritis patients. J Clin Epidemiol 2009; 62:321-7, 327.e1-7. [PMID: 18834713 PMCID: PMC2736855 DOI: 10.1016/j.jclinepi.2008.06.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 05/29/2008] [Accepted: 06/04/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate diagnostic properties of International Classification of Diseases, Version 9 (ICD-9) diagnosis codes and infection criteria to identify bacterial infections among rheumatoid arthritis (RA) patients. STUDY DESIGN AND SETTING We performed a cross-sectional study of RA patients with and without ICD-9 codes for bacterial infections. Sixteen bacterial infection criteria were developed. Diagnostic properties of comprehensive and restrictive sets of ICD-9 codes and the infection criteria were tested against an adjudicated review of medical records. RESULTS Records on 162 RA patients with and 50 without purported bacterial infections were reviewed. Positive and negative predictive values of ICD-9 codes ranged from 54%-85% and 84%-100%, respectively. Positive predictive values of the medical records based criteria were 84% and 89% for "definite" and "definite or empirically treated" infections, respectively. Positive predictive value of infection criteria increased by 50% as disease prevalence increased using ICD-9 codes to enhance infection likelihood. CONCLUSION ICD-9 codes alone may misclassify bacterial infections in hospitalized RA patients. Misclassification varies with the specificity of the codes used and strength of evidence required to confirm infections. Combining ICD-9 codes with infection criteria identified infections with greatest accuracy. Novel infection criteria may limit the requirement to review medical records.
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Affiliation(s)
- Nivedita M Patkar
- Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA
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Saad WEA, Ginat D. Computed tomography and magnetic resonance cholangiography. Tech Vasc Interv Radiol 2008; 11:74-89. [PMID: 18922453 DOI: 10.1053/j.tvir.2008.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with biliary obstruction, determining the level and the cause of the obstruction is essential because it can be a key factor for the next step in diagnostic or therapeutic intervention. Noninvasive cholangiography, such as computed tomography (CT) cholangiography or magnetic resonance (MR) cholangiography, allows the diagnosis of cause and level of biliary disease with minimal risk. Traditional magnetic resonance cholangiopancreatography (MRCP) is an established and effective noninvasive diagnostic modality particularly for extrahepatic biliary tract evaluation. Intrahepatic biliary duct evaluation and functional MR, including evaluating for leaks and gallbladder dyskinesia and outlet obstruction, are evolving diagnostic techniques that show promising results. CT cholangiography techniques are especially useful when MRI is not available or contraindicated or when the quality of MRCP images is suboptimal. CT cholangiography is particularly useful as an adjunct to surgery or postsurgical cases. The primary limitation of cholangiographic contrast-enhanced CT cholangiography (the most prevalent type of CT cholangiography) is its hindrance by poor liver function and/or high-grade biliary obstruction. In this setting MRCP is clearly superior. There are different types of CT cholangiography and MRCP. This article discusses the types of CT cholangiography and MRCP techniques and their clinical applications.
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Nandalur KR, Hussain HK, Weadock WJ, Wamsteker EJ, Johnson TD, Khan AS, D'Amico AR, Ford MK, Nandalur SR, Chenevert TL. Possible biliary disease: diagnostic performance of high-spatial-resolution isotropic 3D T2-weighted MRCP. Radiology 2008; 249:883-90. [PMID: 18941164 DOI: 10.1148/radiol.2493080389] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To retrospectively assess the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) performed by using a high-spatial-resolution isotropic three-dimensional (3D) fast-recovery fast spin-echo (FSE) sequence with parallel imaging for the evaluation of possible biliary disease. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Ninety-five patients (58 female, 37 male; mean age, 51 years; range, 15-91 years) underwent MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence and endoscopic or percutaneous direct visualization between March 2003 and June 2007. Two independent readers evaluated the MRCP images for strictures, dilatation, and intraductal filling defects. Sensitivity, specificity, and interobserver agreement (kappa statistics) were determined. RESULTS The respective sensitivity and specificity for strictures, dilatation, and intraductal filling defects (all choledocholithiasis) were 86% (40 of 47) and 94% (45 of 48), 98% (57 of 58) and 100% (37 of 37), and 68% (19 of 28) and 97% (65 of 67) for reader 1 and 88% (41 of 47) and 94% (45 of 48), 96% (56 of 58) and 100% (37 of 37), and 75% (21 of 28) and 99% (66 of 67) for reader 2. The sensitivity for stones larger than 3 mm was 94% (15 of 16) for reader 1 and 100% (16 of 16) for reader 2, whereas the sensitivity for stones 3 mm or smaller was 33% (four of 12) for reader 1 and 42% (five of 12) for reader 2. Agreement between readers was good to excellent, with kappa values of 0.76, 0.85, and 0.98 for strictures, dilatation, and choledocholithiasis, respectively. CONCLUSION MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence with parallel imaging demonstrates excellent diagnostic capabilities for possible biliary disease, although it is limited for stones 3 mm or smaller in size.
