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Sample records for einzelschuss mr-cholangiopankreatographie mrcp

  1. MRCP. Magnetic resonance cholangiopancreatography; MRCP. Magnetresonanzcholangiopankreatografie

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja [Wisconsin-Madison Univ., Madison, WI (United States). Dept. of Radiology; Lauenstein, Thomas [Evangelisches Krankenhaus Duesseldorf (Germany). Radiologie

    2016-06-15

    Magnetic resonance cholangiopancreatography (MRCP) is a special MR technique to display and analyze the biliary tract and pancreatic ducts. MRCP sequences are equivalent to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic purposes due to technical developments of the classical T2 weighted MRCP sequences and the availability of contrast enhanced T1 weighted sequences. Therefore, MRCP plays a fundamental role in the diagnoses of hepatobliary and pancreatic diseases, which are presented in this review article as are technical details of sequence acquisitions and the underlying anatomy.

  2. MRCP in primary sclerosing cholangitis; MRCP bei primaerer sklerosierender Cholangitis

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    Weber, C.; Krupski, G.; Lorenzen, J.; Adam, G. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Grotelueschen, R.; Rogiers, X. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. fuer Hepatobilaere Chirurgie; Seitz, U. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik fuer Interdisziplinaere Endoskopie

    2003-02-01

    Purpose: Evaluation of MR-cholangiopancreaticography (MRCP) for the diagnosis of primary sclerosing cholangitis (PSC) in correlation with endoscopic retrograde cholangiopancreaticography (ERCP) and in comparison to the diagnostic accuracy of various T2-weighted sequences. Methods and Materials: Fifty-five patients (34 males, 21 females: mean age 40 years, range 16 to 65 years) with suspected PSC were examined in a 1.5 T MR unit (Magnetom Vision, Siemens, Erlangen), using breath-hold transverse and coronal HASTE, paracoronal RARE and thin-sliced HASTE (TS-HASTE) sequences. Applying a five-point-scale, two blinded investigators assessed the image quality for ROC analysis. Morphologic criteria of PSC were documented and correlated with ERCP, which served as the gold standard, and sensitivity, specificity and diagnostic accuracy were calculated. Results: PSC was confirmed in 40 of 55 patients (ERCP 55 of 55, liver biopsy 37 of 55), with concomitant chronic ulcerative colitis in 27 and Crohn's disease in 6 of the 40 patients. Qualitative analysis of the image quality showed no significant difference between RARE, HASTE and thin-sliced HASTE sequences (3.4/3.5/3.2). The RARE sequence had the highest sensitivity (97%), specificity (64%) and accuracy (84%) for the detection of PSC. The difference between HASTE and thin-sliced HASTE was statistically significant (p<0.01). Of the 40 patients with confirmed PSC, 29 were followed by MRI and 3 underwent a liver transplantation within the follow-up period. A Klatskin tumor, which was misdiagnosed by MRCP, was diagnosed by brush biopsy in 1 of the 40 patients. Interobserver variability was adequate to good (kappa 0.4 to 0.7), depending on the chosen sequence. (orig.) [German] Ziel: Wertigkeit der MRCP bei der Diagnostik der primaeren sklerosierenden Cholangitis (PSC) in Korrelation zur endoskopischen retrograden Cholangiopankreatikographie (ERCP) und Vergleich der diagnostischen Treffsicherheit verschiedener T{sub 2

  3. Diagnostic accuracy of MRCP in choledocholithiasis

    International Nuclear Information System (INIS)

    Guarise, Alessandro; Mainardi, Paride; Baltieri, Susanna; Faccioli, Niccolo'

    2005-01-01

    Purpose: To evaluate the accuracy of MRCP in diagnosing choledocholithiasis considering Endoscopic Retrograde Cholangiopancreatography (ERCP) as the gold standard. To compare the results achieved during the first two years of use (1999-2000) of Magnetic Resonance Cholangiopancreatography (MRCP) in patients with suspected choledocholithiasis with those achieved during the following two years (2001-2002) in order to establish the repeatability and objectivity of MRCP results. Materials and methods: One hundred and seventy consecutive patients underwent MRCP followed by ERCP within 72 h. In 22/170 (13%) patients ERCP was unsuccessful for different reasons. MRCP was performed using a 1.5 T magnet with both multi-slice HASTE sequences and thick-slice projection technique. Choledocholithiasis was diagnosed in the presence of signal void images in the dependent portion of the duct surrounded by hyperintense bile and detected at least in two projections. The MRCP results, read independently from the ERCP results, were compared in two different and subsequent periods. Results: ERCP confirmed choledocholithiasis in 87 patients. In these cases the results of MRCP were the following: 78 true positives, 53 true negatives, 7 false positives, and 9 false negatives. The sensitivity, specificity and accuracy were 90%, 88% and 89%, respectively. After the exclusion of stones with diameters smaller than 6 mm, the sensitivity, specificity and accuracy were 100%, 99% and 99%, respectively. MRCP accuracy was related to the size of the stones. There was no significant statistical difference between the results obtained in the first two-year period and those obtained in the second period. Conclusions: MRCP i sufficiently accurate to replace ERCP in patients with suspected choledocholithiasis. The results are related to the size of stones. The use of well-defined radiological signs allows good diagnostic accuracy independent of the learning curve [it

  4. CT vs. MRCP in choledocholithiasis jaundice.

    Science.gov (United States)

    Petrescu, I; Bratu, A M; Petrescu, S; Popa, B V; Cristian, D; Burcos, T

    2015-01-01

    Obstructive jaundice can raise problems to diagnostic imaging. The radiologist must choose the most appropriate examination that delivers the most important diagnostic information because the differences between a lithiasic obstruction and a tumoral one are vital. This information helps the surgeon speed up the process of decision-making, because the treatment may be very different in relation to the nature of the obstruction. This study tries to demonstrate the diagnostic accuracy of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting the obstacle in the common bile duct (CBD) and the possibility of establishing the lithiasic nature of the obstruction. A retrospective analysis was analyzed during an interval of 18 months that included jaundice patients admitted in the General Surgery Department of "Coltea" Clinical Hospital. They were examined by CT scanning and by MRCP, being suspected of choledocholithiasis. 63 patients were included in the study, 34 females and 29 males. 33 CT scans and 30 MRCP exams were performed. CT scan is useful in detecting residual or iterative choledocholithiasis in patients after cholecystectomy, contrast enhanced CT (CECT), being able to differentiate between lithiasic and non-lithiasic obstruction. MRCP delivers important anatomic details of the biliary tree; it is superior to CT in diagnosing the hepatocholedochal lithiasis; MRCP tends to replace endoscopic retrograde cholangiopancreatography (ERCP)--the diagnostic "gold standard" reducing the number of unnecessary invasive diagnostic procedures.

  5. Diagnostic value of high strength MRCP in the obstructive jaundice

    International Nuclear Information System (INIS)

    Yang Yang; Dong Yuhai; Yin Jie; Lv Guoyi

    2007-01-01

    Objective: To evaluate the diagnostic value of high strength MRCP in patients with obstructive jaundice. Methods: Routine MRI and MRCP examination on 161 patients with obstructive jaundice were carded out with 1.5T Siemens super-conductive magnetic resonance machine. Of them, 103 cases were benign lesions and 58 were malignant after surgical and ERCP pathological confirmation. Results: The diagnostic accuracy of MRCP was 100%, with the qualitative diagnostic accuracy at 90.2%. Conclusion: MRCP was the best method in diagnosing patients with obstructive jaundice, the concerned performances of MRCP could provide the dependable basis for surgical operation project. (authors)

  6. The role of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis

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    Yamazaki, Yukinao; Nishikawa, Kunihisa; Ohtaki, Tetsuo; Hata, Masanori; Miyaji, Hideki; Hayashi, Shigeyuki [Fukui Red Cross Hospital (Japan)

    2001-07-01

    Recently, magnetic resonance cholangiopancreatography (MRCP) has been widely used in the clinical field as a noninvasive method to visualize the main pancreatic duct and the biliary system. We evaluated the accuracy of MRCP, abdominal CT and abdominal urtrasonography in the diagnosis of choledocholithiasis in comparison with that of endoscopic retrograde cholangiopancreatography (ERCP). Forty patients with choledocholithiasis with some complications, such as icterus, pancreatitis or cholangitis, were examined by MRCP, CT, US and ERCP. We studied the detection rate of the common bile duct stones in MRCP, CT, US separately, and the diagnostic value of each of the other techniques was compared with that of ERCP. The detection rate of common bile duct stones in MRCP, CT and US was 87.5%, 80.5% and 45.0%, respectively. The combined detection rate in MRCP and CT, MRCP and US, CT and US, and MRCP, CT and US was 95.0%, 97.5%, 80.0% and 100%, respectively. MRCP could not efficiently detect common bile duct stones less than 5 mm in size. Moreover, it was impossible to detect impacted stones in the papilla of Vater by MRCP. Currently, it would seem that the combination of MRCP, CT and US has comparable efficacy for the diagnosis of common bile duct stones in patients with the complications to that of ERCP. (author)

  7. The role of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis

    International Nuclear Information System (INIS)

    Yamazaki, Yukinao; Nishikawa, Kunihisa; Ohtaki, Tetsuo; Hata, Masanori; Miyaji, Hideki; Hayashi, Shigeyuki

    2001-01-01

    Recently, magnetic resonance cholangiopancreatography (MRCP) has been widely used in the clinical field as a noninvasive method to visualize the main pancreatic duct and the biliary system. We evaluated the accuracy of MRCP, abdominal CT and abdominal urtrasonography in the diagnosis of choledocholithiasis in comparison with that of endoscopic retrograde cholangiopancreatography (ERCP). Forty patients with choledocholithiasis with some complications, such as icterus, pancreatitis or cholangitis, were examined by MRCP, CT, US and ERCP. We studied the detection rate of the common bile duct stones in MRCP, CT, US separately, and the diagnostic value of each of the other techniques was compared with that of ERCP. The detection rate of common bile duct stones in MRCP, CT and US was 87.5%, 80.5% and 45.0%, respectively. The combined detection rate in MRCP and CT, MRCP and US, CT and US, and MRCP, CT and US was 95.0%, 97.5%, 80.0% and 100%, respectively. MRCP could not efficiently detect common bile duct stones less than 5 mm in size. Moreover, it was impossible to detect impacted stones in the papilla of Vater by MRCP. Currently, it would seem that the combination of MRCP, CT and US has comparable efficacy for the diagnosis of common bile duct stones in patients with the complications to that of ERCP. (author)

  8. Usefulness of MRCP in pediatric biliary tract diseases

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    Kuroda, Hiroaki; Yoshida, Hideo; Matsunaga, Tadashi; Kouchi, Katsunori; Ohtsuka, Yasuhiro; Ohnuma, Naomi [Chiba Univ. (Japan). School of Medicine

    2000-01-01

    We compared MR cholangiopancreatography (MRCP) with endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatobiliary diseases to examine usefulness of MRCP. Twenty-one patients from 19 days to 10 years of age with pancreatobiliary diseases were examined by MRCP and ERCP. MRCP were obtained using Fast Spin Echo with reconstruction by Maximum Intensity Projection (MIP). As for the biliary tract, we could obtain MRCP comparable to ERCP in all patients. We could obtain the clear images of pancreatic duct in 13 patients, including 2 of the 8 patients under one year of age (25%), all 7 patients between 1 and 3 years of age (100%), 4 over three years of age (67%). We could obtain MRCP of the biliary system in patients with pancreatobiliary diseases comparable to ERCP. ERCP was superior to MRCP as for the pancreatic duct. (author)

  9. Evaluation of dynamic MRCP after secretin stimulation for biliopancreatic diseases

    International Nuclear Information System (INIS)

    Ohhigashi, Seiji; Nishio, Takeki; Watanabe, Fumihiko; Haradome, Hiroki; Doi, Osamu

    2000-01-01

    Both pancreaticobiliary maljunction and pancreatogastrostomy after pancreatoduodenectomy were analyzed to assess the utility of dynamic MRCP after secretin stimulation. Dynamic MRCP obtained every 60 seconds for 15 minutes after secretin administration revealed the bile and pancreatic fluid kinetics. Calculating the intensity value from the MR images allowed objective estimation of the bile and pancreatic fluid kinetics. Thus, this study demonstrated that dynamic MRCP after secretin stimulation was significantly useful in evaluating not only the morphologic features in pancreaticobiliary maljunction but also pancreatic exocrine function after resection of the pancreas. (author)

  10. Clinical evaluation of further-developed MRCP sequences in comparison with standard MRCP sequences

    International Nuclear Information System (INIS)

    Hundt, W.; Scheidler, J.; Reiser, M.; Petsch, R.

    2002-01-01

    The purpose of this study was the comparison of technically improved single-shot magnetic resonance cholangiopancreatography (MRCP) sequences with standard single-shot rapid acquisition with relaxation enhancement (RARE) and half-Fourier acquired single-shot turbo spin-echo (HASTE) sequences in evaluating the normal and abnormal biliary duct system. The bile duct system of 45 patients was prospectively investigated on a 1.5-T MRI system. The investigation was performed with RARE and HASTE MR cholangiography sequences with standard and high spatial resolutions, and with a delayed-echo half-Fourier RARE (HASTE) sequence. Findings of the improved MRCP sequences were compared with the standard MRCP sequences. The level of confidence in assessing the diagnosis was divided into five groups. The Wilcoxon signed-rank test at a level of p<0.05 was applied. In 15 patients no pathology was found. The MRCP showed stenoses of the bile duct system in 10 patients and choledocholithiasis and cholecystolithiasis in 16 patients. In 12 patients a dilatation of the bile duct system was found. Comparison of the low- and high spatial resolution sequences and the short and long TE times of the half-Fourier RARE (HASTE) sequence revealed no statistically significant differences regarding accuracy of the examination. The diagnostic confidence level in assessing normal or pathological findings for the high-resolution RARE and half-Fourier RARE (HASTE) was significantly better than for the standard sequences. For the delayed-echo half-Fourier RARE (HASTE) sequence no statistically significant difference was seen. The high-resolution RARE and half-Fourier RARE (HASTE) sequences had a higher confidence level, but there was no significant difference in diagnosis in terms of detection and assessment of pathological changes in the biliary duct system compared with standard sequences. (orig.)

  11. Clinical evaluation of further-developed MRCP sequences in comparison with standard MRCP sequences

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    Hundt, W.; Scheidler, J.; Reiser, M. [Department of Clinical Radiology, Klinikum Grosshadern, Ludwig-Maximilians University of Munich (Germany); Petsch, R. [Department of MRI, Siemens Medizintechnik, Erlangen (Germany)

    2002-07-01

    The purpose of this study was the comparison of technically improved single-shot magnetic resonance cholangiopancreatography (MRCP) sequences with standard single-shot rapid acquisition with relaxation enhancement (RARE) and half-Fourier acquired single-shot turbo spin-echo (HASTE) sequences in evaluating the normal and abnormal biliary duct system. The bile duct system of 45 patients was prospectively investigated on a 1.5-T MRI system. The investigation was performed with RARE and HASTE MR cholangiography sequences with standard and high spatial resolutions, and with a delayed-echo half-Fourier RARE (HASTE) sequence. Findings of the improved MRCP sequences were compared with the standard MRCP sequences. The level of confidence in assessing the diagnosis was divided into five groups. The Wilcoxon signed-rank test at a level of p<0.05 was applied. In 15 patients no pathology was found. The MRCP showed stenoses of the bile duct system in 10 patients and choledocholithiasis and cholecystolithiasis in 16 patients. In 12 patients a dilatation of the bile duct system was found. Comparison of the low- and high spatial resolution sequences and the short and long TE times of the half-Fourier RARE (HASTE) sequence revealed no statistically significant differences regarding accuracy of the examination. The diagnostic confidence level in assessing normal or pathological findings for the high-resolution RARE and half-Fourier RARE (HASTE) was significantly better than for the standard sequences. For the delayed-echo half-Fourier RARE (HASTE) sequence no statistically significant difference was seen. The high-resolution RARE and half-Fourier RARE (HASTE) sequences had a higher confidence level, but there was no significant difference in diagnosis in terms of detection and assessment of pathological changes in the biliary duct system compared with standard sequences. (orig.)

  12. ORIGINAL ARTICLE ORI ORI Accuracy of MRCP compared with ...

    African Journals Online (AJOL)

    Aim. To determine the accuracy of magnetic resonance cholangiopancreatography (MRCP) compared with the gold standard endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of bile duct disorders at Universitas Hospital, University of the. Free State (UFS), Bloemfontein. Patients and methods.

  13. MRCP in the evaluation of pancreaticobiliary disease in children

    International Nuclear Information System (INIS)

    Arcement, C.M.; Meza, M.P.; Arumanla, S.; Towbin, R.B.

    2001-01-01

    Background. Radiologic assessment of pancreaticobiliary ductal disease (PBDD) in children currently consists of physiologic tests (radionuclide examinations) or invasive anatomic studies (ERCP and PTC). An accurate noninvasive and reproducible examination that can direct the subsequent need for more invasive studies would be helpful in this patient group. Objective. To determine the effectiveness of MRCP as a screening tool for PBBD in the pediatric population. Materials and methods. Over the last year, 33 patients ranging from 7 months to 20 years of age were prospectively evaluated with MRCP on a 1.5 T magnet. One patient was examined twice, several months apart. Thirteen patients had liver transplants. Coronal SPGR and heavily T-2W FSE cross-sectional images were obtained. Standard and oblique 2- to 6-cm-thick slab SSFSE (single-shot fast spin echo) acquisition and 3D MIP reconstruction of 2D FSE images were obtained in the planes of the CBD and pancreatic duct. Nine studies were performed with the patient under sedation with chloral hydrate or nembutal and fentanyl with quiet respiration, and the non-sedated patients were assessed with single breath hold or quiet respiration. Three patients received secretin. MRCP results were correlated with ERCP (9), PTC (7), liver biopsy (13), clinical information (6), surgery (3), and autopsy (2). Results. All 34 studies performed were considered diagnostic. Periportal fluid, proximal bowel fluid, and gallbladder distention did not significantly diminish the diagnostic information in any cases. Motion artifact did not cause serious degradation in image quality. MRCP depicted abnormalities including stones, stricture, intraductal tumor, and extrinsic compression, all of which were confirmed at ERCP, PTC (two unsuccessful in patients with non-dilated ducts by MRCP), surgery, liver biopsy, and autopsy. There were no false-negative examinations. Normal pancreatic studies performed to exclude pancreas divisum were followed

  14. MRCP in the evaluation of pancreaticobiliary disease in children

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    Arcement, C.M.; Meza, M.P.; Arumanla, S.; Towbin, R.B. [Children' s Hospital of Pittsburgh, Dept. of Radiology, Pittsburgh, PA (United States)

    2001-02-01

    Background. Radiologic assessment of pancreaticobiliary ductal disease (PBDD) in children currently consists of physiologic tests (radionuclide examinations) or invasive anatomic studies (ERCP and PTC). An accurate noninvasive and reproducible examination that can direct the subsequent need for more invasive studies would be helpful in this patient group. Objective. To determine the effectiveness of MRCP as a screening tool for PBBD in the pediatric population. Materials and methods. Over the last year, 33 patients ranging from 7 months to 20 years of age were prospectively evaluated with MRCP on a 1.5 T magnet. One patient was examined twice, several months apart. Thirteen patients had liver transplants. Coronal SPGR and heavily T-2W FSE cross-sectional images were obtained. Standard and oblique 2- to 6-cm-thick slab SSFSE (single-shot fast spin echo) acquisition and 3D MIP reconstruction of 2D FSE images were obtained in the planes of the CBD and pancreatic duct. Nine studies were performed with the patient under sedation with chloral hydrate or nembutal and fentanyl with quiet respiration, and the non-sedated patients were assessed with single breath hold or quiet respiration. Three patients received secretin. MRCP results were correlated with ERCP (9), PTC (7), liver biopsy (13), clinical information (6), surgery (3), and autopsy (2). Results. All 34 studies performed were considered diagnostic. Periportal fluid, proximal bowel fluid, and gallbladder distention did not significantly diminish the diagnostic information in any cases. Motion artifact did not cause serious degradation in image quality. MRCP depicted abnormalities including stones, stricture, intraductal tumor, and extrinsic compression, all of which were confirmed at ERCP, PTC (two unsuccessful in patients with non-dilated ducts by MRCP), surgery, liver biopsy, and autopsy. There were no false-negative examinations. Normal pancreatic studies performed to exclude pancreas divisum were followed

  15. Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis.

    Science.gov (United States)

    Wong, Hon-Phin; Chiu, Yu-Lun; Shiu, Bei-Hao; Ho, Lu-Chang

    2012-07-01

    There are risks of common bile duct (CBD) stones in acute cholecystitis, and there is a move among surgeons to identify choledocholithiasis before surgery. Magnetic resonance cholangiopancreaticography (MRCP) has the potential to accurately detect choledocholithiasis in patients with acute cholecystitis. The aim of this study was to evaluate the predictive values of MRCP and elevated biochemical predictors for choledocholithiasis in patients with acute cholecystitis. Between September 2006 and August 2008, of 84 patients with acute cholecystitis based on the diagnosis criteria of the Tokyo guidelines, 57 had MRCP preoperatively. The predictive values of six biochemical predictors for choledocholithiasis were also evaluated. Of the 57 patients, seven (12.28%) had choledocholithiasis, of whom three had CBD stones in nondilated ducts. The smallest stone detected in a dilated CBD and nondilated duct was 3.19 and 4.55 mm in diameter, respectively. None of our patients whose MRCP showed a clear CBD returned with symptomatic choledocholithiasis during the follow-up period. All biochemical predictors and CBD diameter had limited positive predictive values. Magnetic resonance cholangiopancreaticography is a reliable evaluation technique for the detection of choledocholithiasis. It reduces the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and prevents the risk of overlooking choledocholithiasis. No single predictor or combined markers have been found to be reliable for including/excluding the presence of choledocholithiasis.

  16. Magnetic resonance cholangio-panceatography (MRCP) in the diagnosis of biliary disease

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    Okada, Morihiro; Higashi, Katsuhiko; Enomoto, Shotaro; Fujii, Yasunari; Yamane, Hiroshi; Tsujiuchi, Kazushi; Tanimoto, Satoshi [Hidaka General Hospital, Gobo, Wakayama (Japan); Itoh, Hidekazu; Nishioka, Shingo

    1998-05-01

    This study was undertaken to compare the clinical value of MRCP with fast advanced spin echo (FASE) with endoscopic retrograde cholangio-panceatography (ERCP). Thirty-four patients (12 female, 22 male, mean age 65.8 years) suspected of having biliary disease were examined prospectively during a period of 17 months (from April 1996 to August 1997) by MRCP and either ERC or percutaneous transhepatic cholangiography (PTC). MRCP was performed with a 0.5 T scanner (TOSHIBA FLEXART) and a quadrature body coil. MRCP images were obtained using FASE. MRCP enabled a correct diagnosis of the cause of obstruction (nine malignant strictures). In 4 of the 9 patients with malignant strictures, MRCP provided more information than the corresponding ERCP or PTC study. In all cases with malignant strictures, the level of obstruction and the length of the stenotic portion was correctly determined with MRCP. A correct diagnosis of choledocholithiasis was made in 8 of 9 cases, gallstones in the common bile duct were accurately visualized on MRCP. However, the correct diagnosis of hepatolithiasis was made in only 1 of 3 patients. In summary, diagnostic quality MRCP images were obtained in 28 of the 33 patients (85%). In conclusion, our findings indicate that MRCP is a useful method in the diagnosis of biliary disease and may reduce the need for diagnostic ERCP. (author)

  17. Secretin-stimulating MRCP. The diagnosis of pancreaticobiliary reflux

    International Nuclear Information System (INIS)

    Motosugi, Utaroh; Ichikawa, Tomoaki; Araki, Tsutomu

    2003-01-01

    Pancreaticobiliary maljunction is a clinically important condition that may cause the occurrence of biliary malignancies. It is widely accepted that continuous reflux of the pancreatic juice into the common bile duct (CBD) and/or gallbladder is essential as an etiology of biliary malignancies. It has been also mentioned that reflux of the pancreatic juice into the CBD/gallbladder is observed regardless of the presence of pancreaticobiliary maljunction. Secretin-stimulating MRCP may demonstrate not only outflow of the pancreatic juice to the duodenum but also the phenomenon of reflux of the pancreatic juice into the CBD/gallbladder as enlargement of the CBD/gallbladder. We investigated whether secretin-stimulating MRCP can diagnose pancreaticobiliary reflux. (author)

  18. MR cholangiopancreatography (MRCP) at 0.5 T: technique optimisation and preliminary results

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    Pavone, P. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Laghi, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Catalano, C. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Broglia, L. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Messina, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Scipioni, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Di Girolamo, M. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Passariello, R. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy)

    1996-04-01

    The aim of our study was to evaluate the feasibility of MR cholangiopancreatography (MRCP) at 0.5 T. To our knowledge no previous studies of MRCP have been performed at mid-field strength. Thirty-one patients with dilated biliary systems were examined with three-dimensional MRCP. All patients were studied with a 0.5 T superconducting magnet. A three-dimensional turbo spin-echo (TSE) sequence was acquired (TR=5000 ms, TE=244 ms, echo train length=45; acquisition time=14 min 10 s). Coronal images were post-processed with the MIP algorithm. Recently, the parameters have been optimised (TR=3000 ms, TE=700 ms, echo train length=128), reducing the acquisition time to 3 min. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 26 cases; 5 patients underwent percutaneous transhepatic cholangiography PTC. MRCP and ERCP images were evaluated by an experienced radiologist and an endoscopist. MRCP of diagnostic quality was acquired in all patients. Choledocholithiasis was correctly evaluated by MRCP in 12 of 12 patients, compared with 11 correct diagnoses by ERCP. The Presence and the level of the stricture were accurately shown in 16 of 16 patients with MRCP and in 13 of 16 patients with ERCP. The peripheral biliary tree above the obstruction and pancreatic duct were better evaluated by MRCP in all cases. In 3 of 3 patients who had undergone bilio-enteric surgery, a correct evaluation of the site of the anastomosis was possible with MRCP. It is concluded that MRCP performed at mid-field strength allows good visualisation of the dilated biliary system. Excellent results have been obtained on comparison with ERCP. MRCP performed at mit-field strength could have the same clinical value as high field strength MRCP. (orig.)