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Affiliation(s)
- Kiran R Nandalur
- Department of Radiology/MRI, University of Michigan Health System, 1500 E Medical Center Dr, MRI UHB2A209, Ann Arbor, MI 48109-0030, USA
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Sakai Y, Tsuyuguchi T, Yukisawa S, Tsuchiya S, Sugiyama H, Miyakawa K, Ohara T, Ebara M, Miyazaki M, Yokosuka O. Diagnostic value of magnetic resonance cholangiopancreatography for clinically suspicious spontaneous passage of bile duct stones. J Gastroenterol Hepatol 2008; 23:736-40. [PMID: 18070008 DOI: 10.1111/j.1440-1746.2007.05252.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM We investigated the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in patients with clinically suspicious spontaneous passage of bile duct stones. METHODS The study population consisted of 113 patients suspected of having common duct bile stones. Of them, 50 patients were clinically suspected of spontaneous passage of bile duct stones based on the presence of gallbladder stones on ultrasound examination or a history of common bile duct stones after cholecystectomy, clinical symptoms including abdominal pain and fever associated with inflammatory reaction and marked rise of hepatobiliary enzymes which resolved or normalized after conservative treatment without evidence of stones in the common bile duct on MRCP. These 50 patients were prospectively followed up for a median of 10.2 months. RESULTS All patients except for one had had no symptoms related to cholangitis. Only one patient received ERCP due to recurrence of symptoms after 6 months. CONCLUSION When clinical symptoms improve, hematological parameters normalize, and MRCP indicates that there are no stones in the common bile duct, it can be considered that the stones have passed naturally.
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Affiliation(s)
- Yuji Sakai
- Departments of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Hosch W, Stojkovic M, Jänisch T, Heye T, Werner J, Friess H, Kauffmann GW, Junghanss T. MR imaging for diagnosing cysto-biliary fistulas in cystic echinococcosis. Eur J Radiol 2008; 66:262-7. [PMID: 17888605 DOI: 10.1016/j.ejrad.2007.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 07/23/2007] [Accepted: 08/02/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of magnetic resonance imaging (MR imaging) including MR cholangiography for the identification of cysto-biliary fistulas in patients with hepatic hydatid disease. PATIENTS AND METHODS Retrospective analysis of 3 groups of patients (20 patients with 51 echinococcal cysts) in a cohort of 103 patients with cystic echinococcosis with different pretest probabilities for cysto-biliary fistulas. Patients who had MR imaging/MR cholangiography with symptoms and signs of biliary obstruction (5 patients with 16 cysts, group I), before surgery for other reasons than biliary obstruction (9 patients with 14 cysts, group II) and for cyst staging (6 patients with 21 cysts, group III). All MR images were evaluated before surgery for the presence of cyst wall defects and hydatid debris in bile ducts. In groups I and II MR results were compared with surgical, parasitological, and biochemical findings of each individual cyst. RESULTS Based on direct (i.e. defects in the cyst wall and continuity of dilated biliary ducts into adjacent cysts), and indirect MR imaging/MR cholangiography imaging signs (i.e. intraluminal debris) our best estimate of sensitivity and specificity (stage-specific, WHO type CE3 and CE4) for cysto-biliary fistulas was 75% and 95%, respectively. CONCLUSIONS MR imaging with MR cholangiography is a valuable non-invasive imaging technique to assess the risk of cysto-biliary fistula-related complications and for planning of surgery.