  19. Improvement of MR cholangiopancreatography (MRCP) images after black tea consumption

    International Nuclear Information System (INIS)

    Ghanaati, Hossein; Rokni-Yazdi, Hadi; Firouznia, Kavous; Jalali, Amir Hossein; Abahashemi, Firouze; Shakiba, Madjid

    2011-01-01

    Evaluation of the efficacy of black tea as the negative oral contrast agent in MRCP. MRCP was performed before and 5 and 15 min after tea consumption for 35 patients. Depiction of the gall bladder (GB), cystic duct (CD), proximal and distal parts of the common bile duct (CBD), intrahepatic ducts (IHD), ampulla of vater (AV), main pancreatic duct (MPD) and signal loss of stomach and three different segments of the duodenum were investigated according to VAS and Likert scores. Twenty-one of the patients (60%) were female (mean age, 50.3 ± 19.2 years). Regarding visibility of different anatomical parts of the pancreatobiliary tree, the post procedure images were better visualized in the distal part of CBD, AV and MPD in Likert and VAS scoring (all P≤0.001). Regarding obliteration of high signal in the stomach and three different parts of the duodenum, all post procedure images showed significant disappearance of high signal in Likert and VAS scoring systems (all Ps≤0.001). Black tea is a simple and safe negative oral contrast agent which reduces the signal intensity of gastrointestinal tract fluid and provides improved depiction of the MPD, the distal CBD and the ampulla during MRCP. (orig.)

  20. Magnetic Resonance Cholangiopancreatography in 3 Tesla: 2D MRCP versus 3D MRCP in Diagnostic Evaluation with Special Reference to Different Acquisition and Reconstruction Planes

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    Vikram Patil

    2015-03-01

    Full Text Available Purpose: Magnetic resonance cholangiopancreatography (MRCP is an established technique for the evaluation of intra- and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. However, the ideal acquisition and reconstruction plane for optimal bile duct evaluation with 3D technique has not been evaluated.The purpose of our study was to compare different acquisition and reconstruction planes of 3D MRCP for bile duct assessment. Methods: 51 consecutive adult patients suspected to have pancreatico-biliary disease were examined with 3 Tesla (Philips 3 T Ingenia system both a multi thin slice (3D and a breath-hold (Single Shot MRCP technique were performed. In the multi thin slice technique both source images and maximum intensity projections were examined. Two radiologists blinded to clinical information viewed both MRCP techniques independantly. Measure of correlation between each of the techniques and the inter observer agreement were computed. Coronal and axial MIP were reconstructed based on each dataset (resulting in two coronal and two axial MIP, respectively and assessed the MIP, regarding visualization of bile ducts and image quality.Results were compared (Wilcoxon test. Intra- and interobserver variability were calculated (kappa-statistic. Results: In case of coronal data acquisition, visualization of bile duct segments was significantly better on coronal reconstructed MIP images as compared to axial reconstructed MIP (p 0.05. Image quality of coronal and axial datasets did not differ significantly. Obstruction due to tumor was shown in 30% of patients, and calculi in the common bile duct were shown also in 30% of patients employing the 3D MRCP technique. Obstruction due to tumor and calculi were shown in 30% and 21% of patients, respectively, using the SS 2D MRCP technique. Sensitivity and specificity in distinguishing calculi in the common bile duct by 3D MRCP and SS MRCP were 100%, 100%, 70% and 100

  1. Utility of MRCP in clinical decision making of suspected choledocholithiasis: An institutional analysis and literature review.

    Science.gov (United States)

    Badger, Wesley R; Borgert, Andrew J; Kallies, Kara J; Kothari, Shanu N

    2017-08-01

    The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. MRCP vs. operative intervention as the initial choice of treatment/imaging modality. We performed a retrospective review of the electronic medical records for all patients with a coded diagnosis of choledocholithiasis from 2011 to 2014. The initial diagnostic modality was assessed for each hospital encounter. The statistical characteristics of MRCP as compared to fluoroscopic imaging of the biliary tree (ERCP, IOC) were analyzed. Overall, 527 hospital encounters were identified. Initial intervention included ERCP in 63%, MRCP in 12%, and cholecystectomy in 25% of patients. Patients undergoing cholecystectomy first, compared to MRCP or ERCP, tended to have lower values for alkaline phosphatase (P choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Normal pancreatic exocrine function does not exclude MRI/MRCP chronic pancreatitis findings.

    Science.gov (United States)

    Alkaade, Samer; Cem Balci, Numan; Momtahen, Amir Javad; Burton, Frank

    2008-09-01

    Abnormal pancreatic function tests have been reported to precede the imaging findings of chronic pancreatitis. Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is increasingly accepted as the primary imaging modality for the detection of structural changes of early mild chronic pancreatitis. The aim of this study was to evaluate MRI/MRCP findings in patients with symptoms consistent with chronic pancreatitis who have normal Secretin Endoscopic Pancreatic Function test. A retrospective study of 32 patients referred for evaluation of chronic abdominal pain consistent with chronic pancreatitis and reported normal standard abdominal imaging (ultrasound, computed tomography, or MRI). All patients underwent Secretin Endoscopic Pancreatic Function testing and pancreatic MRI/MRCP at our institution. We reviewed the MRI/MRCP images in patients who had normal Secretin Endoscopic Pancreatic Function testing. MRI/MRCP images were assessed for pancreatic duct morphology, gland size, parenchymal signal and morphology, and arterial contrast enhancement. Of the 32 patients, 23 had normal Secretin Endoscopic Pancreatic Function testing, and 8 of them had mild to marked spectrum of abnormal MRI/MRCP findings that were predominantly focal. Frequencies of the findings were as follows: pancreatic duct stricture (n=3), pancreatic duct dilatation (n=3), side branch ectasia (n=4), atrophy (n=5), decreased arterial enhancement (n=5), decreased parenchymal signal (n=1), and cavity formation (n=1). The remaining15 patients had normal pancreatic structure on MRI/MRCP. Normal pancreatic function testing cannot exclude abnormal MRI/MRCP especially focal findings of chronic pancreatitis. Further studies needed to verify significance of these findings and establish MRI/MRCP imaging criteria for the diagnosis of chronic pancreatitis.

  3. Accuracy of MRCP compared to ERCP in the diagnosis of bile duct ...

    African Journals Online (AJOL)

    Aim. To determine the accuracy of magnetic resonance cholangiopancreatography (MRCP) compared with the gold standard endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of bile duct disorders at Universitas Hospital, University of the. Free State (UFS), Bloemfontein. Patients and methods.

  4. A Cholecystocolonic Fistula Detected by MRCP in a Patient with Chronic Cholecystitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    A cholecystocolonic fistula is an uncommon late complication of chronic gallstone disease. Although it may cause acute life-threatening complications such as bowel obstruction or massive hemorrhaging, its accurate preoperative diagnosis may be difficult due to minimal or nonspecific symptoms. Cholecystocolonic fistulas have been diagnosed by various methods, including ERCP. However, the diagnosis of a cholecystocolonic fistula using MRCP has not been reported in the literature. In this case report, we describe a case of a cholecystocolonic fistula detected by MRCP.

  5. The Value of Secretin-Enhanced MRCP in Patients With Recurrent Acute Pancreatitis.

    Science.gov (United States)

    Sandrasegaran, Kumar; Tahir, Bilal; Barad, Udaykamal; Fogel, Evan; Akisik, Fatih; Tirkes, Temel; Sherman, Stuart

    2017-02-01

    The purpose of this study is to assess the additional value of secretin-enhanced MRCP over conventional (non-secretin-enhanced) MRCP in diagnosing disease in patients with recurrent acute pancreatitis. A retrospective review of a radiology database found 72 patients with recurrent acute pancreatitis who had secretin-enhanced MRCP and ERCP correlation within 3 months of each other between January 2007 and December 2011. Of these patients, 54 had no history of pancreatic tumor or surgery and underwent MRI more than 3 months after an episode of acute pancreatitis. In addition, 57 age- and sex-matched control subjects with secretin-enhanced MRCP and ERCP correlation and without a diagnosis of recurrent acute pancreatitis or chronic pancreatitis were enrolled as the control group. All studies were anonymized, and secretin-enhanced MRCP images (image set A) were separated from conventional 2D and 3D MRCP and T2-weighted images (image set B). Image sets A and B for each patient were assigned different and randomized case numbers. Two blinded reviewers independently assessed both image sets for ductal abnormalities and group A image sets for exocrine response to secretin. There were statistically significantly more patients with recurrent acute pancreatitis with reduced exocrine function compared with patients in the control group (32% vs 9%; p acute pancreatitis were more likely to have side branch dilation (p = 0.02; odds ratio, 3.6), but not divisum, compared with the control group. Secretin-enhanced images were superior to non-secretin-enhanced images for detecting ductal abnormalities in patients with recurrent acute pancreatitis, with higher sensitivity (76% vs 56%; p = 0.01) and AUC values (0.983 vs 0.760; p acute pancreatitis showed exocrine functional abnormalities. Secretin-enhanced MRCP had a significantly higher yield for ductal abnormalities than did conventional MRI and should be part of the MRCP protocol for investigation of patients with recurrent acute

  6. Assessment of the form and patency of the pancreatic duct by magnetic resonance cholangiopancreatography (MRCP)

    International Nuclear Information System (INIS)

    Kitamura, Masaya; Takahashi, Tuyoshi; Yoshida, Muneki; Shimada, Ken; Kakita, Akira; Isobe, Yoshinori

    1999-01-01

    There have been no reliable methods for the assessment of the patency of an end-to-side style pancreaticojejunal anastomosis in Whipple procedure. We evaluated the ability of MR-Cholangiopancreatography (MRCP) to assess the form and patency of the pancreatic duct in 181 patients. The pancreatic duct was displayed on MRCP in 70.9% of the patients. The domostrative rate of the pancreatic duct on MRCP and the PFD test were well correlated (p=0.031). Further, we assessed the patency of pancreaticojejunal anastomosis in Whipple procedure by MRCP following a secretin load. It was considered that the pancreatic duct to be patent when pancreatic excretion into the jejunum had increased and/or the ability to display the pancreatic duct had improved on MRCP following an i.v. load of secretin. A secretin-loading MRCP was suggested to be of much help in the assessment of the patency of pancreaticojejunostomy in patients undergoing Whipple procedure for a long-term follow up. (author)

  7. Comparison between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP)

    International Nuclear Information System (INIS)

    Pulpeiro, J. R.; Armesto, V.; Lopez-Roses, L.; Lancho, A.; Gonzalez, A.

    2000-01-01

    To assess the correlation between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). The authors carried out a prospective study of 71 patients suspected of having biliary diseases. MRCP was performed, followed by ERCP.MRCP was done with a 1.5-T system using hypergradients, abdominal phase array coil and single-shot fast spin-echo (SSFSE) sequences with maximum signal intensity in T2-weighted images. This sequence only provides images of the fluids, similar to those obtained with ERCP. The results of ERCP were employed as a reference standard. Thirty patients were found to have stenosis (19 malignant and 11 benign). 25 had choledocholithiasis and 16 showed no abnormal findings. The correlation was complete in patients with stenosis. MRCP detected 23 cases of choledocholithiasis (ERCP was normal in the remaining two patients, but calculi were discovered on shpincterotomy). MRCP confirmed the normal condition of the bile duct in 12 of the 16 patients free of biliary disease (2 patients in whom ERCP had been normal had been diagnosed as having bile duct dilatation due to choledocholithiasis 24 hours and 10 days earlier, respectively, and two cases of presented ectasia due to fibrosis of the sphincter of Oddi showed good emptying during ERCP). MRCP using SSFSE is highly correlated with ERCP, which should be reserved for cases in which the diagnosis is in doubt or endoscopic management is necessary. (Author) 25 refs

  8. The primary applications of Gd-DTPA as an oral negative gastrointestinal contrast agent for MRCP

    International Nuclear Information System (INIS)

    Chen Yanping; Zhang Xuelin; Cheng Guanxun; Chang Renmin; Zhang Yuzhong; Cang Peng; Xia Qiong

    2003-01-01

    Objective: Using oral Gd-DTPA as a negative contrast agent to null the bowel signal during MR cholangiopancreatography (MRCP) to improve the quality of MRCP. Methods: A phantom study was performed to select the optimal concentration of Gd-DTPA to be used as an oral negative contrast agent in MRCP. 15 patients suspected of biliary tract and pancreatic disease were performed with MRCP before and after using 250 ml oral contrast agents (1:5 diluted Gd-DTPA, 1.488 g/L). All MR images were acquired using a 1.5 T whole body MR scanner (Vision Plus, Siemens). MRCP was acquired using two-dimensional single slice fast spin-echo sequence and HASTE (half-fourier acquisition single-shot fast spin echo) sequence. Results: The phantom study showed that the dilution ratio 1:5 of Gd-DTPA oral contrast agent was best in decreasing the signal intensity both in T 2 WI (59.3%) and in HASTE sequence (82.45%). All the dilution ratio of Gd-DTPA oral contrast agent decreased the signal intensity up to 90% on single slice MRCP. In all the patients the high signal intensity from the stomach and intestinal fluid was completely suppressed. The depictions of common bile duct and pancreatic duct were markedly improved by the oral contrast agent (P<0.05). Conclusion: 1:5 diluted (1.488 g/L) oral MR contrast agent Gd-DTPA can be an effective and safe negative contrast agent in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in MRCP

  9. Evaluation of date syrup as an oral negative contrast agent for MRCP.

    Science.gov (United States)

    Govindarajan, Arunkumar; Lakshmanan, Prakash Manikka; Sarawagi, Radha; Prabhakaran, Velu

    2014-11-01

    The purpose of this study was to compare the in vitro effects of date syrup with those of other contrast agents by qualitative and quantitative analysis and in vivo evaluation of the use of date syrup to improve the quality of MRCP images. Phantoms containing date syrup, ferumoxsil, pineapple juice, and water were imaged by 1.5-T MRI with T2-weighted and MRCP sequences, and signal-to-noise ratios were calculated. Biochemical analysis of date syrup was performed to find the nature of iron in it, and the iron content was quantified by energy-dispersive x-ray spectroscopy. Sixty patients underwent MRCP before and 30 minutes after ingestion of 100 mL of date syrup. Unenhanced and contrast-enhanced images were scored for gastrointestinal tract signal suppression and visualization of various pancreaticobiliary structures. In vitro evaluation showed that images obtained with date syrup had a signal-to-noise ratio comparable to that of images obtained with ferumoxsil in T2-weighted and MRCP sequences. The iron concentration in date syrup was 2.6 mg/dL, and it was in ferric form. Images obtained after oral contrast administration had statistically significant improvement in gastrointestinal tract signal suppression (p syrup can be used as a negative oral contrast agent for gastrointestinal tract signal suppression during MRCP and for improving visualization of various pancreaticobiliary structures.

  10. Non-invasive quantification of pancreatic exocrine function using secretin-stimulated MRCP

    International Nuclear Information System (INIS)

    Punwani, S.; Gillams, A.R.; Lees, W.R.

    2003-01-01

    Our objective was to quantify water volume using magnetic resonance cholangiopancreatography (MRCP) sequences and apply this to secretin-stimulated studies with the aim of quantifying pancreatic exocrine function. A commercially available single-shot MRCP sequence was used in conjunction with a body phased-array coil and a 1.5-T MR system. Signal intensity was measured in samples of water, pancreatic, duodenal juice, and secretin-stimulated pancreatic juice. A water phantom was made and MR calculated volumes compared with known water volumes within the phantom. Changes in small intestinal volume in response to secretin were measured in a group of 11 patients with no evidence of pancreatic disease. Changes in water volume were plotted over time. The pancreatic duct diameter before and after secretin was noted and filling defects were sought. All patients also underwent an axial breath-hold T1-weighted gradient-echo sequence and the pancreatic parenchyma was evaluated for size and signal intensity. There was no difference in the signal intensity of the different juice samples. There was excellent correlation between known and calculated MRCP volumes (χ 2 =0.99). All patients demonstrated normal duct morphology on MRCP and normal pancreatic parenchyma on T1-weighted imaging. The mean flow rate in the patient population was 8.1±2.5 ml/s over a median of 7 min (range 5-9 min). The MRCP sequence can be used to measure water volume. Sequential MRCP measurements following secretin permitted calculation of volume change and flow rate. This should prove useful as an indicator of pancreatic exocrine function. (orig.)

  11. Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

    Energy Technology Data Exchange (ETDEWEB)

    Ozkavukcu, Esra [Ankara University School of Medicine, Department of Radiology (Turkey)], E-mail: eozkavukcu@gmail.com; Erden, Ayse; Erden, Ilhan [Ankara University School of Medicine, Department of Radiology (Turkey)

    2009-07-15

    Purpose: To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods: Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n = 16) studies accompanied by MR portography (n = 13), dynamic CE CT (n = 3) or dynamic CE MRI (n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results: All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion: MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

  12. Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

    International Nuclear Information System (INIS)

    Ozkavukcu, Esra; Erden, Ayse; Erden, Ilhan

    2009-01-01

    Purpose: To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods: Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n = 16) studies accompanied by MR portography (n = 13), dynamic CE CT (n = 3) or dynamic CE MRI (n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results: All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion: MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

  13. The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis

    Science.gov (United States)

    Mandelia, Ankur; Gupta, Arun Kumar; Verma, Devendra Kumar; Sharma, Sanjeev

    2013-01-01

    Introduction: Magnetic Resonance Cholangio-Pancreatography (MRCP) is a non-invasive radiological investigation which can be performed rapidly and which does not expose the patients to ionised radiations or iodinated contrast material. The present study was conducted to evaluate the role of MRCP in detection of Common Bile Duct (CBD) stones in patients with suspected choledocholithiasis. Material and Methods: This prospective study included 30 patients with a suspicion of choledocholithiasis which was based on clinical evaluation, biochemical or radiological investigations. Ultrasonography and MRCP were performed in all patients. All patients underwent open surgery. CBD exploration was performed in all patients, either due to presence of palpable stones or due to the presence of dilated CBD (> 7 mm). Demonstration of CBD stones intra-operatively was considered the ‘gold standard’ for their presence, defined as stones visualised and extracted or attempted for extraction during surgical CBD exploration. Results: Intra–operatively, 21 (70%) out of 30 patients had cholelithiasis. 26 (86.67%) out of 30 patients had dilated CBD stones intra-operatively. In 20 (66.67%) out of 30 patients, choledocholithiasis was detected intra-operatively. The sensitivity, specificity, positive and negative predictive value of ultrasonography in detecting CBD stones in the present study was 65%, 60%, 76.47% and 46.15% respectively. The sensitivity, specificity, positive and negative predictive value of MRCP in diagnosis of CBD stones in the present study was 95%, 90%, 95% and 90% respectively. Conclusions: MRCP is a non–invasive investigation without complications and it has high sensitivity, specificity and positive and negative predictive values in detection of CBD stones. MRCP should be done in all cases with a suspicion of CBD stones, where facilities and expertise are available. PMID:24179904

  14. Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Negrelli, Riccardo; Manfredi, Riccardo; Pedrinolla, Beatrice; Boninsegna, Enrico; Ventriglia, Anna; Mehrabi, Sara; Pozzi Mucelli, Roberto [G.B. Rossi University Hospital, University of Verona, Department of Radiology, Verona (Italy); Frulloni, Luca [Universita di Verona, Department of Gastroenterology, Policlinico G.B. Rossi, Verona (Italy)

    2014-08-09

    To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis. MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement. Signal intensity abnormalities were localized in the head in 10/26 (38.5 %) and in the body-tail in 16/26 (61.5 %) patients. MRCP showed a single MPD stenosis in 12/26 (46.1 %) and multiple MPD stenosis in 14/26 (53.8 %) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6 %) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2 %) patients with contrast retention. MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma. (orig.)

  15. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review

    International Nuclear Information System (INIS)

    Kaltenthaler, Eva C; Walters, Stephen J; Chilcott, Jim; Blakeborough, Anthony; Vergel, Yolanda Bravo; Thomas, Steven

    2006-01-01

    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. 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. 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. MRCP is a comparable diagnostic investigation in comparison to ERCP for diagnosing biliary obstruction

  16. Factors and Outcomes Associated with MRCP Use prior to ERCP in Patients at High Risk for Choledocholithiasis.

    Science.gov (United States)

    Anand, Gobind; Patel, Yuval A; Yeh, Hsin-Chieh; Khashab, Mouen A; Lennon, Anne Marie; Shin, Eun Ji; Canto, Marcia I; Okolo, Patrick I; Kalloo, Anthony N; Singh, Vikesh K

    2016-01-01

    Background. Consensus guidelines recommend that patients at high risk for choledocholithiasis undergo endoscopic retrograde cholangiopancreatography (ERCP) without additional imaging. This study evaluates factors and outcomes associated with performing magnetic resonance cholangiopancreatography (MRCP) prior to ERCP among patients at high risk for choledocholithiasis. Methods. An institutional administrative database was searched using diagnosis codes for choledocholithiasis, cholangitis, and acute pancreatitis and procedure codes for MRCP and ERCP. Patients categorized as high risk for choledocholithiasis were evaluated. Results. 224 patients classified as high risk, of whom 176 (79%) underwent ERCP only, while 48 (21%) underwent MRCP prior to ERCP. Patients undergoing MRCP experienced longer time to ERCP (72 hours versus 35 hours, p choledocholithiasis is common and associated with greater length of hospital stay, higher radiology charges, and a trend towards higher hospital charges.

  17. Factors and Outcomes Associated with MRCP Use prior to ERCP in Patients at High Risk for Choledocholithiasis

    Directory of Open Access Journals (Sweden)

    Gobind Anand

    2016-01-01

    Full Text Available Background. Consensus guidelines recommend that patients at high risk for choledocholithiasis undergo endoscopic retrograde cholangiopancreatography (ERCP without additional imaging. This study evaluates factors and outcomes associated with performing magnetic resonance cholangiopancreatography (MRCP prior to ERCP among patients at high risk for choledocholithiasis. Methods. An institutional administrative database was searched using diagnosis codes for choledocholithiasis, cholangitis, and acute pancreatitis and procedure codes for MRCP and ERCP. Patients categorized as high risk for choledocholithiasis were evaluated. Results. 224 patients classified as high risk, of whom 176 (79% underwent ERCP only, while 48 (21% underwent MRCP prior to ERCP. Patients undergoing MRCP experienced longer time to ERCP (72 hours versus 35 hours, p<0.0001, longer length of stay (8 days versus 6 days, p=0.02, higher hospital charges ($23,488 versus $19,260, p=0.08, and higher radiology charges ($3,385 versus $1,711, p<0.0001. The presence of common bile duct stone(s on ultrasound was the only independent factor associated with less use of MRCP (OR 0.09, p<0.0001. Conclusions. MRCP use prior to ERCP in patients at high risk for choledocholithiasis is common and associated with greater length of hospital stay, higher radiology charges, and a trend towards higher hospital charges.

  18. Noninvasive investigation of exocrine pancreatic function: Feasibility of cine dynamic MRCP with a spatially selective inversion-recovery pulse.

    Science.gov (United States)

    Yasokawa, Kazuya; Ito, Katsuyoshi; Tamada, Tsutomu; Yamamoto, Akira; Hayashida, Minoru; Tanimoto, Daigo; Higaki, Atsushi; Noda, Yasufumi; Kido, Ayumu

    2015-11-01

    To investigate the feasibility of noncontrast-enhanced cine dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatially selective inversion-recovery (IR) pulse for evaluating exocrine pancreatic function in comparison with the N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test as a pancreatic exocrine function test. Twenty subjects with or without chronic pancreatitis were included. MRCP with a spatially selective IR pulse was repeated every 15 seconds for 5 minutes to acquire a total of 20 images (cine-dynamic MRCP). The median and mean frequency of the observation (the number of times) and the moving distance (mean secretion grading scores) of pancreatic juice inflow on cine-dynamic MRCP were compared with a BT-PABA test. The urinary PABA excretion rate (%) had significant positive correlations with both the mean secretion grade (r = 0.66, P = 0.002) and frequency of secretory inflow (r = 0.62, P = 0.004) in cine dynamic MRCP. Both the mean frequency of observations of pancreatic secretory inflow (1.4 ± 1.6 times vs. 14.3 ± 4.2 times, P Cine dynamic MRCP with a spatially selective IR pulse may have potential for estimating the pancreatic exocrine function noninvasively as a substitute for the BT-PABA test. © 2015 Wiley Periodicals, Inc.

  19. An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

    International Nuclear Information System (INIS)

    Önder, Hakan; Ekici, Faysal; Adin, Emin; Kuday, Suzan; Gümüş, Hatice; Bilici, Aslan

    2013-01-01

    Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions

  20. Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP

    Science.gov (United States)

    Wang, Deng-Bin; Yu, Jinxing; Fulcher, Ann S; Turner, Mary A

    2013-01-01

    AIM: To determine the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) features of pancreatitis with pancreas divisum (PD) and the differences vs pancreatitis without divisum. METHODS: Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study. During one year period, 1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner. Two experienced radiologists retrospectively reviewed all the studies in consensus. Disputes were resolved via consultation with a third experienced radiologist. The assessment included presence and the imaging findings of PD, pancreatitis, and distribution of abnormalities. The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group. MRCP and MRI findings were correlated with final diagnosis. Fisher exact tests and Pearson × 2 tests were performed. RESULTS: Pancreatitis was demonstrated at MRCP and MRI in 173 cases (38 cases with and 135 cases without divisum) among the 1439 consecutive cases. The recurrent acute pancreatitis accounted for 55.26% (21 of 38) in pancreatitis patients associated with PD, which was higher than 6.67% (9 of 135) in the control group, whereas the chronic pancreatitis was a dominant type in the control group (85.19%, 115 of 135) when compared to the study group (42.11%, 16 of 38) (χ2 = 40.494, P pancreatitis with PD, the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD (17 of 38, 44.74% vs 30 of 135, 22.22%) (χ2 = 7.257, P pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum. PMID:23946595

  1. The exploratory development of A self-made oral Gd-DTPA solution for low field MRCP in children

    International Nuclear Information System (INIS)

    Sheng Mao; Zhou Min; Gu Zhicheng; Wu Jizhi; Guo Wanliang; Ni Yongbiao; Fang Lin

    2010-01-01

    Objective: To evaluate the value of ingestion self-made Gd-DTPA solutin for low field magnetic resonance cholangiopancreatography (MRCP) (0.35T) in children. Methods: Phantom experiments were performed to select the optimal concentration of Gd-DTPA to be used as an oral negative contrast agent in low field MRCP. Twenty children suspected of celiac disease were performed with MRCP before and after ingestion Gd-DTPA solution. Signal intensity measurements of gastroduodenal lumens, pancreatobiliary ducts, and image quality scores were obtained systematically before and after contrast ingestion. Results: The selected Gd-DTPA concentration was 1.992 mmol/L. Ingestion of 80 ml solution eliminated or suppressed efficiently the gastroduodenal signal intensity, improving the MRCP image quality scores (P<0.01) significantly in children. Conclusion: 1.992 mmol/L self-made Gd-DTPA solutin can suppress or eliminate water signals from gastrointestinal tract and improve the quality of low field MRCP image in children. (authors)

  2. Diagnosis of choledocholithiasis using magnetic resonance cholangiopancreatography (MRCP) 0.5T single-slice 2D-fast advanced spin echo (FASE)

    International Nuclear Information System (INIS)

    Watanabe, Manabu; Sumino, Yasukiyo

    2003-01-01

    A number of authors have recently evaluated the accuracy of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of choledocholithiasis at high field strength (1.5 T), but few have specifically addressed the use of MRCP at mid-field strength (0.5 T). The aim of this study was to prospectively compare MRCP at 0.5 T with endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of choledocholithiasis. One hundred fifty-two patients with suspected choledocholithiasis underwent MRCP at 0.5 T with two-dimensional (2D) heavily T2-weighted fast advanced spin echo (FASE) and ERCP. MRCP findings were then compared with ERCP findings. ERCP revealed choledocholithiasis in 40 patients (38 at first attempt, 2 after repeat ERCP); the diagnosis was confirmed by endoscopic sphincterotomy or endoscopic papillary dilatation. In all MRCP examinations images of satisfactory quality were obtained. There were 40 true-positives, 110 true-negatives, 2 false-positives, and no false-negatives: a sensitivity of 100% and specificity of 98.2%. This corresponds to a positive predictive value of 95.2% and a negative predictive value of 100%. MRCP at 0.5 T with 2D-FASE, a noninvasive and rapid modality, can accurately diagnose choledocholithiasis. ERCP is indispensable in the treatment of choledocholithiasis, but the diagnostic ability of MRCP with the widely used 0.5 T is adequate, with results similar to those of high field strength. (author)

  3. Diagnostic accuracy of MRCP in choledocholithiasis; Accuratezza diagnostica della colangiowirsung-RM nella coledocolitiasi

    Energy Technology Data Exchange (ETDEWEB)

    Guarise, Alessandro; Mainardi, Paride [Ospedale Sacro Cuore-Don Calabria, Negrar, Verona (Italy). Servizio di Radiologia; Baltieri, Susanna; Faccioli, Niccolo' [Verona Univ., Verona (Italy). Istituto di Radiologia Policlinico G. B. Rossi

    2005-03-01

    Purpose: To evaluate the accuracy of MRCP in diagnosing choledocholithiasis considering Endoscopic Retrograde Cholangiopancreatography (ERCP) as the gold standard. To compare the results achieved during the first two years of use (1999-2000) of Magnetic Resonance Cholangiopancreatography (MRCP) in patients with suspected choledocholithiasis with those achieved during the following two years (2001-2002) in order to establish the repeatability and objectivity of MRCP results. Materials and methods: One hundred and seventy consecutive patients underwent MRCP followed by ERCP within 72 h. In 22/170 (13%) patients ERCP was unsuccessful for different reasons. MRCP was performed using a 1.5 T magnet with both multi-slice HASTE sequences and thick-slice projection technique. Choledocholithiasis was diagnosed in the presence of signal void images in the dependent portion of the duct surrounded by hyperintense bile and detected at least in two projections. The MRCP results, read independently from the ERCP results, were compared in two different and subsequent periods. Results: ERCP confirmed choledocholithiasis in 87 patients. In these cases the results of MRCP were the following: 78 true positives, 53 true negatives, 7 false positives, and 9 false negatives. The sensitivity, specificity and accuracy were 90%, 88% and 89%, respectively. After the exclusion of stones with diameters smaller than 6 mm, the sensitivity, specificity and accuracy were 100%, 99% and 99%, respectively. MRCP accuracy was related to the size of the stones. There was no significant statistical difference between the results obtained in the first two-year period and those obtained in the second period. Conclusions: MRCP i sufficiently accurate to replace ERCP in patients with suspected choledocholithiasis. The results are related to the size of stones. The use of well-defined radiological signs allows good diagnostic accuracy independent of the learning curve. [Italian] Scopo: Valutare l

  4. Single dose oral ranitidine improves MRCP image quality: a double-blind study

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    Bowes, M.T. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Martin, D.F. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)]. E-mail: derrick.martin@smtr.nhs.uk; Melling, A. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Roberts, D. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Laasch, H.-U. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Sukumar, S. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Morris, J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)

    2007-01-15

    Aim: To investigate the possibility of whether a single 300 mg dose of ranitidine given orally 2-3 h before magnetic resonance cholangiopancreatography (MRCP) could reduce the signal from the stomach and duodenum, and thus increase the conspicuousness of the biliary tree. Materials and methods: Thirty-five volunteers (22 female, 13 male), (age range 21-50) were underwent MRCP in a double-blind, placebo-controlled, randomized, crossover trial on a Philips Intera 1.5 T machine using a phased array surface coil. Imaging was carried out in the coronal oblique plane. Six 40 mm sections were acquired at varying angles to delineate the biliary tree and pancreatic duct. The 70 examinations were blindly scored by three consultants experienced in cholangiography. Results: After ranitidine administration there was a significant decrease in signal from the stomach (mean = 17.7, p = 0.0005, CI 10, 25.3) and duodenum (mean = 18.4, p = 0.0005, 95%CI 9.6, 27.1) with a significant increase in conspicuousness of the distal common duct (mean = 7.7, p = 0.033, 95%CI 0.7, 14.7) and proximal common duct (mean = 8.7, p = 0.010 CI 2.2, 15.2). There were no adverse effects. Conclusion: Oral ranitidine is a cheap and effective agent to decrease signal from the upper gastrointestinal tract and to improve visibility of the biliary tree.

  5. Single dose oral ranitidine improves MRCP image quality: a double-blind study

    International Nuclear Information System (INIS)

    Bowes, M.T.; Martin, D.F.; Melling, A.; Roberts, D.; Laasch, H.-U.; Sukumar, S.; Morris, J.

    2007-01-01

    Aim: To investigate the possibility of whether a single 300 mg dose of ranitidine given orally 2-3 h before magnetic resonance cholangiopancreatography (MRCP) could reduce the signal from the stomach and duodenum, and thus increase the conspicuousness of the biliary tree. Materials and methods: Thirty-five volunteers (22 female, 13 male), (age range 21-50) were underwent MRCP in a double-blind, placebo-controlled, randomized, crossover trial on a Philips Intera 1.5 T machine using a phased array surface coil. Imaging was carried out in the coronal oblique plane. Six 40 mm sections were acquired at varying angles to delineate the biliary tree and pancreatic duct. The 70 examinations were blindly scored by three consultants experienced in cholangiography. Results: After ranitidine administration there was a significant decrease in signal from the stomach (mean = 17.7, p = 0.0005, CI 10, 25.3) and duodenum (mean = 18.4, p = 0.0005, 95%CI 9.6, 27.1) with a significant increase in conspicuousness of the distal common duct (mean = 7.7, p = 0.033, 95%CI 0.7, 14.7) and proximal common duct (mean = 8.7, p = 0.010 CI 2.2, 15.2). There were no adverse effects. Conclusion: Oral ranitidine is a cheap and effective agent to decrease signal from the upper gastrointestinal tract and to improve visibility of the biliary tree

  6. [Comparison of 2D and 3D sequences for MRCP. Clinical value of the different techniques].

    Science.gov (United States)

    Wallnoefer, A M; Herrmann, K A; Beuers, U; Zech, C J; Gourtsoyianni, S; Reiser, M F; Schoenberg, S O

    2005-11-01

    Magnetic resonance cholangio-pancreaticograpy (MRCP) is a non-invasive imaging modality of the pancreatico-biliary system which plays an increasingly important role in the clinical and diagnostic workup of patients with biliary or pancreatic diseases. The present review is designed to give an overview of the currently available and appropriate sequences, their technical background, as well as new developments and their relevance to the various clinical issues and challenges. The impact of the latest technical innovations, such as integrated parallel imaging techniques and navigator-based respiratory triggering, on the diagnostic capacities of MRCP is discussed. In this context, the individual value of RARE, T2w single shot turbo/fast spin echo (SSFSE) and the recently introduced 3D T2w turbo/fast spin echo sequences (T2w 3D-T/FSE) is reviewed. RARE imaging may be preferred in severely ill patients with limitations in cooperation, SSFSE is particularly effective in differentiating benign and malignant stenosis, and 3D-FSE offers additional advantages in the detection of small biliary concrements.

  7. Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse.

    Science.gov (United States)

    Yasokawa, Kazuya; Ito, Katsuyoshi; Tamada, Tsutomu; Yamamoto, Akira; Hayashida, Minoru; Torigoe, Teruyuki; Tanimoto, Daigo; Higaki, Atsushi; Noda, Yasufumi; Kido, Ayumu

    2016-12-01

    To evaluate the influence of oral ingestion on the secretory flow dynamics of physiological pancreatic juice within the main pancreatic duct in healthy subjects by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively. Thirty-eight healthy subjects were investigated. MRCP with spatially-selective IR pulse was repeated every 15 s for 5 min to acquire a total of 20 images (cine-dynamic MRCP). A set of 20 MRCP images was repeatedly obtained before and after liquid oral ingestion every 7 min (including 2-min interval) for 40 min (a total of seven sets). Secretion grade of pancreatic juice on cine-dynamic MRCP was compared before and after oral ingestion using the nonparametric Wilcoxon signed-rank test. Median secretion grades of pancreatic juice at 5 min (score = 2.15), 12 min (score = 1.95) and 19 min (score = 2.05) after ingestion were significantly higher than that before ingestion (score = 1.40) (P = 0.004, P = 0.032, P = 0.045, respectively). Secretion grade of pancreatic juice showed a maximum peak of 2.15 at 5 min after ingestion. Thereafter, the secretion grade of pancreatic juice tended to gradually decline. Non-invasive cine-dynamic MRCP using spatially-selective IR pulse showed potential for evaluating postprandial changes in the secretory flow dynamics of pancreatic juice as a physiological reaction. • Secretion grade of pancreatic juice at cine-dynamic MRCP after ingestion was evaluated. • Secretion grade was significantly increased within 19 min after liquid meal ingestion. • Secretion grade showed maximum peak of 2.15 at 5 min after ingestion. • Postprandial changes in pancreatic juice flow can be assessed by cine-dynamic MRCP.

  8. Comparison between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP); Comparacion entre calongiografia por resonancia magnetica (CPRM) y colangiografia retrograda endoscopia (CPRE)

    Energy Technology Data Exchange (ETDEWEB)

    Pulpeiro, J. R.; Armesto, V. [Clinica Nosa Senora dos Ollos Grandes. Lugo (Spain); Lopez-Roses, L.; Lancho, A.; Gonzalez, A. [Hospital Xeral. Lugo (Spain)

    2000-07-01

    To assess the correlation between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). The authors carried out a prospective study of 71 patients suspected of having biliary diseases. MRCP was performed, followed by ERCP.MRCP was done with a 1.5-T system using hypergradients, abdominal phase array coil and single-shot fast spin-echo (SSFSE) sequences with maximum signal intensity in T2-weighted images. This sequence only provides images of the fluids, similar to those obtained with ERCP. The results of ERCP were employed as a reference standard. Thirty patients were found to have stenosis (19 malignant and 11 benign). 25 had choledocholithiasis and 16 showed no abnormal findings. The correlation was complete in patients with stenosis. MRCP detected 23 cases of choledocholithiasis (ERCP was normal in the remaining two patients, but calculi were discovered on shpincterotomy). MRCP confirmed the normal condition of the bile duct in 12 of the 16 patients free of biliary disease (2 patients in whom ERCP had been normal had been diagnosed as having bile duct dilatation due to choledocholithiasis 24 hours and 10 days earlier, respectively, and two cases of presented ectasia due to fibrosis of the sphincter of Oddi showed good emptying during ERCP). MRCP using SSFSE is highly correlated with ERCP, which should be reserved for cases in which the diagnosis is in doubt or endoscopic management is necessary. (Author) 25 refs.

  9. Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse

    Energy Technology Data Exchange (ETDEWEB)

    Yasokawa, Kazuya; Ito, Katsuyoshi; Tamada, Tsutomu; Yamamoto, Akira; Hayashida, Minoru; Torigoe, Teruyuki; Tanimoto, Daigo; Higaki, Atsushi; Noda, Yasufumi; Kido, Ayumu [Kawasaki Medical School, Department of Diagnostic Radiology, Kurashiki, Okayama (Japan)

    2016-12-15

    To evaluate the influence of oral ingestion on the secretory flow dynamics of physiological pancreatic juice within the main pancreatic duct in healthy subjects by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively. Thirty-eight healthy subjects were investigated. MRCP with spatially-selective IR pulse was repeated every 15 s for 5 min to acquire a total of 20 images (cine-dynamic MRCP). A set of 20 MRCP images was repeatedly obtained before and after liquid oral ingestion every 7 min (including 2-min interval) for 40 min (a total of seven sets). Secretion grade of pancreatic juice on cine-dynamic MRCP was compared before and after oral ingestion using the nonparametric Wilcoxon signed-rank test. Median secretion grades of pancreatic juice at 5 min (score = 2.15), 12 min (score = 1.95) and 19 min (score = 2.05) after ingestion were significantly higher than that before ingestion (score = 1.40) (P = 0.004, P = 0.032, P = 0.045, respectively). Secretion grade of pancreatic juice showed a maximum peak of 2.15 at 5 min after ingestion. Thereafter, the secretion grade of pancreatic juice tended to gradually decline. Non-invasive cine-dynamic MRCP using spatially-selective IR pulse showed potential for evaluating postprandial changes in the secretory flow dynamics of pancreatic juice as a physiological reaction. (orig.)

  10. Biliary anatomy in potential right hepatic lobe living donor liver transplantation (LDLT): The utility of CT cholangiography in the setting of inconclusive MRCP

    International Nuclear Information System (INIS)

    McSweeney, Sean E.; Kim, Tae Kyoung; Jang, Hyun-Jung; Khalili, Korosh

    2012-01-01

    Objective: To determine the utility of CT cholangiography (CT-Ch) in preoperative evaluation of the biliary anatomy of living-donor liver transplantation (LDLT) donors when magnetic resonance cholangiopancreatography (MRCP) is inconclusive. Materials and methods: Over a 2-year period, 22 potential living liver donors underwent contrast-enhanced CT-Ch for preoperative evaluating biliary anatomy due to inconclusive results on MRCP and subsequently donated their right hepatic lobe. Nineteen of them underwent intraoperative cholangiography and were included in this study. Two radiologists retrospectively reviewed both MRCP and CT-Ch with 1-month interval and documented the types of bile duct branching patterns and visualization score of intrahepatic bile ducts (4-point scale). Results: There were no complications associated with CT-Ch examinations. CT-Ch was concordant with the reference standard in 18/19 (95%) including 7/8 typical branching type and 11/11 anomalous branching types. MRCP was concordant with the reference standard in 14/19 (74%) including 4/8 typical branching types and 10/11 anomalous branching types. The discordant case by CT-Ch was the identification of a tiny accessory right intrahepatic duct joining the common bile duct which was not visualized on intraoperative cholangiography. CT-Ch showed higher visualization score (mean, 3.9) than MRCP (mean, 2.6) (P < .001). Conclusion: CT-Ch can be effectively used for the depiction of the branching pattern of the bile duct at the hepatic hilum when MRCP is inconclusive.

  11. Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients.

    Science.gov (United States)

    Kang, Stella K; Heacock, Laura; Doshi, Ankur M; Ream, Justin R; Sun, Jeffrey; Babb, James S

    2017-06-01

    To compare the performance of non-contrast MRI with half-Fourier acquisition single-shot turbo spin echo (HASTE) vs. contrast-enhanced MRI/3D-MRCP for assessment of suspected choledocholithiasis in hospitalized patients. 123 contrast-enhanced abdominal MRI/MRCP scans in the hospital setting for possible choledocholithiasis were retrospectively evaluated. Endoscopic retrograde cholangiopancreatography, intraoperative cholangiogram or documented clinical resolution served as the reference standard. Readers first evaluated the biliary tree using coronal and axial HASTE and other non-contrast sequences, and later reviewed the entire exam with post-contrast sequences and 3D-MRCP. Test performance for the image sets was compared for choledocholithiasis, acute hepatitis, cholangitis, and acute cholecystitis. Reader agreement, MRCP image quality, and confidence levels were also assessed. Clinical predictors of age and fever were tested for association with perceived need for contrast in biliary assessment. There were 27 cases of choledocholithiasis, 31 cases of acute hepatitis, 37 cases of acute cholecystitis, and 3 clinically diagnosed cases of acute cholangitis. Both the abbreviated and full contrast-enhanced/MRCP image sets resulted in high accuracy for choledocholithiasis (91.1-94.3% vs. 91.9-92.7%). There was no difference in sensitivity or specificity for either reader for any diagnosis between image sets (p > 0.40). 1 reader showed improved confidence (p choledocholithiasis, performance of non-contrast abdominal MRI with HASTE is similar to contrast-enhanced MRI with 3D-MRCP, offering potential for decreased scanning time and improved patient tolerability.

  12. Examination of intra-gastrointestinal tract signal elimination in MRCP. Combined use of positive contrast agent and fast inversion recovery

    International Nuclear Information System (INIS)

    Kato, Joji; Kawamura, Yoshihiko

    1999-01-01

    To examine the effects of removing the gastrointestinal signal in MRCP, investigations were carried out on the combined use of intestine-positive contrast medium FerriSeltz with Ferric ammonium citrate as the main component and high-speed imaging using fast inversion recovery. The contrast effect was significantly elevated to 9.90±1.77 after administration, compared with 5.3±2.45 before administration (p<0.001). The enhancement effect also was significantly elevated to 14.45±3.18 after administration, compared with 3.50±3.10 before administration (p<0.001). These results were obtained because the null point of FerriSeltz aqueous solution (5.97 mmol/1) was in the range of about 150-200 ms. With the present method, adequate suppression of the signal intensity of the digestive tract was obtained relatively easily on MRCP, and the technique was found to be effective. (author)

  13. ROLE OF MRCP IN DIAGNOSING PANCREATICOBILIARY DISORDERS WITH SURGICAL AND HISTOPATHOLOGICAL CORRELATION- A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE, GGH, KAKINADA, ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Radha Rani Kaki

    2017-05-01

    Full Text Available BACKGROUND Magnetic Resonance Cholangiopancreatography (MRCP was introduced in 1991 as a noninvasive method of imaging the biliary tree. Although, Endoscopic Cholangiopancreatography (ERCP has been the mainstay for diagnosing and treating pancreaticobiliary disease, complications such as pancreatitis, cholangitis, haemorrhage and duodenal perforation have made its limited use as a routine diagnostic test. Although, ERCP is still the standard of reference for imaging the pancreaticobiliary system, MRCP is the examination of choice in a setting where ERCP is difficult or impossible. It is useful in cases with severe biliary obstruction to evaluate the ducts proximal to the obstruction. MATERIALS AND METHODS In this prospective cohort study, 50 patients were studied predominantly by MRI and also by CT and ultrasound (wherever necessary. Imaging findings were evaluated, tabulated and correlated with surgical and histopathological findings and also clinical findings (wherever available. The findings were statistically analysed. RESULTS Most patients were in age range of 20-30 years. Male:females ratio was 5:3. Most of the cases came with pain abdomen and jaundice for evaluation were subjected to MRCP. Among those most common cases were chronic pancreatitis, cholelithiasis, pseudocysts and postop follow up cases to evaluate postop biliary strictures/biliary enteric anastomotic strictures and bile leaks. CONCLUSION MRCP in combination with other investigations like ultrasound, CT and clinical findings can be helpful in early diagnosis and for proper management of the patient.

  14. Secretin-enhanced magnetic resonance cholangiopancreaticography: value for the diagnosis of chronic pancreatitis; Sekretinstimulierte Magnetresonanzcholangiopankreaticografie (MRCP): Wertigkeit in der Diagnostik der chronischen Pankreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Heverhagen, J.T.; Burbelko, M.; Schenck zu Schweinsberg, T.; Funke, C.; Wecker, C.; Walthers, E.M.; Rominger, M. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik

    2007-08-15

    Endoscopic retrograde cholangiopancreaticography (ERCP) is the morphologic gold standard for the diagnosis of chronic pancreatitis. Magnetic Resonance Imaging (MRI) enables the visualization of not only the pancreatic duct but also the surrounding parenchyma using T2- and T1-weighted sequences before and after the application of a contrast agent. Moreover, it allows the depiction of ductal segments distal to a stenosis or occlusion. However, conventional Magnetic Resonance Cholangiopancreaticography (MRCP) was not able to achieve accuracy similar to that of ERCP. Despite many technological innovations, such as fast breath-hold acquisitions or respiratory-gated 3D sequences, this drawback could not be overcome. In recent years, secretin-enhanced MRCP has been used for the diagnosis of chronic pancreatitis. A recent study showed that secretin not only improves the visibility of the pancreatic duct and its side branches but it also enhances the diagnostic accuracy of MRCP. The sensitivity, specificity, and positive and negative predictive values were improved by the application of secretin. Moreover, the agreement between independent observers increased after the use of secretin. In addition, quantitative post-processing tools have been developed that enable the measurement of the exocrine pancreatic output non-invasively using secretin-enhanced MRCP. These tools facilitate applications, such as functional follow-up after pancreaticogastrostomy and pancreaticogastric anastomoses, evaluation of the functional status of the graft after pancreas transplantation and follow-up of pancreatic drainage procedures and duct disruption. (orig.)

  15. Automatic gallbladder segmentation using combined 2D and 3D shape features to perform volumetric analysis in native and secretin-enhanced MRCP sequences.

    Science.gov (United States)

    Gloger, Oliver; Bülow, Robin; Tönnies, Klaus; Völzke, Henry

    2017-11-24

    We aimed to develop the first fully automated 3D gallbladder segmentation approach to perform volumetric analysis in volume data of magnetic resonance (MR) cholangiopancreatography (MRCP) sequences. Volumetric gallbladder analysis is performed for non-contrast-enhanced and secretin-enhanced MRCP sequences. Native and secretin-enhanced MRCP volume data were produced with a 1.5-T MR system. Images of coronal maximum intensity projections (MIP) are used to automatically compute 2D characteristic shape features of the gallbladder in the MIP images. A gallbladder shape space is generated to derive 3D gallbladder shape features, which are then combined with 2D gallbladder shape features in a support vector machine approach to detect gallbladder regions in MRCP volume data. A region-based level set approach is used for fine segmentation. Volumetric analysis is performed for both sequences to calculate gallbladder volume differences between both sequences. The approach presented achieves segmentation results with mean Dice coefficients of 0.917 in non-contrast-enhanced sequences and 0.904 in secretin-enhanced sequences. This is the first approach developed to detect and segment gallbladders in MR-based volume data automatically in both sequences. It can be used to perform gallbladder volume determination in epidemiological studies and to detect abnormal gallbladder volumes or shapes. The positive volume differences between both sequences may indicate the quantity of the pancreatobiliary reflux.

  16. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound.

    Science.gov (United States)

    Qiu, Yan; Yang, Zhengpeng; Li, Zhituo; Zhang, Weihui; Xue, Dongbo

    2015-11-14

    The diagnosis of associated choledocholithiasis prior to cholecystectomy for patients with gallstones is important for the surgical decision and treatment efficacy. However, whether ultrasound is sufficient for preoperative diagnosis of choledocholithiasis remains controversial, with different opinions on whether routine magnetic resonance cholangiopancreatography (MRCP) is needed to detect the possible presence of common bile duct (CBD) stones. In this study, a total of 413 patients with gallstones who were admitted to the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University in China for a period of 3 years and underwent both ultrasound and MRCP examinations were retrospectively analysed. After reviewing and screening these cases according to the literature, 11 indicators including gender, age, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, γ-aminotransferase, CBD diameter, and concurrent acute cholecystitis were selected and comparatively analysed. Among the 413 patients, a total of 109 cases showed concurrent gallstones and choledocholithiasis, accounting for 26.39 % of all cases. Among them, 60 cases of choledocholithiasis were revealed by ultrasound examination, accounting for 55.05 %, while 49 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP instead (the missed diagnosis rate of ultrasound was 44.95 %). The results of statistical analysis suggested that alanine aminotransferase, acute cholecystitis, and CBD diameter were the three most relevant factors for missed diagnosis by ultrasound. The accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high. However, elevated alanine aminotransferase, concurrent acute cholecystitis, and CBD diameter were identified as key factors that may affect the accuracy of the diagnosis. Thus

  17. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    Science.gov (United States)

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P choledocholithiasis.