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Affiliation(s)
- Waldemar Hosch
- Department of Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Abdalian R, Dhar P, Jhaveri K, Haider M, Guindi M, Heathcote EJ. Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: evaluating the role of routine magnetic resonance imaging. Hepatology 2008; 47:949-57. [PMID: 18200555 DOI: 10.1002/hep.22073] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED Large bile duct injury (that seen on cholangiography) is not usually considered a feature of autoimmune hepatitis (AIH) in adults but is present in up to 50% of children with AIH. The aim of this work was to study the prevalence of large bile duct abnormalities identified by magnetic resonance cholangiography (MRC) in adults given a diagnosis of AIH. Seventy-nine (n = 79) patients given a diagnosis of AIH (mean AIH score: 15.1 +/- 3.4) were screened with MRC for evidence of sclerosing cholangitis (SC). Results were reviewed by two radiologists. Clinical parameters were correlated with MRC findings. A histological review of available liver biopsies (n = 29) was performed. Of the 79 patients surveyed, 8 (10%) had MRC findings consistent with primary sclerosing cholangitis (PSC). The interrater variability was excellent (kappa = 0.87). Younger age at diagnosis (24.3 +/- 11.9), higher baseline alkaline phosphatase (186.4 +/- 98.3), higher bilirubin at time of MRC (45.8 +/- 37.2), and greater lobular activity on initial liver biopsy were significantly associated with the detection of this overlap of SC with AIH (P = 0.024, P = 0.037, P = 0.032, and P = 0.041, respectively), but not alkaline phosphatase/aspartate aminotransferase ratio, time between the initial diagnosis of AIH and the MRC, or the presence of cirrhosis on initial liver histology. Two cases with a normal MRC had histological lesions typical of small duct PSC. CONCLUSION The presence of SC detected by MRC and from liver histology in adult patients with AIH may not be clinically overt, and thus the prevalence of this AIH/SC overlap may be higher than previously recognized. Our data suggest that routine radiological evaluation of the biliary tree should be performed in adults given a diagnosis of AIH, as in children the presence of this overlap negatively impacts on survival.
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Affiliation(s)
- Rupert Abdalian
- Department of Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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TSITOURIDIS J, KOUKLAKIS G, PAPASTERGIOU C, IASONIDOU C, XIARCHOS P. Choledocholithiasis: Evaluation with MR Cholangiography. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1999.tb00006.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- John TSITOURIDIS
- Department of Gastroenterology and Rudiology, 424 General Army Hospital, Thessaloniki, Greece
| | - George KOUKLAKIS
- Department of Gastroenterology and Rudiology, 424 General Army Hospital, Thessaloniki, Greece
| | - Christos PAPASTERGIOU
- Department of Gastroenterology and Rudiology, 424 General Army Hospital, Thessaloniki, Greece
| | - Christina IASONIDOU
- Department of Gastroenterology and Rudiology, 424 General Army Hospital, Thessaloniki, Greece
| | - Panagiotis XIARCHOS
- Department of Gastroenterology and Rudiology, 424 General Army Hospital, Thessaloniki, Greece
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Kim YK, Han YM, Kim CS. Usefulness of fat-suppressed T1-weighted MRI using orally administered superparamagnetic iron oxide for revealing ampullary carcinomas. J Comput Assist Tomogr 2007; 31:519-25. [PMID: 17882025 DOI: 10.1097/01.rct.0000250106.01047.4b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the value of adding fat-suppressed (FS) T1-weighted magnetic resonance imaging (MRI) with orally administered superparamagnetic iron oxide (SPIO) to the 3-dimensional dynamic MRI for revealing ampullary carcinomas. MATERIALS Twenty-five patients with ampullary carcinoma who underwent MRI with orally administered SPIO, including a FS T1-weighted fast low-angle shot (FLASH) sequence, a respiratory-triggered turbo spin-echo (RT-TSE) sequence, and the 3-phasic 3-dimensional dynamic images, were enrolled in this study. About 5 min before the examination, a mixture of 8.4 mg of SPIO and 300 mL water was administered orally to all patients. The images were compared quantitatively by measuring the tumor-pancreas (duodenum) contrast-to-noise ratio and, qualitatively, by evaluating tumor conspicuity. Three separate sets of images, that is, the dynamic set, the combination of the dynamic set, and the RT-TSE, and the combination of the dynamic set and the FLASH were analyzed by 2 observers in consensus. RESULTS For the tumor-pancreas (duodenum) contrast-to-noise ratio, the FLASH was significantly higher than those of the dynamic set and RT-TSE (P < 0.05). The tumor conspicuity with the combination of the dynamic set and the FLASH was also significantly better than those of the dynamic set, and the combination of the dynamic set and RT-TSE (P = 0.001). For 15 tumors that were surgically confirmed, the combined reading of the FLASH imaging and dynamic set allowed more accurate surgical staging (14/15, 93.3%) than did the dynamic imaging set or the combined reading of the dynamic set and RT-TSE (11/15, 73.3%). CONCLUSIONS Addition of the FS FLASH image using orally administered SPIO to the dynamic MRI is useful for revealing ampullary carcinoma.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School JeonJu, South Korea.