  18. Comparison of optimized 3D-SPACE and 3D-TSE sequences at 1.5T MRCP in the diagnosis of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Sudholt, P. [University Hospital Marburg (Germany). Dept. of Diagnostic and Interventional Radiology; Zaehringer, C.; Tyndall, A.; Bongartz, G.; Hohmann, J. [University Hospital Basel (Switzerland). Clinic for Radiology and Nuclear Medicine; Urigo, C. [Ars Medica Clinic, Gravesano-Lugano (Switzerland). Radiology

    2015-06-15

    The aim of the study was to evaluate whether or not MRCP using a 3D-SPACE sequence allows for better image quality and a higher level of diagnostic confidence than a conventional 3D-TSE sequence at 1.5T regarding the diagnosis of choledocholithiasis in a routine clinical setting. 3D-SPACE and 3D-TSE sequences were performed in 42 consecutive patients with suspected choledocholithiasis undergoing MRCP. Evaluation of image quality and diagnostic confidence was done on the pancreaticobiliary tree which was subdivided into 10 segments. They were scored and statistically evaluated separately for visibility and diagnostic certainty by three radiologists with differing levels of experience on a five-point scale of 1 to 5 and -2 to 2, respectively. Student t-test was performed, and the interobserver agreement was also calculated. Image quality for each segment was significantly better for the 3D-SPACE sequence compared to the 3D-TSE sequence (4.48±0.94 vs. 3.98±1.20; 5-point scale p<0.01). Diagnostic confidence for the reporting radiologist was also significantly better for 3D-SPACE than for 3D-TSE (1.68±0.56 vs. 1.46±0.70; 3-point scale; p<0.01). The interobserver agreement was high in both sequences, 0.62-0.83 and 0.64-0.82, respectively. The optimized 3D-SPACE sequence allows for better image quality in 1.5T MRCP examinations and leads to a higher diagnostic confidence for choledocholithiasis compared to the conventional 3D-TSE sequence.

  19. Comparison of optimized 3D-SPACE and 3D-TSE sequences at 1.5T MRCP in the diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Sudholt, P.; Zaehringer, C.; Tyndall, A.; Bongartz, G.; Hohmann, J.; Urigo, C.

    2015-01-01

    The aim of the study was to evaluate whether or not MRCP using a 3D-SPACE sequence allows for better image quality and a higher level of diagnostic confidence than a conventional 3D-TSE sequence at 1.5T regarding the diagnosis of choledocholithiasis in a routine clinical setting. 3D-SPACE and 3D-TSE sequences were performed in 42 consecutive patients with suspected choledocholithiasis undergoing MRCP. Evaluation of image quality and diagnostic confidence was done on the pancreaticobiliary tree which was subdivided into 10 segments. They were scored and statistically evaluated separately for visibility and diagnostic certainty by three radiologists with differing levels of experience on a five-point scale of 1 to 5 and -2 to 2, respectively. Student t-test was performed, and the interobserver agreement was also calculated. Image quality for each segment was significantly better for the 3D-SPACE sequence compared to the 3D-TSE sequence (4.48±0.94 vs. 3.98±1.20; 5-point scale p<0.01). Diagnostic confidence for the reporting radiologist was also significantly better for 3D-SPACE than for 3D-TSE (1.68±0.56 vs. 1.46±0.70; 3-point scale; p<0.01). The interobserver agreement was high in both sequences, 0.62-0.83 and 0.64-0.82, respectively. The optimized 3D-SPACE sequence allows for better image quality in 1.5T MRCP examinations and leads to a higher diagnostic confidence for choledocholithiasis compared to the conventional 3D-TSE sequence.

  20. Evaluation of pancreatic exocrine insufficiency by cine-dynamic MRCP using spatially selective inversion-recovery (IR) pulse: Correlation with severity of chronic pancreatitis based on morphological changes of pancreatic duct.

    Science.gov (United States)

    Yasokawa, Kazuya; Ito, Katsuyoshi; Kanki, Akihiko; Yamamoto, Akira; Torigoe, Teruyuki; Sato, Tomohiro; Tamada, Tsutomu

    2018-05-01

    To evaluate the correlation between the pancreatic exocrine insufficiency estimated by cine-dynamic MRCP using spatially selective IR pulse and the severity stages (modified Cambridge classification) based on morphological changes of the pancreatic duct in patients with suspected chronic pancreatitis. Thirty-nine patients with suspected chronic pancreatitis underwent cine-dynamic MRCP with a spatially selective IR pulse. The secretion grading score (5-point scale) based on the moving distance of pancreatic juice inflow on cine-dynamic MRCP was assessed, and compared with the stage of the severity of chronic pancreatitis based on morphological changes of pancreatic duct. The stage of the severity of chronic pancreatitis based on morphological changes had significant negative correlations with the secretion grade (r=-0.698, P0.70 in 2 (33%) of 6 patients showing normal pancreatic exocrine function. It should be noted that the degree of morphological changes of pancreatic duct does not necessarily reflect the severity of pancreatic exocrine insufficiency at cine-dynamic MRCP in stage 2-3 chronic pancreatitis. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Spectrum of biliary abnormalities in portal cavernoma cholangiopathy (PCC) secondary to idiopathic extrahepatic portal vein obstruction (EHPVO)-a prospective magnetic resonance cholangiopancreaticography (MRCP) based study.

    Science.gov (United States)

    Jabeen, Shumyla; Robbani, Irfan; Choh, Naseer A; Ashraf, Obaid; Shaheen, Feroze; Gojwari, Tariq; Gul, Sabeeha

    2016-12-01

    To characterize biliary abnormalities seen in portal cavernoma cholangiopathy (PCC) on MR cholangiopancreaticography (MRCP) and elucidate certain salient features of the disease by collaborating our findings with those of previous studies. We prospectively enrolled 52 patients with portal cavernoma secondary to idiopathic extrahepatic portal vein obstruction, who underwent a standard MRCP protocol. Images were analyzed for abnormalities involving the entire biliary tree. Terms used were those proposed by the Indian National Association for Study of the Liver. Angulation of the common bile duct (CBD) was measured in all patients with cholangiopathy. Cholangiopathy was seen in 80.7% of patients on MRCP. Extrahepatic ducts were involved in 95% of patients either alone (26%) or in combination with the intrahepatic ducts (69%). Isolated involvement of the intrahepatic ducts was seen in 4.8% of patients. Abnormalities of the extrahepatic ducts included angulation (90%), scalloping (76.2%), extrinsic impression/indentation (45.2%), stricture (14.3%) and smooth dilatation (4.8%). The mean CBD angle was 113.2 ± 19.8°. Abnormalities of the intrahepatic ducts included smooth dilatation (40%), irregularity (28%) and narrowing (9%). Cholelithiasis, choledocholithiasis and hepatolithiasis were seen in 28.6% (12) patients, 14.3% (6) patients and 11.9% (5) patients, respectively. There was a significant association between choledocholithiasis and CBD stricture, with no significant association between choledocholithiasis and cholelithiasis. A significant association was also seen between hepatolithiasis and choledocholithiasis. The spectrum of biliary abnormalities in PCC has been explored and some salient features of the disease have been elucidated, which allow a confident diagnosis of this entity. Advances in knowledge: PCC preferentially involves the extrahepatic biliary tree. Changes in the intrahepatic ducts generally occur as sequelae of involvement of the extrahepatic

  2. Graduates of different UK medical schools show substantial differences in performance on MRCP(UK Part 1, Part 2 and PACES examinations

    Directory of Open Access Journals (Sweden)

    Mollon Jennifer

    2008-02-01

    Full Text Available Abstract Background The UK General Medical Council has emphasized the lack of evidence on whether graduates from different UK medical schools perform differently in their clinical careers. Here we assess the performance of UK graduates who have taken MRCP(UK Part 1 and Part 2, which are multiple-choice assessments, and PACES, an assessment using real and simulated patients of clinical examination skills and communication skills, and we explore the reasons for the differences between medical schools. Method We perform a retrospective analysis of the performance of 5827 doctors graduating in UK medical schools taking the Part 1, Part 2 or PACES for the first time between 2003/2 and 2005/3, and 22453 candidates taking Part 1 from 1989/1 to 2005/3. Results Graduates of UK medical schools performed differently in the MRCP(UK examination between 2003/2 and 2005/3. Part 1 and 2 performance of Oxford, Cambridge and Newcastle-upon-Tyne graduates was significantly better than average, and the performance of Liverpool, Dundee, Belfast and Aberdeen graduates was significantly worse than average. In the PACES (clinical examination, Oxford graduates performed significantly above average, and Dundee, Liverpool and London graduates significantly below average. About 60% of medical school variance was explained by differences in pre-admission qualifications, although the remaining variance was still significant, with graduates from Leicester, Oxford, Birmingham, Newcastle-upon-Tyne and London overperforming at Part 1, and graduates from Southampton, Dundee, Aberdeen, Liverpool and Belfast underperforming relative to pre-admission qualifications. The ranking of schools at Part 1 in 2003/2 to 2005/3 correlated 0.723, 0.654, 0.618 and 0.493 with performance in 1999–2001, 1996–1998, 1993–1995 and 1989–1992, respectively. Conclusion Candidates from different UK medical schools perform differently in all three parts of the MRCP(UK examination, with the

  3. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP

    International Nuclear Information System (INIS)

    Yu, X.-R.; Huang, W.-Y.; Zhang, B.-Y.; Li, H.-Q.; Geng, D.-Y.

    2014-01-01

    Aim: To retrospectively evaluate the criteria for discriminating infiltrative cholangiocarcinoma from benign common bile duct (CBD) stricture using three-dimensional dynamic contrast-enhanced (3D-DCE) magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP) imaging and to determine the predictors for cholangiocarcinoma versus benign CBD stricture. Materials and methods: 3D-DCE MRI and MRCP images in 28 patients with infiltrative cholangiocarcinoma and 23 patients with benign causes of CBD stricture were reviewed retrospectively. The final diagnosis was based on surgical or biopsy records. Two radiologists analysed the MRI images for asymmetry, including the wall thickness, length, and enhancement pattern of the narrowed CBD segment, and upstream CBD dilatation. MRI findings that could be used as predictors were identified by univariate analysis and multivariable stepwise logistic regression analysis. Results: Malignant strictures were significantly thicker (4.4 ± 1.2 mm) and longer (16.7 ± 7.7 mm) than the benign strictures (p < 0.05), and upstream CBD dilatation was larger in the infiltrative cholangiocarcinoma cases (20.7 ± 5.7 mm) than in the benign cases (16.5 ± 5.2 mm; p = 0.018). During both the portal venous and equilibrium phases, hyperenhancement was more frequently observed in malignant cases than in benign cases (p < 0.001). The results of the multivariable stepwise logistic regression analysis showed that both hyperenhancement of the involved CBD during the equilibrium phase and the ductal thickness were significant predictors for malignant strictures. When two diagnostic predictive values were used in combination, almost all patients with malignant strictures (n = 26, 92.9%) and benign strictures (n = 21, 91.3%) were correctly identified; the overall accuracy was 92.2% with correct classifications in 47 of the 51 patients. Conclusion: Infiltrative cholangiocarcinoma and benign CBD

  4. Magnetic Resonance Cholangiopancreatography (MRCP)

    Science.gov (United States)

    ... cholangiopancreatography (ERCP). ERCP is a diagnostic procedure that combines endoscopy , which uses an illuminated optical instrument to ... The teddy bear denotes child-specific content. Related Articles and Media Magnetic Resonance Imaging (MRI) Safety Biliary ...

  5. 前期高齢者の自発的随意運動における運動関連脳電位(MRCP)について

    OpenAIRE

    時任, 真一郎

    2009-01-01

    Voluntary movement task performance in elderly men was investigated by comparing movement-related cortical potential (MRCP) in young and elderly men. In this study, we found that onset of elderly men in voluntary movement tasks were significantly slower and greater equipotential than young men. Those was suggested that the movement continuance years and the experience before the senile state influence the movement preparation stage according to the movement problem accomplishment to say nothi...

  6. Disorganized junior doctors fail the MRCP (UK).

    Science.gov (United States)

    Stanley, Adrian G; Khan, Khalid M; Hussain, Walayat; Tweed, Michael

    2006-02-01

    Career progression during undergraduate and early postgraduate years is currently determined by successfully passing examinations. Both academic factors (secondary school examination results, learning style and training opportunities) and non-academic factors (maturity, ethnic origin, gender and motivation) have been identified as predicting examination outcome. Few studies have examined organization skills. Disorganized medical students are more likely to perform poorly in end-of-year examinations but this observation has not been examined in junior doctors. This study asked whether organization skills relate to examination outcome amongst junior doctors taking the clinical Part II examination for the Membership of the Royal College of Physicians (Practical Assessment of Clinical Examination Skills). The study was conducted prospectively at four consecutive clinical courses that provided clinical teaching and practice to prepare trainees for the examination. Arrival time at registration for the course was the chosen surrogate for organization skills. Trainees were advised that they should arrive promptly at 8.00 a.m. for registration and it was explained that the course would start at 8.30 a.m. Recorded arrival times were compared with the pass lists published by the Royal College of Physicians. The mean arrival time was 8.17 a.m. A total of 81 doctors (53.3%) passed the examination with a mean arrival time of 8.14 a.m. However, 71 doctors failed the exam and arrived, on average, six minutes later than doctors who passed (p?=?0.006). Better-prepared junior doctors were more likely to pass the final examination. Arriving on time represents a composite of several skills involved in the planning of appropriate travel arrangements and is therefore a valid marker of organization skills and preparation. This novel study has shown that good time-keeping skills are positively associated with examination outcome.

  7. ORIGINAL ARTICLE ORI ORI Accuracy of MRCP compared with ...

    African Journals Online (AJOL)

    abnormalities in patients with obstructive jaundice are important to both surgeons and endoscopists. Biliary obstruction may be the result of choledocholithiasis, tumours or trauma, among other causes. The most common cause is choledocholithiasis. ERCP is still the gold standard for exploration of the biliopancreatic region ...

  8. Common spatial pattern with polarity check for reducing delay latency in detection of MRCP based BCI system

    DEFF Research Database (Denmark)

    Yao, Lin; Chen, Mei Lin; Sheng, Xinjun

    2017-01-01

    Dual tasking refers to the simultaneous execution of two tasks with different demands. In this study, we aimed to investigate the effect of a second task on a main task of motor execution and on the ability to detect the cortical potential related to the main task from non-invasive electroencepha...

  9. Light field driven streak-camera for single-shot measurements of the temporal profile of XUV-pulses from a free-electron laser; Lichtfeld getriebene Streak-Kamera zur Einzelschuss Zeitstrukturmessung der XUV-Pulse eines Freie-Elektronen Lasers

    Energy Technology Data Exchange (ETDEWEB)

    Fruehling, Ulrike

    2009-10-15

    The Free Electron Laser in Hamburg (FLASH) is a source for highly intense ultra short extreme ultraviolet (XUV) light pulses with pulse durations of a few femtoseconds. Due to the stochastic nature of the light generation scheme based on self amplified spontaneous emission (SASE), the duration and temporal profile of the XUV pulses fluctuate from shot to shot. In this thesis, a THz-field driven streak-camera capable of single pulse measurements of the XUV pulse-profile has been realized. In a first XUV-THz pump-probe experiment at FLASH, the XUV-pulses are overlapped in a gas target with synchronized THz-pulses generated by a new THz-undulator. The electromagnetic field of the THz light accelerates photoelectrons produced by the XUV-pulses with the resulting change of the photoelectron momenta depending on the phase of the THz field at the time of ionisation. This technique is intensively used in attosecond metrology where near infrared streaking fields are employed for the temporal characterisation of attosecond XUV-Pulses. Here, it is adapted for the analysis of pulse durations in the few femtosecond range by choosing a hundred times longer far infrared streaking wavelengths. Thus, the gap between conventional streak cameras with typical resolutions of hundreds of femtoseconds and techniques with attosecond resolution is filled. Using the THz-streak camera, the time dependent electric field of the THz-pulses was sampled in great detail while on the other hand the duration and even details of the time structure of the XUV-pulses were characterized. (orig.)

  10. The role of magnetic resonance cholangiopancreatography and ...

    African Journals Online (AJOL)

    ) is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in the diagnosis of obstructive biliary disorders. Aim: To compare the findings of MRCP with ...

  11. Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones - A comparison with ERCP and clinical follow-up

    NARCIS (Netherlands)

    Kats, J; Kraai, M; Dijkstra, AJ; Koster, K; ter Borg, F; Hazenberg, HJA; Schattenkerk, ME; des Plantes, BGZ; Eddes, EH

    2003-01-01

    Background/Aims: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was

  12. Cost-effectiveness of endoscopic ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients suspected of pancreaticobiliary disease

    DEFF Research Database (Denmark)

    Ainsworth, A P; Rafaelsen, S R; Wamberg, P A

    2004-01-01

    BACKGROUND: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163...

  13. Secretin-stimulated MR cholangio-pancreatography in the evaluation of asymptomatic patients with non-specific pancreatic hyperenzymemia

    Energy Technology Data Exchange (ETDEWEB)

    Donati, Francescamaria, E-mail: fra.donati@katamail.co [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy); Boraschi, Piero; Gigoni, Roberto; Salemi, Simonetta [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy); Faggioni, Lorenzo; Bertucci, Cristina; Cecchi, Claudia; Bartolozzi, Carlo [Diagnostic and Interventional Radiology, University of Pisa, Via Rome 67, I-56126 Pisa (Italy); Falaschi, Fabio [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy)

    2010-08-15

    Purpose: To assess the diagnostic value of secretin-stimulated MRCP (SS-MRCP) compared with conventional MRCP in asymptomatic patients with mild elevations of pancreatic enzymes. Materials and methods: Eighty asymptomatic patients with pancreatic hyperenzymemia underwent MR imaging at 1.5 T-device (Signa EXCITE, GE Healthcare). After the acquisition of axial T1w,T2w sequences, and conventional MRCP, SS-MRCP was performed using a single-slice coronal breath-hold, thick-slab, SSFSE T2w sequence, repeated every 30 s up to 15 min following intravenous injection of secretin (Secrelux, Sanochemia). Results: On the basis of the standards of reference, our final diagnoses were: negative findings (n = 23), pancreas divisum (n = 22), mild chronic pancreatitis (n = 14), inflammatory ampullary stenosis (n = 3), juxtapapillary duodenal diverticulum (n = 1), small cystic lesions (<1 cm) (n = 22; 5/22 cases associated with pancreas divisum). The image quality of SS-MRCP was significantly higher than that of conventional MRCP (p < 0.0001). Standards of reference did not differ significantly from of SS-MRCP findings (p = 0.5), while was statistically different from those of conventional MRCP (p < 0.0001). A significant difference was found between conventional MRCP and SS-MRCP findings (p < 0.0001). Conclusion: In asymptomatic patients with non-specific pancreatic hyperenzymemia SS-MRCP may represent the best non-invasive diagnostic technique, since it gives morphological and functional information.

  14. Preoperative evaluation of the cystic duct for laparoscopic cholecystectomy: comparison of navigator-gated prospective acquisition correction- and conventional respiratory-triggered techniques at free-breathing 3D MR cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Itatani, Ryo [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Namimoto, Tomohiro; Sakamoto, Fumi; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Kajihara, Hiroo; Yoshimura, Akira; Katahira, Kazuhiro [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Nasu, Jiro [Kumamoto Chuo Hospital, Department of Digestive Surgery, Kumamoto (Japan); Matsushita, Ikuo [Kumamoto Chuo Hospital, Department of Gastroenterological Medicine, Kumamoto (Japan); Kidoh, Masafumi [Amakusa Medical Center, Department of Diagnostic Radiology, Amakusa, Kumamoto (Japan)

    2013-07-15

    To evaluate the quality of magnetic resonance cholangiopancreatography (MRCP) images obtained with a three-dimensional navigator-gated (NG) technique and compare findings with conventional respiratory-triggered (RT) images in pre-laparoscopic cholecystectomy patients. Turbo-spin-echo (TSE) RT-MRCP (average 242 s) and balanced turbo-field-echo (bTFE) NG-MRCP (average 263 s) were acquired at 1.5-T MRI for 49 pre-laparoscopic cholecystectomy patients. Two radiologists independently assessed image quality, visibility of anatomical structures, common bile duct (CBD) stones, and signal-to-noise ratios (SNRs). Interobserver agreement was also evaluated. The anatomical details of the cystic duct were clearly demonstrated in 33 (67.3 %, reader A) and 35 (71.4 %, reader B) patients on RT-MRCP, and in 45 (91.8 %) and 44 (89.7 %) patients on NG-MRCP. On NG-MRCP, visualisation of the cystic duct (3.22/3.12), its origin (3.57/3.55), and the gallbladder(3.61/3.59) was statistically better than on RT-MRCP (2.90/2.78, 3.29/3.12, 2.98/2.88, respectively). The overall image quality was statistically better on NG-MRCP than RT-MRCP. Each technique identified the presence of CBD stones in all affected patients. The SNR was significantly higher on NG-MRCP (CHD 22.40, gallbladder 17.13) than RT-MRCP (CHD 17.05, gallbladder 9.30). Interobserver agreement was fair to perfect. Navigator-gated MRCP is more useful than respiratory-triggered MRCP for evaluating the gallbladder and cystic duct in patients scheduled for laparoscopic cholecystectomy. circle Magnetic resonance cholangiopancreatography (MRCP) provides important cystic duct information before laparoscopic cholecystectomy. (orig.)

  15. MRI and MRCP of chronic pancreatitis. 1: technique and methods; La valutazione delle pancreatiti croniche con Risonanza Magnetica e colangiopancreatografia con Risonanza Magnetica. Prima parte: aspetti tecnico-metodologici

    Energy Technology Data Exchange (ETDEWEB)

    Laghi, A.; Pavone, P.; Catalano, C.; Panebianco, V.; Luccichenti, G.; Fabiano, S.; Passariello, R. [Rome Univ. La Sapienza, Rome (Italy). Ist. di Radiologia

    1999-10-01

    Until recently, MR examinations of the pancreas were limited by motion artifacts, vascular pulsatility and poor spatial resolution. Today, new techniques have been developed, which allow to overcome these problems and provide additional information such as selective images of biliary and pancreatic ducts and vascular structures. As a complement to baseline sequences, MR cholangiopancreatography images can be acquired, possibly integrated by functional examination after secretin administration. Finally, contrast-enhanced MR angiography opens new perspectives for vascular studies, particularly for the locoregional staging of pancreatic cancer. [Italian] Lo studio del pancreas con risonanza magnetica e' stato fino a pochi anni fa limitato dagli artefatti da movimento, da pulsatilita' vascolare e dalla ridotta risoluzione spaziale. Recentemente sono state sviluppate nuove tecniche che consentono da un lato di risolvere tali problemi e dall'altro di fornire informazioni aggiuntive, quali immagini selettive delle vie biliari e del dotto pancreatico e delle strutture vascolari. Come completamento all'esame di base si possono ottenere immagini di colangiopancreatografia con RM, eventualmente integrate da prove funzionali, rappresentate dall'iniezione di secretina. Infine, le nuove tecniche di angiografia con RM con mdc, nelle quali si effettua un'acquisizione durante la prima fase di passaggio arterioso o venoso dopo introduzione rapida del mdc a livello di una vena periferica, aprono nuove prospettive per lo studio vascolare, in particolare nella stadiazione loco-regionale dei processi neoplastici.

  16. Clinical efficacy of magnetic resonance cholangiopancreatography in the diagnosis of biliary tract diseases

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka [Sendai City Medical Center (Japan)] (and others)

    2001-10-01

    This study was carried out to clarify the efficacy of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary tract diseases. Three hundred and eleven patients who underwent MRCP and ERCP during the period from January 1999 to December 1999 at our institution were included in the study. Two gastroenterologists who were blinded to results of direct cholangiography and final diagnoses interpreted MRCP images prospectively. The biliary duct was visualized by MRCP and ERCP in 99.4% and 89.5% of the cases, respectively. The sensitivity, specificity, and accuracy of MRCP in the diagnosis of choledocholithiasis were 95%, 97%, and 97%, respectively. MRCP depicted the presence of strictures with a sensitivity, specificity, and accuracy of 97%, 96%, and 96%, respectively. There were three false-positive cases because of artifacts from arterial compression. The accuracy of MRCP and ERCP in differentiation of benign strictures from malignant ones was 85% and 96%, respectively. Based on these results, it is concluded that MRCP has high capability in visualization of the biliary tree, and in detection of stones and strictures. To avoid over and under-diagnosis, awareness of some pitfalls inherent in, MRCP is important. We suggest that MRCP should be recommended for patients with suspicion of biliary tract diseases in the initial stage of making diagnosis. (author)

  17. Is There a Difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Rafaelsen, Søren Rafael; Wamberg, Peter

    2003-01-01

    BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS...... following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing...... endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP...

  18. 3 T MR cholangiopancreatography appearances of biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Z.X., E-mail: hangzhoudzx73@126.co [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Yuan, J.H. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chong, V. [Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore (Singapore); Zhao, D.J. [Department of Hepatobiliary Surgery, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chen, F.H.; Li, Y.M. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China)

    2011-03-15

    Aim: To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. Materials and methods: Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. Results: On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. Conclusion: The 'three-line' sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.

  19. Magnetic Resonance Imaging Including Magnetic Resonance Cholangiopancreatography for Tumor Localization and Therapy Planning in Malignant Hilar Obstructions

    International Nuclear Information System (INIS)

    Haenninen, E.L.

    2005-01-01

    PURPOSE: To assess image quality and overall accuracy of magnetic resonance imaging (MRI), including two magnetic cholangiopancreatography (MRCP) techniques, for the diagnostics and preoperative work-up of malignant hilar obstructions. MATERIAL AND METHODS: Thirty-one patients with malignant hilar obstructions (hilar cholangiocarcinoma, n=30; hepatocellular carcinoma, n=1) received MRCP by two techniques (single-shot thick-slab and multisection thin-slice MRCP) and unenhanced and contrast material-enhanced MRI. MR assessment included the evaluation of image quality and visualization of bile ducts (5-point scale), and the classification of tumor status. MR results were subsequently correlated with the results from surgery and pathology. RESULTS: The maximum intensity projections of multisection thin-slice MRCP had significantly more artifacts compared to MRCP in the single-shot thick-slab technique, and overall image quality of single-shot thick-slab MRCP was rated significantly superior compared to multisection thin-slice MRCP (4.4 ± 0.7 and 4.1 ± 0.9, respectively). Moreover, ductal visualization of different parts of the biliary system was rated superior with single-shot thick-slab MRCP. In contrast, the original data from multisection thin slice MRCP facilitated visualization of periductal lesions and adjacent structures. Overall MR accuracy for the assessment of tumor status, periductal infiltration, and lymph node metastases was 90%, 87%, and 66%, respectively. CONCLUSION: For evaluation of malignant hilar obstructions, MRCP by the single-shot thick-slab technique had superior image quality and fewer artifacts; in contrast, besides sole biliary visualization, multisection MRCP depicted complementary adjacent parenchymal and periductal structures. We therefore recommend MRI, with a combination of both MRCP techniques, for the diagnostic work-up and therapy planning of malignant hilar obstructions

  20. The Role of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Choledocholithiasis: Do Benefits Outweigh the Costs?

    Science.gov (United States)

    Ward, William H; Fluke, Laura M; Hoagland, Benjamin D; Zarow, Gregory J; Held, Jenny M; Ricca, Robert L

    2015-07-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in evaluation of the biliary tree for choledocholithiasis. Formal indications for magnetic resonance cholangiopancreatography (MRCP) in suspected choledocholithiasis are lacking. Our objective was to determine if MRCP affects management of patients who otherwise would undergo ERCP. A review was conducted of all MRCPs and ERCPs at our institution from 2008 to 2012 with suspected choledocholithiasis. Patients who underwent MRCP and ERCP were compared with those who underwent ERCP alone. Demographic data were collected and notation of whether a post-MRCP ERCP occurred was the primary variable. MRCP was performed in 107 patients for choledocholithiasis. Eighty-eight patients were negative for choledocholithiasis (82%) and 76 were discharged without ERCP (71%). Thirty-one patients received a diagnosis of choledocholithiasis and were referred for ERCP. Of the 19 patients with MRCP-diagnosed common bile duct stones, 95 per cent were confirmed by ERCP (odds ratio 18.0, P Choledocholithiasis was found in 116 patients (92%), whereas 12 patients (9%) had no common bile duct stones and three had an alternate diagnosis. In conclusion, MRCP significantly affected the management of patients who would have undergone ERCP. MRCP did not increase length of stay and contributed to the 95 per cent positivity rate of subsequent ERCPs. These data illustrate the utility of MRCP in suspected choledocholithiasis patients at a low cost with regard to risk and time.

  1. Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Varghese, J.C.; Liddell, R.P.; Farrell, M.A.; Murray, F.E.; Osborne, D.H.; Lee, M.J

    2000-01-01

    AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and trans-abdominal ultrasound in the detection of choledocholithiasis, and to compare bile duct stone characteristics using endoscopic retrograde cholangiopancreatography (ERCP), MRCP and ultrasound. MATERIALS AND METHODS: Of 191 consecutive patients referred for diagnostic ERCP, choledocholithiasis was diagnosed in 34 patients using direct cholangiography. The latter took the form of ERCP (n 29), intraoperative cholangiography (n = 3) or percutaneous transhepatic cholangiography (n = 2). All patients underwent MRCP and ultrasound examinations and their findings for choledocholitiasis were compared with those at direct cholangiography. Finally, in the 29 patients with choledocholithiasis diagnosed under ERCP, stone characteristics were compared across the three investigations of ERCP, MRCP and ultrasound. RESULTS: Compared with direct cholangiography, MRCP showed a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. Ultrasound showed a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP revealed a greater number of stones and these were more proximally distributed within the bile ducts when compared to MRCP. CONCLUSIONS: MRCP is highly accurate in the diagnosis of choloedocholithiasis and has the potential to replace diagnostic ERCP. MRCP underestimates the number of bile duct stones present. Varghese, J.C. (2000)

  2. Feasibility of 3D navigator-triggered magnetic resonance cholangiopancreatography with combined parallel imaging and compressed sensing reconstruction at 3T.

    Science.gov (United States)

    Seo, Nieun; Park, Mi-Suk; Han, Kyunghwa; Kim, Dongeun; King, Kevin F; Choi, Jin-Young; Kim, Honsoul; Kim, Hye Jin; Lee, Minsu; Bae, Heejin; Kim, Myeong-Jin

    2017-11-01

    To assess the feasibility of 3D navigator-triggered magnetic resonance cholangiopancreatography (MRCP) with combined parallel imaging (PI) and compressed sensing (CS). With Institutional Review Board approval, 30 consecutive patients who underwent MRCP for suspected pancreaticobiliary disease were prospectively recruited. All patients underwent 3D navigator-triggered MRCP with conventional PI alone, and with combined PI and CS using a 3T machine. The acquisition time and relative duct-to-periductal contrast ratios (RCs) at three biliary segments were quantitatively compared between the two MRCP methods. Qualitative image parameters were independently evaluated by two blinded radiologists, and were compared between two methods using the Wilcoxon signed-rank test. The mean acquisition time of MRCP with combined PI and CS (131.87 ± 33.60 sec) was significantly shorter compared with that of MRCP with PI (253.63 ± 56.08 sec; P 0.999). Combined PI and CS reconstruction is feasible for 3D navigator-triggered MRCP, providing image quality comparable to that of MRCP with PI alone, in about half the acquisition time. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1289-1297. © 2017 International Society for Magnetic Resonance in Medicine.

  3. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography

    International Nuclear Information System (INIS)

    Kondo, Shintaro; Isayama, Hiroyuki; Akahane, Masaaki; Toda, Nobuo; Sasahira, Naoki; Nakai, Yosuke; Yamamoto, Natsuyo; Hirano, Kenji; Komatsu, Yutaka; Tada, Minoru; Yoshida, Haruhiko; Kawabe, Takao; Ohtomo, Kuni; Omata, Masao

    2005-01-01

    Objectives: New modalities, namely, endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), and helical computed-tomographic cholangiography (HCT-C), have been introduced recently for the detection of common bile duct (CBD) stones and shown improved detectability compared to conventional ultrasound or computed tomography. We conducted this study to compare the diagnostic ability of EUS, MRCP, and HCT-C in patients with suspected choledocholithiasis. Methods: Twenty-eight patients clinically suspected of having CBD stones were enrolled, excluding those with cholangitis or a definite history of choledocholithiasis. Each patient underwent EUS, MRCP, and HCT-C prior to endoscopic retrograde cholangio-pancreatography (ERCP), the result of which served as the diagnostic gold standard. Results: CBD stones were detected in 24 (86%) of 28 patients by ERCP/IDUS. The sensitivity of EUS, MRCP, and HCT-C was 100%, 88%, and 88%, respectively. False negative cases for MRCP and HCT-C had a CBD stone smaller than 5 mm in diameter. No serious complications occurred while one patient complained of itching in the eyelids after the infusion of contrast agent on HCT-C. Conclusions: When examination can be scheduled, MRCP or HCT-C will be the first choice because they were less invasive than EUS. MRCP and HCT-C had similar detectability but the former may be preferable considering the possibility of allergic reaction in the latter. When MRCP is negative, EUS is recommended to check for small CBD stones

  4. Is There a Difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Rafaelsen, Søren Rafael; Wamberg, Peter

    2003-01-01

    BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS...... difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations...... endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP...

  5. Magnetic Resonance Cholangiopancreatography: Image Quality, Ductal Morphology, and Value of Additional T2- and T1-weighted Sequences for the Assessment of Suspected Pancreatic Cancer

    International Nuclear Information System (INIS)

    Lopez Haenninen, E.; Ricke, H.; Amthauer, H.; Roettgen, R.; Boehmig, M.; Langrehr, J.; Pech, M.; Denecke, T.; Rosewicz, S.; Felix, R.

    2005-01-01

    Purpose: To assess image quality and duct morphology on magnetic resonance cholangiopancreatography (MRCP) and also the value of additional T2- and T1-weighted sequences for differentiation of benignity and malignancy in patients with suspected pancreatic tumors. Material and Methods: One-hundred-and-fourteen patients received MRCP and unenhanced and contrast material-enhanced MR imaging. MR results were analyzed independently by two blinded readers, and subsequently correlated with the results from surgery, biopsy, and follow-up. Assessment included the evaluation of image quality, duct visualization and morphology, and the differentiation of pancreatic lesion status (benign versus malignant).Results: Overall, 49 patients had benign final diagnoses, while 65 had a malignant diagnosis. Image quality of single-shot thick-slab MRCP was rated significantly better than the MIP images of multisection MRCP. With MRCP alone, the two readers' accuracy in the assessment of pancreatic lesion status was 72% (95% CI, 64% to 83%) and 69% (95% CI, 56% to 77%), respectively; with the addition of T2- and T1-weighted images the accuracy significantly improved to 89% (95% CI, 82% to 95%) and 84% (95% CI, 77% to 92%) for readers 1 and 2, respectively. Conclusion: Single-shot thick-slab MRCP and multisection MRCP provide complementary results; however, single-shot MRCP had superior image quality. Moreover, assessment of ductal morphology with MRCP alone facilitated the diagnosis of different pathologic conditions of the pancreatobiliary system in the majority of patients. However, with the addition of T2- and T1-weighted sequences the overall diagnostic accuracy was significantly improved and thus we consider that a comprehensive MR approach should comprise both MRCP techniques and parenchymal sequences

  6. Parallel imaging improves the image quality and duct visibility of breathhold two-dimensional thick-slab MR cholangiopancreatography.

    Science.gov (United States)

    Lee, Ju Hee; Lee, Seung Soo; Kim, Joo Young; Kim, In Seong; Byun, Jae Ho; Park, Seong Ho; Lee, Moon-Gyu

    2014-02-01

    To evaluate the effect of parallel imaging (PI) with different acceleration factors on the image quality and duct visibility of breathhold two-dimensional (2D) thick-slab single-shot turbo spin-echo (SSTSE) MR cholangiopancreatography (MRCP) images. Breathhold 2D thick-slab SSTSE MRCP was performed three times, i.e., without PI, with PI factor 2, and with PI factor 3, at 1.5 Tesla (T) for each of 85 patients. Two, independent readers evaluated the image quality and the visibility of five duct segments and ranked their preference of the three MRCP sequences. The data were analyzed using the repeated-measures analysis of variance test, the Friedman test, and the linear-by-linear chi-square test. MRCP sequences with PI factor 2 or 3 generated better image quality (P  0.05). Among the three sequences, both readers most often preferred the MRCP with PI factor 3, followed by the MRCP with PI factor 2 (P slab SSTSE MRCP. Copyright © 2013 Wiley Periodicals, Inc.

  7. MR cholangiopancreatography diagnosis for cholangitis caused by clonorchis sinensis

    International Nuclear Information System (INIS)

    Cui Bing; Hu Qiugen; Wang Yan

    2003-01-01

    Objective: To evaluate the MR cholangiopancreatography (MRCP) diagnosis for cholangitis caused by clonorchis sinensis. Methods: Fifty-four cases with cholangitis caused by clonorchis sinensis were examined by MRCP (3D FASE-Heavy T 2 WI sequence). The results of MRCP were compared with that of ERCP, laparoscopy, and pathology. Results: The diagnostic accuracy for the cause of the disease was 88.9%. Main findings on MRCP included slight dilation of the intra-hepatic biliary duct (n=46), small cystiform dilation of peripheral biliary ending (n=43), extra-hepatic biliary dilations (n=15) and strictures (n=19), and low signal intensity filling defect in the common bile duct and gallbladder (n=6). Conclusion: MRCP of biliary tree images can be obtained with 3D FASE Heavy T 2 WI sequence in considerable details. The characteristic of the cholangitis caused by clonorchis sinensis on MRCP was the slight dilation or stricture of extensive intra-hepatic biliary duct, combined with small cystiform dilation of peripheral biliary ending. MRCP was an ideal technique in diagnosing the disease

  8. Usefulness of MR cholangiopancreatography after intravenous morphine administration

    International Nuclear Information System (INIS)

    Lee, So Jung; Ko, Ji Ho; Cho, Young Duk; Jung, Mi Hee; Yoon, Byung Chull

    2007-01-01

    We wanted to assess the usefulness of MRCP after intravenous morphine administration in the evaluation of the hepatopancreatic pancreatico-biliary ductal system. We studied 15 patients who were suspected of having disease of hepatopancreatic ductal system and they did not have any obstructive lesion on ultrasonography and/or CT. MRCP was acquired before and after morphine administration (0.04 mg/kg, intravenously). Three radiologists scored the quality of the images of the anatomic structures in the hepatopancreatic ductal system. We directly compared the quality of the images obtained with using the two methods and the improvement of the artifacts by pulsatile vascular compression. The MRCP images obtained after intravenous morphine administration were better than those obtained before morphine administration for visualizing the hepatopancreatic ductal system. On direct comparison, the MRCP images obtained after morphine administration were better in 12 cases, equivocal in two cases, and the images before morphine administration were better in only one case. In three patients, MRCP before morphine injection showed signal loss at the duct across the pulsatile hepatic artery. In two of three patients, MRCP after morphine injection showed no signal loss in this ductal area. MRCP after intravenous morphine administration enables physicians to see the hepatopancreatic ductal system significantly better and the artifacts caused by pulsation of the hepatic artery can be avoided

  9. Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ferrara, Calogero; Valeri, Gianluca; Salvolini, Luca [Department of Radiology, University of Ancona (Italy); Giovagnoni, Andrea [Department of Radiology, University of Modena (Italy)

    2002-06-01

    Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown aetiology. Diagnosis is based on clinical and laboratory data in conjunction with imaging of the biliary tree using endoscopic retrograde cholangiopancreatography (ERCP). Objective: To evaluate the clinical usefulness of MR cholangiopancreatography (MRCP) in the diagnosis of PSC in children. Materials and methods: Twenty-one children with clinical and laboratory suspicion of PSC were enrolled. MRCP was performed using a superconductive system with a phased-array coil. Rapid acquisition with relaxation enhancement (RARE) T2-weighted and half-Fourier single-shot turbo-spin-echo (HASTE) sequences were used. The distribution and extent of biliary tree changes were evaluated and classified according to Majoie's classification. A comparison between MRCP and ERCP was performed blind in all cases to evaluate the usefulness of MRI. Results: In 13 cases (62%), MRCP showed abnormalities of the biliary tree which were considered positive for PSC, while in 8 cases there were no signs of PSC. Both MRCP and ERCP correctly identified changes in 13 cases and excluded abnormalities in 5. MRCP had a sensitivity of 81%, specificity of 100%, negative predictive value of 62%, positive predictive value of 100% and an accuracy of 85%. Conclusions: MRCP can be proposed as the preliminary non-invasive imaging modality for the diagnosis of PSC in children. (orig.)

  10. Primary sclerosing cholangitis in children: utility of magnetic resonance cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Babyn, Paul S.; Manson, David E. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Roberts, Eve [The Hospital for Sick Children, Department of Gastroenterology, Toronto (Canada); Moineddin, Rahim [University of Toronto, Department of Family and Community Medicine, Toronto (Canada)

    2008-08-15

    Even when histologic findings are highly suggestive of primary sclerosing cholangitis (PSC), cholangiographic correlation is required for the diagnosis. The present gold standard, endoscopic retrograde cholangiopancreatography (ERCP), is invasive and associated with complications. To evaluate the usefulness of magnetic resonance cholangiopancreatography (MRCP) in diagnosing PSC in children. MRCP studies were retrospectively reviewed in 20 children with clinical suspicion of PSC and who had undergone liver biopsy. MRCP studies were considered positive or negative for PSC depending on the presence or absence of dilatation, irregularity, multifocal strictures and beading of the bile ducts. Twenty children (14 boys, 6 girls) with an average age of 13 years qualified for the study. Of 19 diagnostic MRCP studies, 16 were called positive and 3 were called negative. An overall diagnosis of PSC-positive was assigned to all 19 patients based on clinical and laboratory findings, biopsy results and cholangiographic data. Based on this overall diagnosis, MRCP was 84% sensitive and accurate to diagnose PSC in children. MRCP can be a valuable tool in diagnosing pediatric PSC that can demonstrate major intra- and extrahepatic ducts in most cases. An unequivocally positive MRCP study should not be followed by ERCP for diagnosing PSC in children. (orig.)

  11. The role of magnetic resonance cholangiopancreatography and diffusion-weighted imaging for the differential diagnosis of obstructive biliary disorders

    Directory of Open Access Journals (Sweden)

    Zeynep Cetiner-Alpay

    2017-06-01

    Full Text Available Background: Although endoscopic retrograde cholangiopancreatography (ERCP is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP and diffusion-weighted imaging (DWI in the diagnosis of obstructive biliary disorders. Aim: To compare the findings of MRCP with ERCP in patients with obstructive biliary disorders and to investigate the diagnostic efficacy of MRCP combined with DWI. Study design: Retrospective, analytic, cross-sectional study. Methods: The MRCP images of 126 patients who underwent both MRCP and ERCP owing to biliary obstruction were reviewed. Nine patients were excluded because of incomplete diagnostic workup or a long period (>3 months between MRCP and ERCP. Ninety-two patients underwent DWI, which was also evaluated. The sensitivity, specificity and accuracy of MRCP and DWI were analysed. Results: The sensitivity, specificity and accuracy of MRCP according to ERCP results as the gold standard was 97%, 71% and 93% for assessment of biliary dilatation; 100%, 94.7% and 97.5% for the diagnosis of choledocholithiasis; 93.7%, 100% and 99% for the identification of benign strictures; 100%, 100% and 100% for the diagnosis of malignant tumours; and 100%, 100% and 100% for the detection of complicated hydatid cysts; respectively. The sensitivity and specificity of DWI for the diagnosis of malignant tumour was 100%. In the detection of choledocholithiasis, the sensitivity and specificity of DWI was 70.8% and 100%. Conclusions: MRCP is an alternative, non-invasive, diagnostic modality, comparable with ERCP for the evaluation of pancreaticobiliary diseases. DWI can be helpful for diagnosis of choledocholithiasis and tumours.

  12. 3D-TSE MR-cholangiography with respiratory triggering in the diagnosis of hepatopathies in infants and young children; 3D-TSE MR-Cholangiopankreatikographie mit Atemtriggerung zur Abklaerung von unklaren Hepatopathien bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Textor, H.J.; Pauleit, D.; Flacke, S.; Keller, E.; Schild, H.H. [Bonn Univ. (Germany). Radiologische Klinik; Keller, K.M. [Bonn Univ. (Germany). Kinderklinik und Poliklinik; Neubrand, M. [Bonn Univ. (Germany). Medizinische Klinik; Gieseke, J. [Philips Medizin Systeme Unternehmensbereich der Philips GmbH, Hamburg (Germany)

    1999-05-01

    Purpose: Evaluation of 3D-TSE MR-cholangiography with respiratory triggering in the work up of hepatopathies in infants and young children. Patients and Method: 16 infants (4-16 years) with increased transaminases, two with recurrent pancreatitis, were examined at 1.5 T (ACS-NT II, Philips Medical Systems) using a 3D-TSE MRCP with respiratory triggering in addition to a regular MRI of the liver. The MRCP was compared to ERCP. Two radiologists and one gastroenterologist evaluated the technical quality, visualization of the pancreaticobiliary system, and the diagnostic value of the examinations. Results: Technically feasible were 14/16 MRCPs and 13/16 ERCPs. Two MRCP were not of diagnostic value due to motion artifacts and in three ERCP cannulation of the papilla was not possible. 14/16 ERCP required general anaesthesia, while MRCP needed i.v. sedation in two patients only. Extrahepatic ducts/cystic duct-pancreatic duct were visualized in 14/12/8 patients using MRCP, and in 13/10/3 patients using ERCP, both without adverse effects or complications. Intrahepatic ducts were better delineated with MRCP. In 10 patients with histologically proven periportal fibrosis (n=7) and liver fibrosis (n=1) or antineutrophil cytoplasmatic antibodies and associated inflammatory bowel disease, MRCP and ERCP revealed pathological results. Conclusion: MRCP using a 3D-TSE sequence with respiratory triggering is a good non-invasive technique for delineation of the biliary tract in infants and young children for the work up to hepatopathies. (orig.) [Deutsch] Ziel: Evaluation der 3D-TSE MR-Cholangiographie mit Atemtriggerung in der Diagnostik unklarer Hepatopathien im Kindesalter. Patienten und Methode: 16 Kinder (4-16 Jahre) mit unklarer Transaminasenerhoehung, davon zwei mit rezidivierenden Pankreatitiden, erhielten an einem 1,5 Tesla-Geraet (ACS-NT II, Philips Medizin Systeme) im Rahmen eines Leber-MRT eine atemgetriggerte koronare 3D-Turbo-Spin-Echo (TSE) MRCP. Bei einem 16jaehrigen

  13. A multimodal approach to acute biliary pancreatitis during pregnancy: a case series.

    Science.gov (United States)

    Polydorou, Andreas; Karapanos, Konstantinos; Vezakis, Antonios; Melemeni, Aikaterini; Koutoulidis, Vasilios; Polymeneas, Georgios; Fragulidis, Georgios

    2012-10-01

    The treatment of acute biliary pancreatitis during pregnancy remains controversial. We present our experience of treating 7 pregnant women with acute biliary pancreatitis and verified or suspected choledocholithiasis, by using magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and sphincterotomy followed by laparoscopic cholecystectomy. MRCP was performed in all patients to confirm the presence of common bile duct stones, their size and number. ERCP and sphincterotomy were performed without the use of radiation. The procedure was terminated only when all stones (the number clarified at MRCP), were retrieved into the duodenum. All patients underwent laparoscopic cholecystectomy the following day. Neither post-ERCP nor postoperative major complications were noted. All but one patient reached a healthy natural-term labor. One patient had a planned cesarean section on 35th week. The combination of MRCP, nonradiation ERCP, and immediate laparoscopic cholecystectomy provides definite treatment and seems to put both mother and fetus at lower risk than presumed.

  14. Breath-hold MR cholangiopancreatography with three-dimensional, segmented, echo-planar imaging and volume rendering

    NARCIS (Netherlands)

    P.A. Wielopolski (Piotr); J. Gaa; D.R. Wielopolski; M. Oudkerk (Matthijs)

    1999-01-01

    textabstractEnd-expiration, 21-second breath-hold, three-dimensional magnetic resonance (MR) cholangiopancreatography (MRCP) was developed with segmented echo-planar imaging. In 15 healthy subjects and 14 randomly selected patients undergoing liver studies,

  15. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka [Sendai City Medical Center (Japan)] [and others

    2000-12-01

    To clarify the significance of magnetic resonance cholangiopancreatography (MRCP) in the acute phase of acute cholecystitis, MRCP was carried out in forty-five patients with acute cholecystitis in their acute phase. The MR pericholecystic high signal was observed in 38 of the 45 patients (84%). Enlargement of the gallbladder, presence of gallstones, and impacted stones was seen in 71%, 53%, and 18%, respectively. The MR pericholecystic high signal was classified into four categories: type 0, not observed; type 1, a liner high signal; type 2, a band-like high signal; type 3, a radiating high signal. In patients who showed a type 3 MR pericholecystic high signal, 91% required percutaneous transhepatic gallbladder drainage, and most of the gallbladders were diagnosed as necrotic cholecystitis by histology. The accuracy of MRCP for the diagnosis of choledocholithiasis was 96%. It was suggested that MRCP for patients with acute cholecystitis in the acute phase provides useful information for planning the treatment. (author)

  16. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis

    International Nuclear Information System (INIS)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka

    2000-01-01

    To clarify the significance of magnetic resonance cholangiopancreatography (MRCP) in the acute phase of acute cholecystitis, MRCP was carried out in forty-five patients with acute cholecystitis in their acute phase. The MR pericholecystic high signal was observed in 38 of the 45 patients (84%). Enlargement of the gallbladder, presence of gallstones, and impacted stones was seen in 71%, 53%, and 18%, respectively. The MR pericholecystic high signal was classified into four categories: type 0, not observed; type 1, a liner high signal; type 2, a band-like high signal; type 3, a radiating high signal. In patients who showed a type 3 MR pericholecystic high signal, 91% required percutaneous transhepatic gallbladder drainage, and most of the gallbladders were diagnosed as necrotic cholecystitis by histology. The accuracy of MRCP for the diagnosis of choledocholithiasis was 96%. It was suggested that MRCP for patients with acute cholecystitis in the acute phase provides useful information for planning the treatment. (author)

  17. Trial of MR cholangiopancreatography combined with Gd-DTPA

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Koshi; Ha-Kawa, S.K.; Kurokawa, Hiroaki; Nakano, Yoshihisa; Tanaka, Yoshimasa [Kansai Medical Univ., Moriguchi, Osaka (Japan); Asakura, Tamaki; Maeda, Toshihiko; Ohshima, Taichi

    1997-08-01

    Gd-DTPA can be used as a negative contrast agent on T2-weighted images because of T2 shortening effect. Fast asymmetric spin echo (FASE) sequences were used on magnetic resonance cholangiopancreatography (MRCP). Precontrast images showed high signal intensity in choledochalpancreatic venous plexus, which aggravated visualization of the bile duct and pancreatic duct. Intravenous administration of Gd-DTPA reduced signal intensity in pericholedochal or peripancreatic small veins, and improved image quality of MRCP. (author)

  18. The effective use of acai juice, blueberry juice and pineapple juice as negative contrast agents for magnetic resonance cholangiopancreatography in children

    International Nuclear Information System (INIS)

    Bittman, Mark E.; Callahan, Michael J.