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Fernández-Esparrach G, Ginès A, Sánchez M, Pagés M, Pellisé M, Fernández-Cruz L, López-Boado MA, Quintó L, Navarro S, Sendino O, Cárdenas A, Ayuso C, Bordas JM, Llach J, Castells A. Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study. Am J Gastroenterol 2007; 102:1632-9. [PMID: 17521400 DOI: 10.1111/j.1572-0241.2007.01333.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the diagnostic value of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in: (a) patients with a dilated biliary tree unexplained by ultrasonography (US) (group 1), and (b) the diagnosis of choledocholithiasis in patients with nondilated biliary tree (group 2). METHODS Patients were prospectively evaluated with EUS and MRCP. The gold standard used was surgery or EUS-FNA and ERCP, intraoperative cholangiography, or follow-up when EUS and/or MRCP disclosed or precluded malignancy, respectively. Likelihood ratios (LR) and pretest and post-test probabilities for the diagnosis of malignancy and choledocholithiasis were calculated. RESULTS A total of 159 patients met one of the inclusion criteria but 24 of them were excluded for different reasons. Thus, 135 patients constitute the study population. The most frequent diagnosis was choledocholithiasis (49% in group 1 and 42% in group 2, P= 0.380) and malignancy was more frequent in group 1 (35%vs 7%, respectively, P < 0.001). When EUS and MRCP diagnosed malignancy, its prevalence in our series (35%) increased up to 98% and 96%, respectively, whereas it decreased to 0% and 2.6% when EUS and MRCP precluded this diagnosis. In patients in group 2, when EUS and MRCP made a positive diagnosis of choledocholithiasis, its prevalence (42%) increased up to 78% and 92%, respectively, whereas it decreased to 6% and 9% when any pathologic finding was ruled out. CONCLUSIONS EUS and MRCP are extremely useful in diagnosing or excluding malignancy and choledocholithiasis in patients with dilated and nondilated biliary tree. Therefore, they are critical in the approach to the management of these patients.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, CIBER HEPAD, University of Barcelona, Barcelona, Spain
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Soto JA. "MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences"--a commentary. AJR Am J Roentgenol 2007; 189:5-6. [PMID: 17579142 DOI: 10.2214/ajr.06.1693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jorge A Soto
- Department of Radiology, Boston University Medical Center, 88 E Newton St., H-2, Boston, MA 02118, USA
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Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancreatography of biliary system abnormalities in children. Clin Imaging 2007; 31:93-101. [PMID: 17320775 DOI: 10.1016/j.clinimag.2006.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 11/20/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of magnetic resonance cholangiopancreatography (MRCP) with a single-shot fast spin-echo sequence as a noninvasive method to evaluate the biliary system in children. METHODS Twenty-five MRCP examinations of 23 patients were evaluated. On the basis of surgical (n=5), endoscopic retrograde cholangiopancreatography (n=4), liver biopsy (n=4), clinical data, and follow-up observation, 6 children were considered to have no significant abnormality. The other 17 children were found to have pancreaticobiliary disease, including choledochal cyst, biliary system dilatation, choledocholithiasis, biliary atresia, multiseptated gallbladder, anomalous pancreaticobiliary union, ruptured hydatic cyst, and biloma. The findings were correlated with the ultrasonography, computed tomography, surgical, and endoscopic retrograde cholangiopancreatography results. RESULTS Magnetic resonance cholangiopancreatography showed the first branch of the intrahepatic duct, the common hepatic duct, the gallbladder, and the common bile duct in 14 children. Cystic duct was not seen in infants, but was partially visible in younger children. Although the main pancreatic duct was visible in head and body portions in 65% of the patients, it was visible in 17% of the patients in the tail. The diagnostic accuracy of MRCP was 100% in patients with choledochal cysts and stenoses. In a patient with hydatic cyst, cystobiliary communication was successfully demonstrated. CONCLUSION Magnetic resonance cholangiopancreatography can be used effectively for the evaluation of the biliary system in children.