    2014-01-01

    Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in the evaluation of known or suspected pancreaticobiliary disease in children. The administration of a negative oral contrast agent can improve the quality of the examination without significant additional cost. We describe our experience with certain brands of acai juice, blueberry juice and pineapple juice as negative oral contrast agents in children. We believe these fruit juices are safe, palatable and may improve MRCP image quality. (orig.)

  19. The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis.

    Science.gov (United States)

    Hjartarson, Jón H; Hannesson, Pétur; Sverrisson, Ingvar; Blöndal, Sigurður; Ívarsson, Bjarki; Björnsson, Einar S

    2016-10-01

    To investigate the ability of Magnetic resonance cholangiopancreatography (MRCP) to exclude choledocholithiasis (CDL) in symptomatic patients. Patients suspected of choledocholithiasis who underwent MRCP from 2008 through 2013 in a population based study at the National University Hospital of Iceland were retrospectively analysed, using ERCP and/or intraoperative cholangiography as a gold standard diagnosis for CDL. Overall 920 patients [66% women, mean age 55 years (SD 21)] underwent MRCP. A total of 392 patients had a normal MRCP of which 71 underwent an ERCP investigation demonstrating a CBD stone in 29 patients. A normal MRCP was found to have a 93% negative predictive value (NPV) and 89% probability of having no CBD stone demonstrated as well as no readmission due to gallstone disease within six months following MRCP. During a 6-month follow-up period of the 321 patients who did not undergo an ERCP nine (2.8%) patients were readmitted with right upper quadrant pain and elevated liver tests which later normalised with no CBD stone being demonstrated, three (0.9%) patients were readmitted with presumed gallstone pancreatitis, two (0.6%) patients were readmitted with cholecystitis and two (0.6%) patients were lost to follow-up. Seven patients of those 321 underwent an intraoperative cholangiography (IOC) and all were negative for CBD stones. For the sub-group requiring ERCP following a normal MRCP the NPV was 63%. Our results support the use of MRCP as a tool for exclusion of choledocholithiasis with the potential to reduce the amount of unnecessary ERCP procedures.

  20. MR cholangio pancreatography: clinical applications; Colangiopancreatografia por ressonancia magnetica: aplicacoes clinicas

    Energy Technology Data Exchange (ETDEWEB)

    D`Ippolito, Giuseppe; Galvao Filho, Mario; Jesus, Paulo Eduardo Marinho de; Wolosker, Angela; Borri, Maria Lucia [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Centro Diagnostico

    1998-05-01

    MR cholangio-pancreatography (MRCP) has been replacing diagnostic conventional cholangio-pancreatography. MRCP is a new, noninvasive and rapidly evolving technique for imaging diseases of the biliary tree and pancreatic ducts. Images are obtained without administration of oral or intravenous contrast. Our objective is to demonstrate the main clinical applications of MPCP, its limits and advantages over other methods. In our series of 60 patients we have detected choledocholithiasis, sclerosing cholecystitis, chronic pancreatitis, pancreatic and ampullary tumors. (author) 16 refs., 14 figs.

  1. Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Ankur Attri

    2016-01-01

    Full Text Available Background: Magnetic resonance cholangiopancreatography (MRCP has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangiopancreatography. We studied the role of MRCP in adult patients with obstructive biliopathy to analyze its etiological spectrum and radiological findings. Materials and Methods: Total fifty patients referred for mrcp with a clinical diagnosis of obstructive jaundice were included in our study. Imaging findings were correlated with the final diagnosis made by histopathological or cytological findings and with the therapeutic outcome. Aim: To evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice and to correlate findings on mrcp with surgical findings where possible. Results: Of fifty patients, 29 were benign lesions and 21 were malignant lesions. Among the benign lesions, 12 had choledocholithiasis and 16 had benign strictures. One case was of a choledochal cyst. Among the malignant lesions, 12 were gallbladder carcinoma, six were cholangiocarcinoma, two were periampullary carcinoma, and one was a case of metastatic deposit. The overall sensitivity of MRCP was 96.5%, specificity was 95.2%, and with an accuracy of 96% for benign lesions. The accuracy, sensitivity, and specificity of MRCP in the diagnosis of benign strictures was 92%, 93.7%, and 91.2%, for choledocholithiasis was 92%, 75%, and 97.3%, and for malignant lesions was 95.2, 96.5%, and 96%, respectively. Conclusion: MRCP is a relatively quick, accurate, and noninvasive imaging modality for the assessment of obstructive jaundice, in ruling out potentially correctable underlying cause.

  2. MR cholangio pancreatography: clinical applications

    International Nuclear Information System (INIS)

    D'Ippolito, Giuseppe; Galvao Filho, Mario; Jesus, Paulo Eduardo Marinho de; Wolosker, Angela; Borri, Maria Lucia

    1998-01-01

    MR cholangio-pancreatography (MRCP) has been replacing diagnostic conventional cholangio-pancreatography. MRCP is a new, noninvasive and rapidly evolving technique for imaging diseases of the biliary tree and pancreatic ducts. Images are obtained without administration of oral or intravenous contrast. Our objective is to demonstrate the main clinical applications of MPCP, its limits and advantages over other methods. In our series of 60 patients we have detected choledocholithiasis, sclerosing cholecystitis, chronic pancreatitis, pancreatic and ampullary tumors. (author)

  3. MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP

    International Nuclear Information System (INIS)

    Lomas, D.J.; Bearcroft, P.W.P.; Gimson, A.E.

    1999-01-01

    The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. (orig.)

  4. Selective use of magnetic resonance cholangiopancreatography in clinical practice may miss choledocholithiasis in gallstone pancreatitis

    Science.gov (United States)

    Srinivasa, Sanket; Sammour, Tarik; McEntee, Bernard; Davis, Nicola; Hill, Andrew G.

    2010-01-01

    Background Gallstone pancreatitis is a consequence of ampullary obstruction by common bile duct (CBD) calculi. Magnetic resonance cholangiopancreatography (MRCP) has been advocated for routine use to diagnose choledocholithiasis. However, the selective use of MRCP in clinically equivocal situations has not been explored until now. This study examines the diagnostic value of selective MRCP in gallstone pancreatitis. Methods We conducted a retrospective audit of all presentations of gallstone pancreatitis between January 2001 and December 2007 at Middlemore Hospital, Auckland, New Zealand. Demographic data, clinical presentation, biochemical and radiological findings and outcomes were reviewed. Results There were 339 cases of gallstone pancreatitis during the study period; 236 patients were women and the mean age was 52 years. Overall, choledocholithiasis was diagnosed in 95 patients. A total of 117 patients underwent MRCP within a median of 4 days of admission, with 15 (13.7%) showing choledocholithiasis. There was no significant difference in time to MRCP between positive and negative groups. Endoscopic retrograde cholangiopancreatography (ERCP)/intraoperative cholangiography (IOC) confirmed 13 of 15 stones within a median of 2.5 days. However, MRCP missed 8 cases of choledocholithiasis subsequently demonstrated on ERCP/IOC, where clinical suspicion remained after a negative MRCP. Its sensitivity was 62% and specificity 98%. The positive likelihood ratio was 6.5 and the negative likelihood ratio was 0.1. In all, 222 patients followed different clinical pathways with 82 CBD stones diagnosed by ERCP/IOC. Conclusion Selective MRCP is highly specific in gallstone pancreatitis but may not be sensitive enough to exclude choledocholithiasis in this context. PMID:21092433

  5. MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP

    Energy Technology Data Exchange (ETDEWEB)

    Lomas, D.J.; Bearcroft, P.W.P.; Gimson, A.E. [University Department of Radiology, Addenbrooke Hospital, Cambridge (United Kingdom)

    1999-09-01

    The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. (orig.) With 6 figs., 1 tab., 20

  6. 75 r:t

    African Journals Online (AJOL)

    1971-01-16

    Jan 16, 1971 ... The over-all standard of the reproductions and printing is outstanding, and I have no hesitation in recommending that ... visers in the Pharmaceutical Industry. Ed. by E. L. Harris. M.B., B.Ch., M.R.C.P., M.R.C.P. ... Industry (Great Britain) in February 1969. The work is inter- esting on 2 counts. Firstly it is a clear ...

  7. The effective use of acai juice, blueberry juice and pineapple juice as negative contrast agents for magnetic resonance cholangiopancreatography in children

    Energy Technology Data Exchange (ETDEWEB)

    Bittman, Mark E. [Cohen Children' s Medical Center of New York, North Shore Long Island Jewish Health System, Department of Radiology, New Hyde Park, NY (United States); Callahan, Michael J. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States)

    2014-07-15

    Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in the evaluation of known or suspected pancreaticobiliary disease in children. The administration of a negative oral contrast agent can improve the quality of the examination without significant additional cost. We describe our experience with certain brands of acai juice, blueberry juice and pineapple juice as negative oral contrast agents in children. We believe these fruit juices are safe, palatable and may improve MRCP image quality. (orig.)

  8. The role of MRI in evaluation of acute pancreatitis

    International Nuclear Information System (INIS)

    Baba, Maiko; Munechika, Horotsugu

    2003-01-01

    The purpose of this study is to assess the role of MRI in acute pancreatitis. The findings of MPD (main pancreatic duct) and CBD (common bile duct) on MR cholangiopancreatography (MRCP) images were retrospectively reviewed in 60 patients with acute pancreatitis. The patients were divided into two groups; severe and mild pancreatitis, according to the criteria of Japanese group of investigation for pancreatic diseases. T2 weighed MR images were compared with contrast-enhanced CT images for evaluation of severity of the disease. MRCP images were also compared with endoscopic retrograde cholangiopancreatography (ERCP) images for evaluation of MPD and CBD. CBD was more clearly demonstrated by MRCP than MPD. Both MPD and CBD were more clearly seen in the mild group than in the severe group. A few false-negative cases were seen in MRCP. T2 weighed MR images were almost the same as contrast-enhanced CT images in diagnosis of acute pancreatitis. MRCP is useful for evaluation of CBD in severe cases and for evaluation of both CBD and MPD in mild cases of acute pancreatitis. The severity of disease can be evaluated by combination of T2 weighted MR images and MRCP alternative to contrast-enhanced CT. (author)

  9. Imaging patients with 'post-cholecystectomy syndrome': an algorithmic approach

    International Nuclear Information System (INIS)

    Terhaar, O.A.; Abbas, S.; Thornton, F.J.; Duke, D.; O'Kelly, P.; Abdullah, K.; Varghese, J.C.; Lee, M.J.

    2005-01-01

    AIM: To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP) MATERIALS AND METHODS: In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of <10 mm was considered normal, whereas ≥10 mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods. RESULTS: In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome. CONCLUSION: US and LFTs are first-line tests in PCS. If the CBD on US is ≥10 mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging

  10. Evaluation of the use of blueberry juice in magnetic resonance cholangiopancreatography

    International Nuclear Information System (INIS)

    Tanaka, Yasunori; Fujita, Osamu; Yuuki, Masako; Matsuoka, Takae; Yamamoto, Kazuhiro; Shimizu, Tadahumi; Narabayashi, Isamu; Nishio, Seiichi

    1998-01-01

    We evaluated the use of blueberry juice (BJ), which is rich in manganese, as an oral negative contrast agent for magnetic resonance cholangiopancreatography (MRCP) and compared the findings thus obtained with corresponding findings for ferric ammonium citrate solution (FerriSeltz; FS). The optimum concentrations for the two oral contrast agents were determined by a phantom examination. Precontrast and postcontrast MRCP images were obtained in 26 patients and 4 volunteers using BJ and in 30 patients using FS. The pulse sequence applied for MRCP was a single shot fast spin-echo (ssfse) with an echo time of 950 to 1300 ms. In several cases, multislice ssfse with 90 ms echo time was conducted using both BJ and FS. Additionally, 8 volunteers who had recently consumed food or liquids underwent precontrast and postcontrast MRCP using BJ. BJ and FS eliminated the high signal intensity of gastrointestinal fluids which degrade MRCP images. In the multislice ssfse images with 90 ms. Echo time, BJ reduced the intragastrointestinal high intensity signal, but FS did not. In all volunteers whose stomachs were filled with food and/or water, intragastrointestinal high intensity signal was eliminated with use of BJ. We concluded that BJ is very useful as an MRCP negative contrast agent. (author)

  11. Evaluation of the use of blueberry juice in magnetic resonance cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Yasunori; Fujita, Osamu; Yuuki, Masako; Matsuoka, Takae; Yamamoto, Kazuhiro; Shimizu, Tadahumi; Narabayashi, Isamu [Osaka Medical Coll., Takatsuki (Japan); Nishio, Seiichi

    1998-07-01

    We evaluated the use of blueberry juice (BJ), which is rich in manganese, as an oral negative contrast agent for magnetic resonance cholangiopancreatography (MRCP) and compared the findings thus obtained with corresponding findings for ferric ammonium citrate solution (FerriSeltz; FS). The optimum concentrations for the two oral contrast agents were determined by a phantom examination. Precontrast and postcontrast MRCP images were obtained in 26 patients and 4 volunteers using BJ and in 30 patients using FS. The pulse sequence applied for MRCP was a single shot fast spin-echo (ssfse) with an echo time of 950 to 1300 ms. In several cases, multislice ssfse with 90 ms echo time was conducted using both BJ and FS. Additionally, 8 volunteers who had recently consumed food or liquids underwent precontrast and postcontrast MRCP using BJ. BJ and FS eliminated the high signal intensity of gastrointestinal fluids which degrade MRCP images. In the multislice ssfse images with 90 ms. Echo time, BJ reduced the intragastrointestinal high intensity signal, but FS did not. In all volunteers whose stomachs were filled with food and/or water, intragastrointestinal high intensity signal was eliminated with use of BJ. We concluded that BJ is very useful as an MRCP negative contrast agent. (author)

  12. Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience

    Science.gov (United States)

    Makmun, Dadang; Fauzi, Achmad; Shatri, Hamzah

    2017-01-01

    Background/Aims Biliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis. Methods This retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard. Results The male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively. Conclusions EUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis. PMID:28241408

  13. Diagnosing common bile duct obstruction: comparison of image quality and diagnostic performance of three-dimensional magnetic resonance cholangiopancreatography with and without compressed sensing.

    Science.gov (United States)

    Kwon, Heejin; Reid, Scott; Kim, Dongeun; Lee, Sangyun; Cho, Jinhan; Oh, Jongyeong

    2018-01-04

    This study aimed to evaluate image quality and diagnostic performance of a recently developed navigated three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) with compressed sensing (CS) based on parallel imaging (PI) and conventional 3D-MRCP with PI only in patients with abnormal bile duct dilatation. This institutional review board-approved study included 45 consecutive patients [non-malignant common bile duct lesions (n = 21) and malignant common bile duct lesions (n = 24)] who underwent MRCP of the abdomen to evaluate bile duct dilatation. All patients were imaged at 3T (MR 750, GE Healthcare, Waukesha, WI) including two kinds of 3D-MRCP using 352 × 288 matrices with and without CS based on PI. Two radiologists independently and blindly assessed randomized images. CS acceleration reduced the acquisition time on average 5 min and 6 s to a total of 2 min and 56 s. The all CS cine image quality was significantly higher than standard cine MR image for all quantitative measurements. Diagnostic accuracy for benign and malignant lesions is statistically different between standard and CS 3D-MRCP. Total image quality and diagnostic accuracy at biliary obstruction evaluation demonstrates that CS-accelerated 3D-MRCP sequences can provide superior quality of diagnostic information in 42.5% less time. This has the potential to reduce motion-related artifacts and improve diagnostic efficacy.

  14. Frequency of common bile duct motion artifacts caused by inferior vena cava pulsation on magnetic resonance cholangiopancreatography

    International Nuclear Information System (INIS)

    Morita, Satoru; Ueno, Eiko; Saito, Naoko

    2008-01-01

    We assessed the frequency of common bile duct (CBD) motion artifacts caused by inferior vena cava (IVC) pulsation on magnetic resonance cholangiopancreatography (MRCP). We retrospectively evaluated CBD motion artifacts in 4 MRCP sequences from each of 115 consecutive patients. We observed 37 (32.2%) ghost artifacts at the ventral and dorsal aspects of the CBD on transaxial, half-Fourier acquisition single-shot turbo spin-echo (HASTE-ax) images; no such artifacts were observed on transaxial T 2 -weighted turbo spin-echo images. In 10 patients, we observed 9 (7.8%) pseudo-defects of the CBD on 3-dimensional T 2 -weighted turbo spin-echo with navigator-triggered prospective acquisition correction technique MRCP and 6 (5.2%) pseudo-defects on single-shot rapid acquisition with relaxation enhancement MRCP. Pseudo-defects were significantly more frequent in patients with ghost artifacts than without (9 of 37 [24.3%] versus one of 78 [1.3%]; P<0.01, McNemar test). Although uncommon, pseudo-defects of the CBD caused by IVC pulsation are observed on MRCP. MRCP interpretation that includes comparison with HASTE-ax images can diminish the potential misinterpretation of such CBD motion artifact as bile duct tumor or biliary stone. (author)

  15. Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Mera, Kiyomi; Tajiri, Hisao; Muto, Manabu [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East] [and others

    1999-06-01

    Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancreas should be carefully diagnosed in combination with CT. (author)

  16. A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?

    Energy Technology Data Exchange (ETDEWEB)

    Siles, Pascale [La Timone Children' s Hospital, Department of Radiology, Marseille (France); Aschero, Audrey; Gorincour, Guillaume; Bourliere-Najean, Brigitte; Petit, Philippe [La Timone Children' s Hospital, Department of Pediatric Radiology, Marseille (France); Roquelaure, Bertrand [La Timone Children' s Hospital, Department of Pediatrics, Marseille (France); Delarue, Arnauld [La Timone Children' s Hospital, Department of Pediatric Surgery, Marseille (France)

    2014-09-15

    Magnetic resonance cholangiopancreatography (MRCP) could aid in the diagnosis of biliary atresia, a hepatic pathology with thin, irregular or interrupted biliary ducts. There is little published evidence of MRCP appearances in normal neonates and young infants. To assess the use of MR cholangiopancreatography in visualizing the biliary tree in neonates and infants younger than 3 months with no hepatobiliary disorder, and to assess this visibility in relationship to the child's age, weight, and sedation and fasting states. Between December 2008 and October 2010 our department performed MRI of the brain, orbits and face on 16 full-term neonates and infants. Each child was younger than 3 months (90 days) and without any hepatobiliary disorders. The children were scanned with a respiratory-gated 0.54 x 0.51 x 0.4-mm{sup 3} 3-D MRCP sequence. We used a reading grid to assess subjectively the visibility of the extrahepatic bile ducts along with extrahepatic bile duct confluence. The visibility of the extrahepatic bile duct confluence was assessed against age, weight, and sedation and fasting states. The extrahepatic bile duct confluence was seen in 10 children out of 16 (62.5%). In the neonate sub-group (corrected age younger than 30 days), the MRCP was technically workable and the extrahepatic bile duct confluence was seen in four cases out of eight (50%). This visualization was up to 75% in the subgroup older than 30 days. However, statistically there was no significant difference in visibility of the extrahepatic bile duct confluence in relationship to age, weight or MRCP performance conditions (feeding, fasting or sedation). The complete normal biliary system (extrahepatic bile duct confluence included) is not consistently visualized in infants younger than 3 months old on non-enhanced MRCP. Thus the use of MRCP to exclude a diagnosis of biliary atresia is compromised at optimal time of surgery. (orig.)

  17. Inaccurate preoperative imaging assessment on biliary anatomy not increases biliary complications after living donor liver transplantation

    International Nuclear Information System (INIS)

    Xu Xiao; Wei Xuyong; Ling Qi; Wang Kai; Bao Haiwei; Xie Haiyang; Zhou Lin; Zheng Shusen

    2012-01-01

    Backgrounds and aims: Accurate assessment of graft bile duct is important to plan surgical procedure. Magnetic resonance cholangiopancreatography (MRCP) has become an important diagnostic procedure in evaluation of pancreaticobiliary ductal abnormalities and has been reported as highly accurate. We aim to estimate the efficacy of preoperative MRCP on depicting biliary anatomy in living donor liver transplantation (LDLT), and to determine whether inaccurate preoperative imaging assessment would increase the biliary complications after LDLT. Methods: The data of 118 cases LDLT were recorded. Information from preoperative MRCP was assessed using intraoperative cholangiography (IOC) as the gold standard. The possible risk factors of recipient biliary complications were analyzed. Results: Of 118 donors, 84 had normal anatomy (type A) and 34 had anatomic variants (19 cases of type B, 9 cases of type C, 1 case of type E, 2 cases of type F and 3 cases of type I) confirmed by IOC. MRCP correctly predicted all 84 normal cases and 17 of 34 variant cases, and showed an accuracy of 85.6% (101/118). The incidence of biliary complications was comparable between cases with accurate and inaccurate classification of biliary tree from MRCP, and between cases with normal and variant anatomy of bile duct. While cases with graft duct opening ≤5 mm showed a significant higher incidence of total biliary complications (21.1% vs. 6.6%, P = 0.028) and biliary stricture (10.5% vs. 1.6%, P = 0.041) compared with cases with large duct opening >5 mm. Conclusion: MRCP could correctly predict normal but not variant biliary anatomy. Inaccurate assessment of biliary anatomy from MRCP not increases the rate of biliary complications, while small-sized graft duct may cause an increase in biliary complications particularly biliary stricture after LDLT.

  18. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: A systematic review

    Science.gov (United States)

    De Castro, Vinicius Leite; Moura, Eduardo G.H.; Chaves, Dalton M.; Bernardo, Wanderley M.; Matuguma, Sergio E.; Artifon, Everson L.A.

    2016-01-01

    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. PMID:27080611

  19. The role of magnetic resonance cholangiopancreatography in the management of acute gallstone pancreatitis

    Science.gov (United States)

    Haqq, J; McCormack, D; Metcalfe, MS; Dennison, AR; Garcea, G

    2013-01-01

    Introduction The aim of this study was to identify whether magnetic resonance cholangiopancreatography (MRCP) can be used selectively in patients with acute gallstone pancreatitis to detect choledocholithiasis, based on liver function tests (LFTs) and ultrasonography appearance. Methods All patients admitted between January 2008 and January 2011 with gallstone pancreatitis (amylase >300u/l) who underwent MRCP were included in the study. LFTs and radiology reports were obtained from the respective computer systems. RESULTS Overall, 173 patients with acute gallstone pancreatitis underwent MRCP and 30% (52/173) showed choledocholithiasis. The mean bilirubin level was significantly higher in those with choledocholithiasis (46 ±5µmol/l vs 36 ±3µmol/l, p=0.0388) although there was no significant difference in alkaline phosphatase (276 ±25iu/l vs 229 ±16iu/l, p=0.1154). However, sensitivity of abnormal bilirubin (>21µmol/l) for choledocholithiasis was only 62% and specificity was 41%. Sensitivity of abnormal alkaline phosphatase (>140iu/l) for choledocholithiasis was only 75% and specificity was 37%. There was a significant association between biliary dilatation on ultrasonography and choledocholithiasis on MRCP (p=0.0099) although the sensitivity of biliary dilatation for choledocholithiasis was only 44% and the specificity was 79%. Furthermore, there was no difference in the incidence of choledocholithiasis on MRCP for those patients with persistently deranged LFTs versus those whose LFTs returned to normal (relative risk: 1.07, 95% confidence interval: 0.61–1.89, p=1.00). Overall, 10% of patients with choledocholithiasis on MRCP had entirely normal LFTs on admission and no biliary dilatation or choledocholithiasis on ultrasonography. Conclusions All patients with acute gallstone pancreatitis should undergo specific imaging, preferably MRCP, to exclude choledocholithiasis as LFTs and ultrasonography are inaccurate in predicting common bile duct stones. PMID

  20. Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

    Directory of Open Access Journals (Sweden)

    Stephen Morris

    Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

  1. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature.

    Science.gov (United States)

    Polistina, Francesco A; Frego, Mauro; Bisello, Marco; Manzi, Emy; Vardanega, Antonella; Perin, Bortolo

    2015-04-28

    To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student's t-test and χ (2) when appropriate. Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent

  2. Compressed-Sensing Accelerated 3-Dimensional Magnetic Resonance Cholangiopancreatography: Application in Suspected Pancreatic Diseases.

    Science.gov (United States)

    Zhu, Liang; Wu, Xi; Sun, Zhaoyong; Jin, Zhengyu; Weiland, Elisabeth; Raithel, Esther; Qian, Tianyi; Xue, Huadan

    2018-03-01

    The aims of this study were to prospectively evaluate image quality, duct visibility, and diagnostic performance in duct-related pathologies of compressed-sensing (CS) accelerated 3-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) prototype protocols and compare these with those of conventional 3D MRCP protocol in patients with suspected pancreatic diseases. The institutional review board approved this prospective study and all patients provided written informed consent. A total of 80 patients (47 men and 33 women; median age, 57 years; age range, 24-87 years) underwent 3D MRCP at 3.0 T. Three protocols were performed in each patient in random order: CS breath-hold (BH) protocol, CS navigator-triggered (NT) protocol, and conventional NT protocol. The acquisition time of each protocol was recorded. Image quality and duct visibility were independently rated in random order on a 5-point scale by 2 radiologists, who were blinded to the protocols. Receiver operating characteristic curves were generated, and area under the curve (Az value) was used to compare the diagnostic performance of each protocol in duct-related pathologies. Acquisition time was 17 seconds for the CS-BH and 134.1 ± 33.5 seconds for the CS-NT protocol, both being significantly shorter than the conventional NT protocol (364.7 ± 78.4 seconds; both P < 0.01). The CS-BH MRCP protocol showed significantly less artifacts compared with the CS-NT and conventional NT protocols (both P < 0.01). Visualization of bile ducts was comparable in all 3 protocols, whereas CS-NT and conventional NT MRCP depicted pancreatic duct better than CS-BH MRCP did (for proximal, middle, and distal segment; all P < 0.05). Compressed-sensing-NT MRCP had the highest diagnostic performance for detecting ductal anomalies, long-segment duct stenosis, abnormal branch ducts, and communication between cystic lesion and pancreatic duct (mean Az value, 0.943-0.983). Compressed-sensing MRCP is feasible in patients with

  3. Clinical role of secretin loading magnetic resonance cholangiopancreatography in the patients undergoing pancreatic resection

    Energy Technology Data Exchange (ETDEWEB)

    Shimada, Ken; Takahashi, Tsuyoshi; Yoshida, Muneki; Kakita, Akira [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    2002-01-01

    We determined factors contributing to increased signal intensity in the reconstructed jejunal loop in patients undergoing pancreatic resection, frequently observed on magnetic resonance cholangiopancreatography following intravenous injection of secretin (S/MRCP). We also evaluated the possible roles of S/MRCP in assessing the patency of pancreatojejunal anastomosis and the secretory function of the remnant pancreas. Subject were 44 patients undergoing several types of pancreatic resection. Baseline output and response to secretin of the remnant pancreas were measured after surgery. S/MRCP and pancreatic function diagnostant (PFD) tests were conducted preoperatively, and in early and late periods after surgery. Baseline pancreatic output was 1.2{+-}0.7 ml/10-min, and increased after secretin load to a maximum 9.0{+-}6.6 ml/10-min in 10 min. Signal intensity of the jejunal loop increased in 2 patients versus 40 patients (95%) during the early versus late postoperative periods. During the late period, PFD was significantly higher in patients with increased signal intensity than in those without. PFD correlated well with cumulative pancreatic output following secretin loading (r=0.820). A major factor responsible for increased signal intensity in S/MRCP of the jejunal loop was increased pancreatic output. The increase in signal intensity was a definitive sign of patent pancreatojejunal anastomosis. S/MRCP thus seems to have a potential for evaluating the secretory function of the remnant pancreas. (author)

  4. Clinical role of secretin loading magnetic resonance cholangiopancreatography in the patients undergoing pancreatic resection

    International Nuclear Information System (INIS)

    Shimada, Ken; Takahashi, Tsuyoshi; Yoshida, Muneki; Kakita, Akira

    2002-01-01

    We determined factors contributing to increased signal intensity in the reconstructed jejunal loop in patients undergoing pancreatic resection, frequently observed on magnetic resonance cholangiopancreatography following intravenous injection of secretin (S/MRCP). We also evaluated the possible roles of S/MRCP in assessing the patency of pancreatojejunal anastomosis and the secretory function of the remnant pancreas. Subject were 44 patients undergoing several types of pancreatic resection. Baseline output and response to secretin of the remnant pancreas were measured after surgery. S/MRCP and pancreatic function diagnostant (PFD) tests were conducted preoperatively, and in early and late periods after surgery. Baseline pancreatic output was 1.2±0.7 ml/10-min, and increased after secretin load to a maximum 9.0±6.6 ml/10-min in 10 min. Signal intensity of the jejunal loop increased in 2 patients versus 40 patients (95%) during the early versus late postoperative periods. During the late period, PFD was significantly higher in patients with increased signal intensity than in those without. PFD correlated well with cumulative pancreatic output following secretin loading (r=0.820). A major factor responsible for increased signal intensity in S/MRCP of the jejunal loop was increased pancreatic output. The increase in signal intensity was a definitive sign of patent pancreatojejunal anastomosis. S/MRCP thus seems to have a potential for evaluating the secretory function of the remnant pancreas. (author)

  5. Magnetic resonance cholangiopancreatography findings of pancreatic diseases: quantitative analysis

    International Nuclear Information System (INIS)

    Xu Jun; Lu Jianping; Wang Jian; Wang Fei; Liu Qi; Wang Li; Gong Jianguo; Jin Aiguo; Zeng Hao

    2004-01-01

    Objective: To study the MR cholangiopancreatography (MRCP) characteristics of different pancreatic diseases, and to identify the diagnostic value of MRCP for pancreatic diseases. Methods: One hundred and eleven patients with suspected pancreatic diseases underwent MRCP examination. The MRCP sequences included thick-slice turbo spin echo (TSE) and thin-slice half-Fourier acquisition single shot turbo spin echo (HASTE) sequences. The pancreatic diseases included pancreatic carcinoma (n=46), chronic pancreatitis (n=39), peri-ampullar carcinoma (n=23), and choledocholith (n=3). Results: (1) The abnormal manifestation of pancreatic duct was observed in 37 cases of pancreatic carcinoma, 24 cases of chronic pancreatitis, and 12 cases of peri-ampullar carcinoma. Dilated pancreatic duct with smooth and regular caliber was observed in 33 cases of pancreatic carcinoma, 0 case of chronic pancreatitis, and 12 cases of peri-ampullar carcinoma, and statistical analysis showed significant difference (χ 2 =57.911, P 2 =60.343, P 2 =61.217, P 2 =34.654, P 2 =54.593, P<0.01). Conclusion: Different MRI characteristics were observed in various pancreatic diseases respectively. MRCP can show the subtle differences among the pancreatic diseases, and is very helpful in the diagnosis and differential diagnosis of pancreatic diseases

  6. Usefulness of magnetic resonance cholangiography in the diagnosis of biliary tract lesions in patients with suspected complication following cholecystectomy; Valor da colangiopancreatografia por ressonancia magnetica no diagnostico de lesoes das vias biliares em pacientes com suspeita de complicacao pos-colecistectomia

    Energy Technology Data Exchange (ETDEWEB)

    Cecin, Alexandre de Oliveira [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem; Lobo, Edson Jose [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Gastroenterologia Cirurgica; Abdalla, Nitamar; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem

    2005-01-15

    Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)

  7. Evaluation of the Microvascular Research Center Training Program for Assessing Microsurgical Skills in Trainee Surgeons

    Directory of Open Access Journals (Sweden)

    Seiji Komatsu

    2013-05-01

    Full Text Available Background  We established the Microvascular Research Center Training Program (MRCPto help trainee surgeons acquire and develop microsurgical skills. Medical students wererecruited to undergo theMRCP to assessthe effectiveness oftheMRCP fortrainee surgeons.Methods  Twenty-two medical students with no prior microsurgical experience, who completed the course from2005 to 2012,were included. TheMRCP comprises 5 stages oftraining,each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubesand blood vessels of chicken carcasses,respectively,within 20minutes. Stage 3 involves anastomosing the femoral artery and vein oflive ratswith a 1-day patency rate of > 80%. Stage4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-daysuccessrate of > 80%. Stage 5 involvessuccessful completion of one case ofratreplantation/transplantation. We calculated the passing rate for each stage and recorded the number ofanastomosesrequired to passstages 3 and 4.Results  The passing rates were 100% (22/22 for stages 1 and 2, 86.4% (19/22 for stage3, 59.1% (13/22 for stage 4, and 55.0% (11/20 for stage 5. The number of anastomosesperformedwas 17.2± 12.2 in stage 3 and 11.3± 8.1 in stage 4.Conclusions  Majority ofthemedicalstudentswho undertook theMRCP acquired basicmicrosurgicalskills. Thus,we conclude thatthe MRCP is an effective microsurgery training programfortrainee surgeons.

  8. The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Masahiro; Fukada, Jun-ichi; Toya, Kazuhito; Ito, Reiko; Ohashi, Toshio; Yorozu, Atsunori [Tokyo Medical Center, Department of Radiology, Tokyo (Japan)

    2005-10-01

    The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP. (orig.)

  9. The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis

    International Nuclear Information System (INIS)

    Okada, Masahiro; Fukada, Jun-ichi; Toya, Kazuhito; Ito, Reiko; Ohashi, Toshio; Yorozu, Atsunori

    2005-01-01

    The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP. (orig.)

  10. Cortical substrates of the effects of caffeine and time-on-task on perception of effort.

    Science.gov (United States)

    de Morree, Helma M; Klein, Christoph; Marcora, Samuele M

    2014-12-15

    Caffeine intake results in a decrease in perception of effort, but the cortical substrates of this perceptual effect of caffeine are unknown. The aim of this randomized counterbalanced double-blind crossover study was to investigate the effect of caffeine on the motor-related cortical potential (MRCP) and its relationship with rating of perceived effort (RPE). We also investigated whether MRCP is associated with the increase in RPE occurring over time during submaximal exercise. Twelve healthy female volunteers performed 100 intermittent isometric knee extensions at 61 ± 5% of their maximal torque 1.5 h after either caffeine (6 mg/kg) or placebo ingestion, while RPE, vastus lateralis electromyogram (EMG), and MRCP were recorded. RPE and MRCP amplitude at the vertex during the first contraction epoch (0-1 s) were significantly lower after caffeine ingestion compared with placebo (P time-on-task were found for EMG amplitude and submaximal force output variables. The covariation between MRCP and RPE across both caffeine and time-on-task (r10 = -0.335, P perception of effort arises from neurocognitive processing of corollary discharges from premotor and motor areas of the cortex. Caffeine seems to reduce perception of effort through a reduction in the activity of cortical premotor and motor areas necessary to produce a submaximal force, and time-on-task has the opposite effect. Copyright © 2014 the American Physiological Society.

  11. MR evaluation of biliary-enteric anastomotic stricture: does contrast-enhanced T1W MRC provide additional information?

    Science.gov (United States)

    Kandasamy, Devasenathipathy; Sharma, Raju; Seith Bhalla, Ashu; Gamanagatti, Shivanand R; Srivastava, Deep N; Sahni, Peush; Kumar, Rakesh

    2011-09-01

    To compare T2W-MRCP and T1W contrast-enhanced MRC (CE-MRC) using Gd-BOPTA for evaluation of biliary-enteric anastomotic (BEA) stricture. Twenty-one patients who were suspected to have BEA stricture underwent T2W-MRCP and CE-MRC on a 1.5T scanner. Images were evaluated for evidence of anastomotic stricture. Composite gold standard was used including the findings on percutaneous transhepatic cholangiogram or percutaneous transhepatic biliary dilatation, surgery, alkaline phosphatase level and clinical follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of T2W-MRCP for the diagnosis of anastomotic stricture were 94.4%, 80%, 94.4% and 80% respectively. On CE-MRC, biliary excretion was seen in only 60.87% anastomoses and only these were taken for analysis. The sensitivity, specificity, PPV and NPV of CE-MRC for the diagnosis of anastomotic stricture were 40%, 75%, 80% and 33.3%. The combined evaluation of T2W-MRCP and CE-MRC showed sensitivity, specificity, PPV and NPV of 83.3%, 80%, 93.8% and 57.1%. At present, T2W-MRCP is still the diagnostic modality of choice in the evaluation of patients with BEA stricture and the usage of Gd-BOPTA enhanced MRC is inappropriate in this setting. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  12. The role of MR cholangiopancreatography in acute abdominal pain (a case study)

    International Nuclear Information System (INIS)

    Obradovic, G.

    2000-01-01

    Rapid technological advances have resulted in improved Magnetic Resonance Imaging (MRI) of the abdomen. In particular, the development of single breath hold sequences have led to a resurgence in imaging of the binary tree and pancreatic duct. For this reason, Magnetic Resonance Cholangiopancreatography (MRCP) is recognised as a valuable tool which is safe, fast and noninvasive. This case study demonstrates that MRCP could identify the intrahepatic duct obstruction adequately, so that the appropriate course of management could be readily instigated. In addition, the excellent quality of MR imaging will lead to an increase in referrals for MRCP if the modality is available and there are no patient contra-indications. Copyright (1999) Australian Institute of Radiography

  13. Influence of spontaneous rhythm on movement-related cortical potential

    DEFF Research Database (Denmark)

    Yao, Lin; Chen, Mei Lin; Sheng, Xinjun

    2017-01-01

    in variability as a novel task is learned, which in turn significantly decreases the detection accuracy. In the current study we sought to investigate if tactile stimulation, often implemented in rehabilitation, may act as a primer to our associative BCI by decreasing MRCP variability. Six chronic stroke...... patients were exposed to one session of tactile stimulation, and the MRCP of an arm lifting task, repeated 30 times, extracted. Results reveal that for three patients the MRCP detection accuracy expressed as the rate of true and false positives was improved. In two patients however the detection accuracy...... declined while one patient was unable to complete the experiment. Since tactile stimulation is a common tool implemented by physiotherapists to train patients to perform dynamic movements with the appropriate muscle pattern to avoid compensatory actions by other muscles it will be important to decipher why...

  14. Common bile duct motion artifacts caused by inferior vena cava pulsation on magnetic resonance cholangiopancreatography. Presidential award proceedings

    International Nuclear Information System (INIS)

    Morita, Satoru; Maruyama, Kazuhiro; Onodera, Yugo; Watanabe, Kunihiro; Suzuki, Takashi; Saito, Naoko; Mitsuhashi, Norio; Ohnishi, Takahiro; Imura, Chiaki

    2008-01-01

    The common bile duct (CBD) moves back and forth, synchronized with the inferior vena cava (IVC) pulsation depending on the cardiac cycle. We retrospectively evaluated the frequency of CBD motion artifact caused by IVC pulsation in magnetic resonance cholangiopancreatography (MRCP). The frequency of pseudo-defects in MRCP was significantly higher in patients with ghost artifact than those without, which was observed at the ventral and dorsal aspects of the CBD on multi-slice half-Fourier acquisition single-shot turbo spin-echo trans-axial (HASTE-ax) images. The present study indicates that pseudo-defects of the CBD caused by IVC pulsation are observed on MRCP. The addition of HASTE-ax images during interpretation can diminish the potential for misinterpreting this CBD motion artifact as a bile duct tumor or biliary stone. (author)

  15. Usefulness of three-dimensional magnetic resonance cholangiopancreatography with partial maximum intensity projection for diagnosing autoimmune pancreatitis.

    Science.gov (United States)

    Yanagisawa, Shin; Fujinaga, Yasunari; Watanabe, Takayuki; Maruyama, Masahiro; Muraki, Takashi; Takahashi, Masaaki; Fujita, Akira; Fujita, Sachie; Kurozumi, Masahiro; Ueda, Kazuhiko; Hamano, Hideaki; Kawa, Shigeyuki; Kadoya, Masumi

    To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without partial maximum intensity projection (MIP) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with autoimmune pancreatitis (AIP). Three-dimensional MRCP and ERCP images were retrospectively analyzed in 24 patients with AIP. We evaluated the narrowing length of the main pancreatic duct (NR-MPD), multiple skipped MPD narrowing (SK-MPD), and side branches arising from the narrowed portion of the MPD (SB-MPD) using four MRCP datasets: 5 original images (MIP 5 ), 10 original images (MIP 10 ), all original images (full-MIP), and a combination of these three datasets (a-MIP). The images were scored using a 3- or 5-point scale. The scores of the four MRCP datasets were statistically analyzed, and the positive rate of each finding was compared between MRCP and ERCP. The median scores for SB-MPD on MIP 5 and a-MIP were significantly higher than those on MIP 10 and full-MIP. In other words, partial MIP is superior to full-MIP for visualization of detailed structures. The positive rate for SB-MPD on full-MIP was significantly lower than that on ERCP, whereas the positive rate on MIP 5 , MIP 10 , and a-MIP was not significantly different from that on ERCP. Moreover, the positive rate for NR-MPD and SK-MPD on the MRCP images was significantly higher than that on the ERCP images. Partial MIP is useful for evaluating the MPD and is comparable with ERCP for diagnosing AIP. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  16. Evaluation of the Microvascular Research Center Training Program for Assessing Microsurgical Skills in Trainee Surgeons

    Science.gov (United States)

    Yamada, Kiyoshi; Yamashita, Shuji; Sugiyama, Narushi; Tokuyama, Eijiro; Matsumoto, Kumiko; Takara, Ayumi; Kimata, Yoshihiro

    2013-01-01

    Background We established the Microvascular Research Center Training Program (MRCP) to help trainee surgeons acquire and develop microsurgical skills. Medical students were recruited to undergo the MRCP to assess the effectiveness of the MRCP for trainee surgeons. Methods Twenty-two medical students with no prior microsurgical experience, who completed the course from 2005 to 2012, were included. The MRCP comprises 5 stages of training, each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubes and blood vessels of chicken carcasses, respectively, within 20 minutes. Stage 3 involves anastomosing the femoral artery and vein of live rats with a 1-day patency rate of >80%. Stage 4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-day success rate of >80%. Stage 5 involves successful completion of one case of rat replantation/transplantation. We calculated the passing rate for each stage and recorded the number of anastomoses required to pass stages 3 and 4. Results The passing rates were 100% (22/22) for stages 1 and 2, 86.4% (19/22) for stage 3, 59.1% (13/22) for stage 4, and 55.0% (11/20) for stage 5. The number of anastomoses performed was 17.2±12.2 in stage 3 and 11.3±8.1 in stage 4. Conclusions Majority of the medical students who undertook the MRCP acquired basic microsurgical skills. Thus, we conclude that the MRCP is an effective microsurgery training program for trainee surgeons. PMID:23730596

  17. Evaluation of the Microvascular Research Center Training Program for Assessing Microsurgical Skills in Trainee Surgeons

    Directory of Open Access Journals (Sweden)

    Seiji Komatsu

    2013-05-01

    Full Text Available BackgroundWe established the Microvascular Research Center Training Program (MRCP to help trainee surgeons acquire and develop microsurgical skills. Medical students were recruited to undergo the MRCP to assess the effectiveness of the MRCP for trainee surgeons.MethodsTwenty-two medical students with no prior microsurgical experience, who completed the course from 2005 to 2012, were included. The MRCP comprises 5 stages of training, each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubes and blood vessels of chicken carcasses, respectively, within 20 minutes. Stage 3 involves anastomosing the femoral artery and vein of live rats with a 1-day patency rate of >80%. Stage 4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-day success rate of >80%. Stage 5 involves successful completion of one case of rat replantation/transplantation. We calculated the passing rate for each stage and recorded the number of anastomoses required to pass stages 3 and 4.ResultsThe passing rates were 100% (22/22 for stages 1 and 2, 86.4% (19/22 for stage 3, 59.1% (13/22 for stage 4, and 55.0% (11/20 for stage 5. The number of anastomoses performed was 17.2±12.2 in stage 3 and 11.3±8.1 in stage 4.ConclusionsMajority of the medical students who undertook the MRCP acquired basic microsurgical skills. Thus, we conclude that the MRCP is an effective microsurgery training program for trainee surgeons.

  18. Comparison of respiratory-triggered 3-D fast spin-echo and single-shot fast spin-echo radial slab MR cholangiopancreatography images in children

    International Nuclear Information System (INIS)

    Chavhan, Govind B.; Almehdar, Abeer; Gupta, Sumeet; Moineddin, Rahim; Babyn, Paul S.

    2013-01-01

    The two most commonly performed magnetic resonance cholangiopancreatography (MRCP) sequences, 3-D fast spin-echo (3-D FSE) and single-shot fast spin-echo radial slabs (radial slabs), have not been compared in children. The purpose of this study was to compare 3-D FSE and radial slabs MRCP sequences on a 3-T scanner to determine their ability to show various segments of pancreaticobiliary tree and presence of artifacts in children. We reviewed 79 consecutive MRCPs performed in 74 children on a 3-T scanner. We noted visibility of major ducts on 3-D FSE and radial slabs. We noted the order of branching of ducts in the right and left hepatic ducts and the degree of visibility of the pancreatic duct. Statistical analysis was performed using McNemar and signed rank tests. There was no significant difference in the visibility of major bile ducts and the order of branching in the right hepatic lobe between sequences. A higher order of branching in the left lobe was seen on radial slabs than 3-D FSE (mean order of branching 2.82 versus 2.27; P-value = 0.0002). The visibility of pancreatic duct was better on radial slabs as compared to 3-D FSE (mean value of 1.53 vs. 0.90; P-value < 0.0001). 3-D FSE sequence was artifact-free in 25/79 (31.6%) MRCP exams as compared to radial slabs, which were artifact-free in 18/79 (22.8%) MRCP exams (P-value = 0.0001). There is no significant difference in the visibility of major bile ducts between 3-D FSE and radial slab MRCP sequences at 3-T in children. However, radial slab MRCP shows a higher order of branching in the left hepatic lobe and superior visibility of the pancreatic duct than 3-D FSE. (orig.)

  19. Magnetic resonance cholangiopancreatography. The fine art of bilio-pancreatic imaging.

    Science.gov (United States)

    Adamek, H E; Breer, H; Layer, G; Riemann, J F

    2002-01-01

    With the introduction of endoscopic retrograde cholangio-pancreatography in the early 1970s, gastroenterologists have a lot of diagnostic options in the biliopancreatic system to their disposal. Meanwhile, magnetic resonance cholangiopancreatography (MRCP) has become a competitive replacement for diagnostic ERCP with the advantage of avoiding complications related to endoscopic techniques. Mounting evidence suggests that both MRCP and MRI (magnetic resonance imaging) have a profound influence of diagnostic algorithms in a variety of hepatobiliary and pancreatic diseases. Copyright 2002 S. Karger AG, Basel and IAP

  20. Oral gadopentetate dimeglumine administration as a negative gastrointestinal contrast agent to improve image quality of MR cholangiopancreatography

    International Nuclear Information System (INIS)

    Chen Yi; Xu Yikai; Zhao Yuhui; Wang Guisheng

    2008-01-01

    Objective: To choose optimal concentration and volume of Gd-DTPA solution as a oral gastrointestinal negative contrast agent for MRCP. To evaluate the role of Gd-DTPA solution in improving image quality of MRCP. Methods: In vitro experiment: Gd-DTPA solution was made with different concentrations. T 1 WI, T 2 WI, two-dimensional single slice fast spin echo sequence and three-dimensional half-fourier acquisition single-shot fast spin echo sequence were performed to measure the signal intensity of these contrast agents respectively, so Gd-DTPA solution with the optimal concentration can be decided as oral negative gastrointestinal contrast agent on MRCP. Clinical study: The Gd-DTPA solution with optimal concentration and volume was regarded as an oral negative gastrointestinal contrast agent of MRCP. Twenty- four' patients were performed with MRCP before and after (5-10 minutes and 10-15 minutes) administration of oral negative gastrointestinal contrast agent and image quality was analyzed. Statistical analysis was performed using analysis of variance with SPSS 10.0. Results: When the concentration of Gd-DTPA solution was ≤0.01 mol/L, the contrast agent was hyperintense on T 1 WI. On T 2 WI, when the concentration was ≥0.015 mol/L, it was as hypointense as basic ground; On 2D FSE MRCP images, controls were hyperintense and the contrast agent with concentration ranging from 0.0025 mol/L to 0.03 mol/L was hypointense. On 3D HEAST MRCP image, controls were hyperintense and when the concentration of Gd-DTPA was ≥0.01 mol, the contrast agent was hypointense. The Gd-DTPA solution with the concentration of 0.01 mol/L and the volume of 100 ml was chosen as MRCP oral negative gastrointestinal contrast agent. On MRCP images after oral administration of the contrast agent, in 10-15 minutes, the average grade scores within 24 patients of the intrahepatic bile duct, the common hepatic bile duct, the gall bladder, the common bile duct and pancreatic duct (the average grade

  1. Intensified tuberculosis case finding among hiv-infected individuals

    African Journals Online (AJOL)

    2011-10-02

    Oct 2, 2011 ... Intensified tuberculosis case finding among hiv-infected individuals. The HIV-TB co-epidemic requires increased surveillance and case finding. K Kranzer, MB BS, MD, MSc, MSc, MRCP. Honorary Clinical Lecturer, Faculty of Infectious Diseases, Department of Clinical Research, London School of Hygiene ...

  2. CASE SERIES Substantive incidental cardiac findings revealed by ...

    African Journals Online (AJOL)

    Joint Division of Medical Imaging and Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada. A Crean, MD, MRCP, FRCR. Corresponding author: M Durand (mirandadurand@gmail.com). Limitations inherent in CT imaging of the thorax left the heart as an ill-defined and largely ...

  3. Spontaneous biliary peritonitis: Is bed side diagnosis possible ...

    African Journals Online (AJOL)

    Second surgery was not required in 34% of cases. There was no mortality or signifi cant morbidity in our series. Conclusion: Spontaneous perforation of bile duct is rare disease and high index of suspicion is required for diagnosis. Simple bed side test can help in diagnosis but T tube cholangiogram or MRCP are must to ...

  4. Evaluation of magnetic resonance cholangiopancreatography at 0.5 T in the diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Hamamoto, Tetsuro; Santoh, Yoshiaki; Okubo, Michiko

    2000-01-01

    The visualization rate of magnetic resonance cholangiopancreatography (MRCP) with a moderate magnetic field (0.5 T) was compared in terms of the maximum diameter of calculi and the imaging method. MRCP with a fast spin echo (FSE) and/or single-shot fast spin echo (SSFSE) sequence was performed in 53 patients diagnosed with extrahepatic biliary lithiasis by endoscopic retrograde cholangiopancreatography (ERCP). The visualization rate of MRCP was 84.9% (45/53). The visualization rate of calculi 5 mm or less in diameter was low, but those 6 mm or more in diameter were visualized in almost every case. Examination by each of the imaging methods yielded a visualization rate of 78.4% (49/51) by FSE, 82.8% (24/29) by SSFSE, and 85.2% (23/27) by a combination of both methods. No calculi 5 mm or less in diameter were detected by FSE, but 4-5 mm calculi were detected in 2 out of 5 cases (40%) by SSFSE. Calculi 6 mm or more in diameter were detected in 40 out of 43 patients by FSE and 22 out of 23 patients by SSFSE. MRCP with a moderate magnetic field was as useful in diagnosing choledocholithiasis as with a high magnetic field. Of the two imaging methods tested, SSFSE appeared to be preferable to FSE. (K.H.)