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Affiliation(s)
- Suat Fitoz
- Department of Radiology, School of Medicine, Ankara University, Ibn-i Sina Hospital, 06100 Sihhiye, Ankara, Turkey.
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Zhang J, Israel GM, Hecht EM, Krinsky GA, Babb JS, Lee VS. Isotropic 3D T2-Weighted MR Cholangiopancreatography with Parallel Imaging: Feasibility Study. AJR Am J Roentgenol 2006; 187:1564-70. [PMID: 17114551 DOI: 10.2214/ajr.05.1032] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the quality of images obtained with fast 3D T2-weighted turbo spin-echo (TSE) MR cholangiopancreatography (MRCP) sequences and 1-mm isotropic voxels with the quality of conventional 2D MRCP images. SUBJECTS AND METHODS Thirty consecutively registered patients (14 women, 16 men; average age, 60.2 years; age range, 32-87 years) underwent imaging at 1.5 T with a 6-element body array coil. All imaging was performed with three MRCP techniques: free-breathing 3D T2-weighted TSE (TR/TE, 1,300/680; flip angle, 180 degrees; field of view, 250-300 mm; matrix size, 256 x 256; slice thickness, 1 mm; parallel acquisition technique factor, 2); breath-hold 3D T2-weighted TSE (same parameters as the free-breathing 3D technique); breath-hold coronal and oblique coronal thick-slab 2D TSE without parallel acquisition technique (2,800/1,100; flip angle, 150-180 degrees). Quantitative measures of image signal and contrast were evaluated by analysis of variance and paired Student's t tests. A 5-point scale (1, nondiagnostic, to 5, high diagnostic confidence) was used to compare the 3D and 2D data sets for image quality and definition of biliary and pancreatic ductal anatomic features. Friedman's nonparametric and Wilcoxon's rank sum tests were performed for statistical analysis of the qualitative assessments. RESULTS Quantitative results showed free-breathing and breath-hold 3D TSE images had significantly higher relative signal intensity and contrast than 2D TSE images (p < 0.0001). The qualitative findings showed that both free-breathing and breath-hold 3D TSE techniques gave better delineation of biliary anatomy (p < 0.0001) than the 2D technique. The overall quality of 3D images was better than that of 2D images, and 3D imaging was better at depicting pancreatic ducts, although the difference did not reach statistical significance. CONCLUSION Three-dimensional volumetric MRCP images are of superior quality and give better delineation of pancreaticobiliary anatomy than conventional 2D images and have the added advantage of multiplanar and postprocessing capabilities.
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Affiliation(s)
- Jingbo Zhang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. C278, New York, NY 10021, USA.
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Lee JK, Kim TK, Byun JH, Kim AY, Ha HK, Kim PN, Lee MG. Diagnosis of intrahepatic and common duct stones: combined unenhanced and contrast-enhanced helical CT in 1090 patients. ACTA ACUST UNITED AC 2006; 31:425-32. [PMID: 16967241 DOI: 10.1007/s00261-006-9076-1] [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] [Received: 03/19/2005] [Accepted: 04/06/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND We determined the accuracy of combined unenhanced and contrast-enhanced helical computed tomography (CT) for diagnosis of bile duct stones. METHODS During a 12-month period, 1090 patients who underwent combined CT and endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangioscopy (PTC) were enrolled in this study. The results of prospective CT interpretation regarding the presence of bile duct stones were compared with results of endoscopic stone removal, PTC and with surgical results. In 70 patients, detectability of stones on CT was evaluated depending on stone types. RESULTS Of 1090 study patients, 175 and 299 patients were confirmed to have intrahepatic and common duct stones, respectively. The sensitivity and specificity of combined CT were 73% and 98% for diagnosis of intrahepatic stones and 71% and 97% for common duct stones. Of 70 patients 24, 25, and 21 patients had cholesterol, black pigment, and brown pigment stones, respectively. Eleven of 24 cholesterol stones, 21 of 25 black pigment stones, and 15 of 21 brown pigment stones were detected on combined CT. CONCLUSION Combined CT is of limited sensitivity for detection of bile duct stones, especially in Western countries where cholesterol stones predominate. It may be of greater value in populations with a higher incidence of pigment stones. Other complementary imaging modalities are needed for patients with negative CT findings who are highly suspected to have biliary stones.
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Affiliation(s)
- Jeong Kyong Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnab-dong, Songpa-ku, Seoul, 138-736, Korea
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Kim YK, Kim CS, Lee JM, Ko SW, Chung GH, Lee SO, Han YM, Lee SY. Value of adding T1-weighted image to MR cholangiopancreatography for detecting intrahepatic biliary stones. AJR Am J Roentgenol 2006; 187:W267-74. [PMID: 16928904 DOI: 10.2214/ajr.05.0266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the value of adding a T1-weighted image to MR cholangiopancreatography (MRCP) to detect bile duct stones. MATERIALS AND METHODS During a 30-month period, 148 patients suspected of having biliary stones and who underwent MRI including MRCP, a fat-suppressed T1-weighted fast low-angle shot (FLASH) sequence, and an axial HASTE sequence were enrolled in this study. The biliary stones were confirmed by ERCP, surgery, and percutaneous transhepatic cholangiography. Of these 148 patients, 73 had extrahepatic stones, 45 had intrahepatic stones, 20 had both extrahepatic and intrahepatic stones, and 10 had no biliary stones. Two separate sets of images, the MRCP set (composed of MRCP and axial HASTE) and the combined interpretion of the MRCP set and the T1-weighted image, were analyzed independently and separately by two observers. The diagnostic accuracy was evaluated using the receiver operating characteristic method. The sensitivity and specificity were also calculated. RESULTS For common duct stones, the diagnostic accuracy and the sensitivity of both image sets showed similar values without any significant difference (0.998 [97.8%] for the combined interpretation; 0.988 [97.8%] for observer 1 and 0.995 [96.8%] for observer 2 for the MRCP set). However, for the intrahepatic stones, the diagnostic accuracy (0.993) and the sensitivity (98.5%) of the combined interpretation were significantly higher than those of the MRCP set for the two observers (0.926 [83.8%] for observer 1 and 0.922 [85.3%] for observer 2) (p < 0.05). No significant difference was seen in the specificity of the two image sets for both the intrahepatic and the common duct stones. CONCLUSION Combining the axial T1-weighted image with MRCP is valuable for detecting intrahepatic stones.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radioology, Chonbuk National University Medical School and Hospital, 634-18 Keumam dong, Jeonju, Chonbuk, South Korea.
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Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006; 6:9. [PMID: 16907974 PMCID: PMC1579209 DOI: 10.1186/1471-2342-6-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 08/14/2006] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for investigating biliary obstruction. The use of MRCP, a non-invasive procedure, may prevent the use of unnecessary invasive procedures. The aim of the study was to compare the findings of MRCP with those of ERCP by the computation of accuracy statistics. METHODS Thirteen electronic bibliographic databases, covering biomedical, science, health economics and grey literature were searched. A systematic review of studies comparing MRCP to diagnostic ERCP in patients with suspected biliary obstruction was conducted. Sensitivity, specificity, likelihood ratios, acceptability and adverse events were reported. RESULTS 25 studies were identified reporting several conditions including choledocholithiasis (18 studies), malignancy (four studies), obstruction (three studies), stricture (two studies) and dilatation (five studies). Three of the 18 studies reporting choledocholithiasis were excluded from the analysis due to lack of data, or differences in study design. The sensitivity for the 15 studies of choledocholithiasis ranged from 0.50 to 1.00 while specificity ranged from 0.83 to 1.00. The positive likelihood ratio ranged: from 5.44-47.72 and the negative likelihood ratio for the 15 studies ranged from 0.00-0.51. Significant heterogeneity was found across the 15 studies so the sensitivities and specificities were summarised by a Receiver Operating Characteristic (ROC) curve. For malignancy, sensitivity ranged from 0.81 to 0.94 and specificity from 0.92 to 1.00. Positive likelihood ratios ranged from 10.12 to 43 and negative likelihood ratios ranged from 0.15 to 0.21, although these estimates were less reliable. CONCLUSION MRCP is a comparable diagnostic investigation in comparison to ERCP for diagnosing biliary obstruction.
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Affiliation(s)
- Eva C Kaltenthaler
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | | | | | - Steven Thomas
- Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
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Moghaddam JA, Amini M, Adibnejad S. Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report. BMC Gastroenterol 2006; 6:1. [PMID: 16396681 PMCID: PMC1351192 DOI: 10.1186/1471-230x-6-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Accepted: 01/05/2006] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding. CASE PRESENTATION We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars) in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation) illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar. CONCLUSION Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.
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Affiliation(s)
- Jamal Akhavan Moghaddam
- Department of General Surgery, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Mollasadra Street, Tehran, Iran
| | - Mohsen Amini
- Department of Gastroenterology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Mollasadra Street, Tehran, Iran
| | - Soheil Adibnejad
- Department of General Surgery, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Mollasadra Street, Tehran, Iran
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Assaban M, Aubé C, Lebigot J, Ridereau-Zins C, Hamy A, Caron C. Intérêt de l’IRM avec perfusion de mangafodipir trisodium dans la détection des fuites biliaires. ACTA ACUST UNITED AC 2006; 87:41-7. [PMID: 16415779 DOI: 10.1016/s0221-0363(06)73968-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the value of contrast-enhanced magnetic resonance cholangiography with Teslascan perfusion for the detection and localization of trauma-induced and postoperative bile leaks. MATERIALS AND METHODS Between October 2002 and December 2004, 7 patients with suspected bile duct leaks after trauma (n = 2) or surgery (n = 5) requiring morphological evaluation were included. MRI examination included single shot fast spin- echo T2 weighted and gradient echo T1 weighted images prior to and 112 minutes in average after IV administration of mangafodipir trisodium. The results of contrast enhanced MR cholangiography were correlated to surgery (n = 3), clinical course (n = 3) and percutaneous drainage (n = 1). RESULTS Mangafodipir trisodium-enhanced imaging showed extravasated Teslascan in collections in 6 patients (86%) whereas the combination of T2 weighted images and mangafodipir trisodium enhanced images revealed biliary collections in 7 patients (100%). The fistula between bile duct and collection was visualized in 4 patients (57%) before mangafodipir trisodium perfusion and in 3 patients (43%) after injection. In one patient the fistula was visible only after injection. Combination of both pre- and post injection MR correctly depicted the origin of bile leak in 5 cases (71%). CONCLUSION Mangafodipir trisodium-enhanced magnetic resonance cholangiography is a non invasive technique that can successfully detect the presence of bile duct leaks. The combination of T2 weighted MR cholangiography and mangafodipir trisodium-enhanced T1 weighted MR cholangiography increases the sensitivity in detection and localization of the site of bile leak.
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Affiliation(s)
- M Assaban
- Département de Radiologie, CHU Angers
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Abstract
Endoscopy during pregnancy raises the unique issue of fetal safety. Endoscopic medications comprise a significant component of fetal risks from endoscopy. Before endoscopy, the gastroenterologist or anesthesiologist should evaluate the potential fetal risks of sedation and analgesia, identify any contraindications to endoscopy, stabilize the maternal medical status as necessary, and correct maternal hypoxia or hypotension. The mother should be informed about the potential teratogenic risks of endoscopic medications during pregnancy. Patients who receive sedation and analgesia should be monitored during endoscopy by continuous electrocardiography, continuous pulse oximetry, and intermittent sphygmomanometry, as well as by the pulse and respiratory rate. General principles of sedation and analgesia during pregnancy include use of the minimal effective dose, avoidance of unnecessary medications, and preferable use of Food and Drug Administration category B medications.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, Klein Professional Building, Philadelphia, PA 19141, USA.
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Persson A, Dahlström N, Smedby O, Brismar TB. Volume rendering of three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective study. Br J Radiol 2005; 78:1078-85. [PMID: 16352582 DOI: 10.1259/bjr/14176682] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic potential of prolonged drip infusion CT cholangiography (DIC-CT) using meglumine iotroxate (Biliscopin) and 3D volume rendering in patients with suspected obstructive biliary disease. From a material of 142 patients who had undergone a drip infusion CT, all cases with a verified surgical or endoscopic retrograde cholangiography (ERC) diagnosis (n=33) were selected. Age-matched controls were selected from the remaining examinations. Three radiologists reviewed all 66 examinations in retrospect, independently as well as in consensus. The image quality and the estimated diagnostic quality were rated as good or moderate in 91% of the 198 reviews. The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively (with sensitivities ranging from 88% to 94% for individual observers, and specificities from 86% to 96%). Two out of three strictures were observed. No false positive strictures were described. The use of volume rendering technique (VRT) improved diagnostic certainty in 28/198 (14%) of the evaluations. The visualization of ductal stones was improved in 18/48 (38%). No differences in diagnostic quality between single and multislice CT were observed. We conclude that a detailed image of the biliary tree with good sensitivity and specificity can be obtained by means of bilirubin-governed infusion time DIC-CT with volume rendering reconstruction.
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Affiliation(s)
- A Persson
- Center for Medical Image Science and Visualization, Linköping University Hospital, Sweden
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Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS, Kim YS, Lee JS, Lee MS, Lee HK, Shim CS, Kim BS. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 2005; 100:1051-7. [PMID: 15842578 DOI: 10.1111/j.1572-0241.2005.41057.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Early ERCP and endoscopic sphincterotomy for stone extraction can benefit the prognosis in patients with severe biliary pancreatitis, but are associated with complications. The ability to identify choledocholithiasis by noninvasive means in biliary pancreatitis is limited. The aim of this study was evaluation of the ability of MRCP to detect choledocholithiasis in patients with acute biliary pancreatitis. In addition, we investigated whether intraductal US (IDUS) could help manage these patients. METHODS Thirty-two patients with suspected biliary pancreatitis were studied prospectively. MRCP was performed immediately before ERCP by separate blinded examiners within 24 h of admission. Wire-guided IDUS was performed during ERCP within 72 h of admission, regardless of the results of MRCP. Using endoscopic extraction of a stone as the reference standard, the diagnostic yield of MRCP was compared with transabdominal US, CT, ERCP, and IDUS. RESULTS The sensitivity of US, CT, MRCP, ERCP, and IDUS for identifying choledocholithiasis was 20.0%, 40.0%, 80.0%, 90.0%, and 95.0%, respectively. The overall agreement between MRCP and ERCP was 90.6% for choledocholithiasis (kappa= 0.808, p < 0.01). The sensitivity of MRCP for detecting choledocholithiasis decreased with dilated bile ducts (bile duct diameter > 10 mm, 72.7% vs 88.9%). The combination of ERCP and IDUS improved accuracy in the diagnosis of choledocholithiasis. CONCLUSIONS MRCP can be used to select patients with biliary pancreatitis who require ERCP. IDUS may be applied in the management of biliary pancreatitis if ERCP is performed.
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Affiliation(s)
- Jong Ho Moon
- Digestive Disease Center, Institute for Digestive Research, Soon Chun Hyang University School of Medicine, Seoul, Korea
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