  5. Evaluation of magnetic resonance cholangiopancreatography at 0.5 T in the diagnosis of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Hamamoto, Tetsuro; Santoh, Yoshiaki; Okubo, Michiko [Yonego Hakuai Hospital, Tottori (Japan)] [and others

    2000-09-01

    The visualization rate of magnetic resonance cholangiopancreatography (MRCP) with a moderate magnetic field (0.5 T) was compared in terms of the maximum diameter of calculi and the imaging method. MRCP with a fast spin echo (FSE) and/or single-shot fast spin echo (SSFSE) sequence was performed in 53 patients diagnosed with extrahepatic biliary lithiasis by endoscopic retrograde cholangiopancreatography (ERCP). The visualization rate of MRCP was 84.9% (45/53). The visualization rate of calculi 5 mm or less in diameter was low, but those 6 mm or more in diameter were visualized in almost every case. Examination by each of the imaging methods yielded a visualization rate of 78.4% (49/51) by FSE, 82.8% (24/29) by SSFSE, and 85.2% (23/27) by a combination of both methods. No calculi 5 mm or less in diameter were detected by FSE, but 4-5 mm calculi were detected in 2 out of 5 cases (40%) by SSFSE. Calculi 6 mm or more in diameter were detected in 40 out of 43 patients by FSE and 22 out of 23 patients by SSFSE. MRCP with a moderate magnetic field was as useful in diagnosing choledocholithiasis as with a high magnetic field. Of the two imaging methods tested, SSFSE appeared to be preferable to FSE. (K.H.)

  6. Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis.

    Science.gov (United States)

    Chen, Wen; Mo, Jing-Jia; Lin, Li; Li, Chao-Qun; Zhang, Jian-Feng

    2015-03-21

    To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in patients with choledocholithiasis. 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. 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, χ (2) = 65.80; P choledocholithiasis. MRCP should be the method of choice for suspected cases of CBD stones.

  7. Tuberculosis 2: Pathophysiology and microbiology of pulmonary ...

    African Journals Online (AJOL)

    2005-08-01

    Aug 1, 2005 ... February 2013 Downloaded from www.southsudanmedicaljournal.com. MaIN arTIClES. 10. Tuberculosis 2: Pathophysiology and microbiology of pulmonary tuberculosis. Robert L. Serafino Wania MBBS, MrCP, MSc (Trop Med). Pathophysiology. Inhalation of Mycobacterium tuberculosis leads to one of.

  8. Does Courvoisier's sign stand the test of time?

    LENUS (Irish Health Repository)

    Murphy, K

    2012-11-01

    To investigate the validity of Courvoisier\\'s sign, in the age of cross-sectional imaging and image analysis software by objectively measuring gallbladder volumes at magnetic resonance cholangiopancreatography (MRCP) in patients with and without biliary obstruction and to assess whether gallbladder volume is more significantly increased in patients with gallstone-related rather than non-gallstone-related biliary obstruction.

  9. Noninvasive study of anatomic variations of the bile and pancreatic duct using magnetic resonance cholangiopancreatography; Estudio no invasivo de variantes anatomicas de la via biliar y pancreatica mediante colangiopancreatografia por resonancia magnetica (CPRM)

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Campo, R.; Martin, J.; Brullet, E. [SDI-UDIAT Corporacio Sanitaria Parc Tauli. Sabadell (Spain); Espinos, J. [Hospital Mutua de Tarrasa (Spain)

    1999-07-01

    To identify anatomic variations of the bile duct and pancreatic duct and papillary anomalies by means of magnetic resonance cholangiopancreatography (MRCP) and determine their correlation with endoscopic retrograde cholangiopancreatography (ERCP) findings. Eighty-five patients were selected by means of a prospective study comparing MRCP and ERCP. Coronal and axial HASTE images and coronal and oblique coronal RARE images were acquired in all the patients. Four of the studies (6%) were excluded because of poor technical quality. Anatomic variations were observed in 26 cases (30.5%), including trifurcation (n=7; 27%), right hepatic duct draining into left hepatic duct (n=2, 7.7%), right hepatic duct draining into common bile duct (n=4; 15.4%), extrahepatic confluence (n=2; 7.7%), medial cystic duct (n=2; 7.7%), parallel cystic duct (n=3; 11.5%), juxtapapillary duodenal diverticulum (n=3; 11.5%) and pancreas divisum (n=3; 11.5%). A good correlation was observed between the MRCP and ERCP findings. The introduction of MRCP into the noninvasive study of biliary disease may be useful in the detection of anatomic variations relevant to laparoscopic surgery and other endoscopic and interventional techniques. (Author) 11 refs.

  10. Ansa Pancreatica: A Case Report of a Type of Ductal Variation in a Patient with Idiopathic Acute Recurrent Pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hye Mi; Park, Jung Yup; Kim, Myeong Jin [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    Ansa pancreatica is a rare type of pancreatic ductal variation. Recently, ansa pancreatic has been considered as a predisposing factor in patients with idiopathic acute pancreatitis. To the best of our knowledge, no previously published report in Korea has described ansa pancreatica. We report a case of acute recurrent pancreatitis with ansa pancreatica, which was revealed on magnetic resonance cholangiopancreatography (MRCP)

  11. A practical approach to the diagnosis and management of ...

    African Journals Online (AJOL)

    2011-10-01

    Oct 1, 2011 ... Graeme Meintjes, MB ChB, MRCP (UK), FCP (SA), DipHIVMan (SA). Associate Professor, Department of Medicine, University of Cape Town. Graeme Meintjes is an Infectious Diseases Physician and Wellcome Trust Fellow based at the University of Cape Town and GF Jooste Hospital in Cape Town. His.

  12. Secretin-enhanced magnetic resonance cholangiopancreaticography: value for the diagnosis of chronic pancreatitis

    International Nuclear Information System (INIS)

    Heverhagen, J.T.; Burbelko, M.; Schenck zu Schweinsberg, T.; Funke, C.; Wecker, C.; Walthers, E.M.; Rominger, M.

    2007-01-01

    Endoscopic retrograde cholangiopancreaticography (ERCP) is the morphologic gold standard for the diagnosis of chronic pancreatitis. Magnetic Resonance Imaging (MRI) enables the visualization of not only the pancreatic duct but also the surrounding parenchyma using T2- and T1-weighted sequences before and after the application of a contrast agent. Moreover, it allows the depiction of ductal segments distal to a stenosis or occlusion. However, conventional Magnetic Resonance Cholangiopancreaticography (MRCP) was not able to achieve accuracy similar to that of ERCP. Despite many technological innovations, such as fast breath-hold acquisitions or respiratory-gated 3D sequences, this drawback could not be overcome. In recent years, secretin-enhanced MRCP has been used for the diagnosis of chronic pancreatitis. A recent study showed that secretin not only improves the visibility of the pancreatic duct and its side branches but it also enhances the diagnostic accuracy of MRCP. The sensitivity, specificity, and positive and negative predictive values were improved by the application of secretin. Moreover, the agreement between independent observers increased after the use of secretin. In addition, quantitative post-processing tools have been developed that enable the measurement of the exocrine pancreatic output non-invasively using secretin-enhanced MRCP. These tools facilitate applications, such as functional follow-up after pancreaticogastrostomy and pancreaticogastric anastomoses, evaluation of the functional status of the graft after pancreas transplantation and follow-up of pancreatic drainage procedures and duct disruption. (orig.)

  13. New Fellows and Honorary Fellow

    Indian Academy of Sciences (India)

    Home; Fellowship. Fellow Profile. Elected: 1956 Section: Medicine. Patel, Dr Jamnadas Chaturbhai M.D., Ph.D. (London), M.R.C.P.. Date of birth: 2 August 1908. Date of death: 11 May 2003. Specialization: Diabetes, Internal Medicine and Tetanus Last known address: 'Backbay View', 3, New Queens Road, Mumbai 400 ...

  14. rheumatoid arthritis health outcome

    African Journals Online (AJOL)

    2004-12-04

    Dec 4, 2004 ... School of Psychology, University of KwaZulu-Natal,. Pietermaritzburg. Girish M Mody, MB ChB, MRCP, FCP, MD, FRCP. Department of Rheumatology, Nelson R Mandela School of Health Sciences, University of KwaZulu-Natal, Durban. Rheumatoid arthritis (RA) is a systemic autoimmune disorder.

  15. The Impact of Gd-Eob-Dtpa-Enhanced MR Cholangiography in Biliary Diseases: Comparison with T2-Weighted MR Cholangiopancreatography.

    Science.gov (United States)

    Özmen, Evrim; Algın, Oktay; Evrimler, Şehnaz; Arslan, Halil

    2016-05-01

    Contrast enhanced magnetic resonance cholangiography is a novel technique and promising method in demonstrating biliary tree anatomy and evaluating biliary disorders. However, to date, there are a limited number of studies that have focused on the impact of this technique. We aimed to evaluate the additional role of contrast enhanced MR cholangiography (MRC) and compare contrast enhanced MRC with T2-weighted (w) magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary disorders. Diagnostic accuracy study. The T2w-MRCP and contrast enhanced MRC sequences of 31 patients whose gold standard test results were available were scored visually for the existence of pathological findings with regard to any of the biliary diseases. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was used as the contrast agent. The correlation values were determined according to the statistical analysis made from those scores and the sensitivity, specificity and accuracy values of each sequence were detected as well. We detected that the correlation values with gold standard methods of contrast enhanced MRC sequences were significantly higher than the ones of T2w-MRCP sequences. The correlation ratios of T2w-MRCP sequences were between 26 and 34%, while those for contrast enhanced MRC sequences were between 81 and 83% for the first reader and the correlation ratios of T2w-MRCP sequences were between 10 and 61%, whereas those of contrast enhanced MRC were between 79 and 81% for the second reader The mean sensitivity, specificity and accuracy values of T2w-MRCP sequences were 14.3-42.5%, 85-89.2% and 59.3-72.5%, respectively, while the mean sensitivity, specificity and accuracy values of contrast enhanced MRC sequences were 100%, 86.7% and 93.2-93.3%, respectively. We suggest that obtaining of contrast enhanced MRC sequences in addition to the T2w-MRCP can be useful in the diagnosis of many diseases in relation with biliary tree.

  16. Serology and ultrasound for diagnosis of choledocholithiasis

    Science.gov (United States)

    Garcea, G; Williams, R; Metcalfe, M; Dennison, AR

    2014-01-01

    Introduction Magnetic resonance cholangiopancreatography (MRCP) is not a routine investigation to exclude choledocholithiasis unless there is clinical or biochemical suspicion of common bile duct (CBD) stones. This study attempted to determine which radiological or serological parameters best predicted CBD stones. Methods All patients undergoing MRCP from 2005 to 2011 were selected. Patients with pancreatitis were excluded. Liver function tests (LFTs) at admission and prior to MRCP were recorded, as was abdominal ultrasonography and MRCP results. Parameters measured routinely on LFTs included alkaline phosphatase (ALP), alanine transaminase (ALT) and bilirubin. Receiver operating characteristic curve area analysis (area under the curve [AUC]) and chi-squared analysis were undertaken. Results Overall, 195 patients were identified, 71 of whom had CBD stones on MRCP. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones. Conclusions Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography. PMID:24780789

  17. The effect of type of afferent feedback timed with motor imagery on the induction of cortical plasticity

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Voigt, Michael; Stevenson, Andrew James Thomas

    2017-01-01

    independently of the type of afferent inflow. An afferent volley generated from a passive movement or an electrical stimulus arrives at the somatosensory cortex at similar times. It is thus likely that the similar effects observed here are strictly due to the tight coupling in time between the afferent inflow...... compared these two interventions (BCIFES and BCIpassive) where the afferent input was timed to arrive at the motor cortex during the PN of the MRCP. Twelve healthy participants attended two experimental sessions. They were asked to perform 30 dorsiflexion movements timed to a cue while continuous......: 8-35 mAmp) or a passive ankle movement (amplitude and velocity matched to a normal gait cycle) was applied such that the first afferent inflow would coincide with the PN of the MRCP. The change in the output of the primary motor cortex (M1) was quantified by applying single transcranial magnetic...

  18. MR cholangiopancreatography in the diagnosis of pancreatic ductal adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sai, Jinkan; Ariyama, Jo; Suyama, Masafumi [Juntendo Univ., Tokyo (Japan). School of Medicine] [and others

    1998-01-01

    We examined the usefulness on the screening of the pancreatic ductal adenocarcinoma using MR cholangiopancreatography (MRCP). We obtained the accuracy of the normal pancreatic duct from 30 patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) before cholelithotomy, showing the normal pancreatic ductal images. The accuracy of the main pancreatic duct: Santorini duct and pancreatic branches was almost 100%, 93% and 83%, respectively, and the detectable minimum diameter of the duct was 0.60{+-}0.14 mm. MRCPs for 1000 outpatients from July 1995 to July 1997 who showed abnormalities of hepatopancreas were carried out and 41 patients were diagnosed of pancreatic carcinoma. Of these, small pancreatic adenocarcinoma (stage t{sub 1}, nodular type) was discovered in 5 cases ({<=}10 mm; 1, 11 to 20 mm; 4). These results suggest that MRCP is useful to discover the pancreatic carcinoma in an early stage and give important clues for the improvement of prognosis. (K.H.)

  19. Magnetic Resonance Imaging of the Gallbladder: Spectrum of Abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Elsayes, K.M.; Oliveira, E.P.; Narra, V.R.; EL-Merhi, F.M.; Brown, J.J. [Dept. of Radiology, Univ of Michigan Health Center, Ann Arbor, Michigan (United States)

    2007-07-15

    Various pathologies involving the gallbladder can manifest clinically, producing nonspecific clinical symptoms and making diagnosis difficult and challenging. Real-time sonography is the most widely used diagnostic study for the gallbladder and the primary screening examination of choice. With increasing use of magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP), gallbladder pathology is frequently seen. Understanding the basic patterns of various disease manifestations and appearance on MRI is the key to making an accurate diagnosis. Given its inherent tissue contrast and contrast sensitivity, MRI in conjunction with MRCP can be a very valuable test in evaluating gallbladder pathology. Gallbladder pathology can be classified into congenital (such as absence), inflammatory (acute, hemorrhagic, and chronic cholecystitis), traumatic, benign (polyps) and malignant tumors (gallbladder carcinoma and lymphoma), and other disease processes can be seen in cholelithiasis, cholesterosis, thickened gallbladder wall, and Mirrizzi syndrome.

  20. Slow pre-movement cortical potentials do not reflect individual response to therapy in writer's cramp

    DEFF Research Database (Denmark)

    Zeuner, K E; Peller, M; Knutzen, A

    2009-01-01

    OBJECTIVE: To investigate whether movement-related cortical potentials (MRCP) provide a physiological correlate that indicates the response to treatment in patients with writer's cramp. METHODS: In 21 patients with writer's cramp, who underwent 4 weeks of limb immobilization followed by re...... apart. RESULTS: Patients benefited from the therapeutical intervention (Zeuner et al., 2008). They showed no abnormalities of the MRCPs at baseline. In controls, MRCPs did not significantly change after 4 weeks. In patients, immobilization and re-training had no effect on MRCPs. There was no correlation......-training for 8 weeks, we recorded MRCPs preceding a self-initiated brisk finger abduction movement. MRCP measurements of pre-movement activity were performed at baseline, after the end of immobilization and four and 8 weeks of re-training. We examined 12 controls, who received no intervention, twice 4 weeks...

  1. Cholangiocarcinoma--an automated preliminary detection system using MLP.

    Science.gov (United States)

    Logeswaran, Rajasvaran

    2009-12-01

    Cholangiocarcinoma, cancer of the bile ducts, is often diagnosed via magnetic resonance cholangiopancreatography (MRCP). Due to low resolution, noise and difficulty is actually seeing the tumor in the images, especially by examining only a single image, there has been very little development of automated systems for cholangiocarcinoma diagnosis. This paper presents a computer-aided diagnosis (CAD) system for the automated preliminary detection of the tumor using a single MRCP image. The multi-stage system employs algorithms and techniques that correspond to the radiological diagnosis characteristics employed by doctors. A popular artificial neural network, the multi-layer perceptron (MLP), is used for decision making to differentiate images with cholangiocarcinoma from those without. The test results achieved was 94% when differentiating only healthy and tumor images, and 88% in a robust multi-disease test where the system had to identify the tumor images from a large set of images containing common biliary diseases.

  2. Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts

    Energy Technology Data Exchange (ETDEWEB)

    Rastegar, Neda; Matteoni-Athayde, Luciana G.; Eng, John [Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions (United States); Takahashi, Naoki [Mayo Clinic (United States); Tamm, Eric P. [MD Anderson Cancer Center (United States); Mortele, Koenraad J. [Beth Israel Deaconess Medical Center (United States); Syngal, Sapna [Dana Farber Cancer Institute (United States); Margolis, Daniel [University of California, Los Angeles (United States); Lennon, Anne Marie; Wolfgang, Christopher L.; Fishman, Elliot K.; Hruban, Ralph H.; Goggins, Michael; Canto, Marcia I. [Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions (United States); Kamel, Ihab R., E-mail: ikamel@jhmi.edu [Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions (United States)

    2015-04-15

    Highlights: •Secretin improved visualization of ductal communication of a cystic pancreatic lesion. •No association between cysts and gender, ethnicity or type of high risk. •Incremental value of secretin could offset the added cost and time. -- Abstract: Purpose: We investigated the incremental diagnostic yield of S-MRCP in a population with high prevalence of small pancreatic cysts. Methods: Standard MRCP protocol was performed with and without secretin using 1.5 T units in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter Cancer of the Pancreas Screening-3 trial (CAPS 3). All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses. Result: Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128 = 4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p = 0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p < 0.0005). Conclusion: At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions.

  3. Quantification of Movement-Related EEG Correlates Associated with Motor Training: A Study on Movement-Related Cortical Potentials and Sensorimotor Rhythms.

    Science.gov (United States)

    Jochumsen, Mads; Rovsing, Cecilie; Rovsing, Helene; Cremoux, Sylvain; Signal, Nada; Allen, Kathryn; Taylor, Denise; Niazi, Imran K

    2017-01-01

    The ability to learn motor tasks is important in both healthy and pathological conditions. Measurement tools commonly used to quantify the neurophysiological changes associated with motor training such as transcranial magnetic stimulation and functional magnetic resonance imaging pose some challenges, including safety concerns, utility, and cost. EEG offers an attractive alternative as a quantification tool. Different EEG phenomena, movement-related cortical potentials (MRCPs) and sensorimotor rhythms (event-related desynchronization-ERD, and event-related synchronization-ERS), have been shown to change with motor training, but conflicting results have been reported. The aim of this study was to investigate how the EEG correlates (MRCP and ERD/ERS) from the motor cortex are modulated by short (single session in 14 subjects) and long (six sessions in 18 subjects) motor training. Ninety palmar grasps were performed before and after 1 × 45 (or 6 × 45) min of motor training with the non-dominant hand (laparoscopic surgery simulation). Four channels of EEG were recorded continuously during the experiments. The MRCP and ERD/ERS from the alpha/mu and beta bands were calculated and compared before and after the training. An increase in the MRCP amplitude was observed after a single session of training, and a decrease was observed after six sessions. For the ERD/ERS analysis, a significant change was observed only after the single training session in the beta ERD. In conclusion, the MRCP and ERD change as a result of motor training, but they are subject to a marked intra- and inter-subject variability.

  4. Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts

    International Nuclear Information System (INIS)

    Rastegar, Neda; Matteoni-Athayde, Luciana G.; Eng, John; Takahashi, Naoki; Tamm, Eric P.; Mortele, Koenraad J.; Syngal, Sapna; Margolis, Daniel; Lennon, Anne Marie; Wolfgang, Christopher L.; Fishman, Elliot K.; Hruban, Ralph H.; Goggins, Michael; Canto, Marcia I.; Kamel, Ihab R.

    2015-01-01

    Highlights: •Secretin improved visualization of ductal communication of a cystic pancreatic lesion. •No association between cysts and gender, ethnicity or type of high risk. •Incremental value of secretin could offset the added cost and time. -- Abstract: Purpose: We investigated the incremental diagnostic yield of S-MRCP in a population with high prevalence of small pancreatic cysts. Methods: Standard MRCP protocol was performed with and without secretin using 1.5 T units in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter Cancer of the Pancreas Screening-3 trial (CAPS 3). All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses. Result: Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128 = 4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p = 0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p < 0.0005). Conclusion: At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions

  5. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases

    International Nuclear Information System (INIS)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-01-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs

  6. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases; Estudio propsective comparativo en el diagnostico de la patologia biliar. Colangiopancreatografia por resonancia magnetica frente a colangiografia directa

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-07-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs.

  7. Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    Ragozzino, A.; Rosa, R. De; Galdiero, R.; Maio, A.; Manes, G.

    2005-01-01

    Bronchobiliary fistula (BBF) is a rare disorder consisting of a passageway between the biliary ducts and the bronchial tree. Many conditions may give rise to this development. Management of these fistulas is often difficult and can be associated with high morbidity and mortality rates. We present a case of BBF developing after hemihepatectomy in a 74-year-old man treated with endoscopic biliary drainage and illustrate MRCP findings

  8. Pancreatitis. An update; Pankreatitis. Ein Update

    Energy Technology Data Exchange (ETDEWEB)

    Schreyer, A.G. [Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg (Germany); Grenacher, L. [Diagnostik Muenchen, MVZ Radiologie, Muenchen (Germany); Juchems, M. [Klinikum Konstanz, Diagnostische und Interventionelle Radiologie, Konstanz (Germany)

    2016-04-15

    Acute and chronic pancreatitis are becoming increasingly more severe diseases in the western world with far-reaching consequences for the individual patient as well as the socioeconomic situation. This article gives an overview of the contribution of radiological imaging to the diagnostics and therapy of both forms of the disease. Acute pancreatitis can be subdivided into severe (20 %) and mild manifestations. The diagnostics should be performed with computed tomography (CT) or magnetic resonance imaging (MRI) for assessing necrosis or potential infections only in severe forms of pancreatitis. In chronic pancreatitis transabdominal ultrasound should initially be adequate for assessment of the pancreas. For the differential diagnosis between pancreatic carcinoma and chronic pancreatitis, MRI with magnetic resonance cholangiopancreatography (MRCP) followed by an endoscopic ultrasound-guided fine needle aspiration is the method of choice. For the primary diagnosis for acute and chronic pancreatitis ultrasound examination is the modality of first choice followed by radiological CT and MRI with MRCP examinations. (orig.) [German] Akute und chronische Pankreatitis sind in der westlichen Welt zunehmende schwere Krankheitsbilder mit tiefgreifenden Konsequenzen fuer den einzelnen Patienten sowie soziooekonomisch. Der Beitrag radiologischer Bildgebung zur Diagnostik und Therapie beider Erkrankungsformen soll im vorliegenden Uebersichtsbeitrag diskutiert werden. Die akute Pankreatitis kann in eine schwere (20 %) und milde Verlaufsform unterteilt werden. Lediglich bei den schweren Formen sollte eine CT- oder MRT-Diagnostik bzgl. der Beurteilung von Nekrosen und moeglichen Infektionen erfolgen. Bei der chronischen Pankreatitis genuegt zunaechst eine Beurteilung des Pankreas durch transabdominellen Ultraschall. Hier sind die MRT mit der Magnetresonanzcholangiopankreatikographie (MRCP) sowie die endosonographisch gesteuerte Feinnadelpunktion die Methode, um

  9. A case of cutaneous scleroderma with primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    H P Nandeesh

    2014-01-01

    Full Text Available Sclerosing cholangitis comprises of a spectrum of cholestatic conditions that are characterized by patchy fibrosis, inflammation and destruction of intra hepatic and extrahepatic ducts. We report a case of a 42 year old woman who presented with darkening of skin with yellowish discolouration of the eyes. Clinical examination revealed icterus, taut skin with hepatosplenomegaly. Liver function tests showed a cholestatic picture. Skin biopsy showed features of cutaneous scleroderma. MRCP and Liver biopsy was suggestive of sclerosing cholangitis.

  10. Quantification of Movement-Related EEG Correlates Associated with Motor Training: A Study on Movement-Related Cortical Potentials and Sensorimotor Rhythms

    Directory of Open Access Journals (Sweden)

    Mads Jochumsen

    2017-12-01

    Full Text Available The ability to learn motor tasks is important in both healthy and pathological conditions. Measurement tools commonly used to quantify the neurophysiological changes associated with motor training such as transcranial magnetic stimulation and functional magnetic resonance imaging pose some challenges, including safety concerns, utility, and cost. EEG offers an attractive alternative as a quantification tool. Different EEG phenomena, movement-related cortical potentials (MRCPs and sensorimotor rhythms (event-related desynchronization—ERD, and event-related synchronization—ERS, have been shown to change with motor training, but conflicting results have been reported. The aim of this study was to investigate how the EEG correlates (MRCP and ERD/ERS from the motor cortex are modulated by short (single session in 14 subjects and long (six sessions in 18 subjects motor training. Ninety palmar grasps were performed before and after 1 × 45 (or 6 × 45 min of motor training with the non-dominant hand (laparoscopic surgery simulation. Four channels of EEG were recorded continuously during the experiments. The MRCP and ERD/ERS from the alpha/mu and beta bands were calculated and compared before and after the training. An increase in the MRCP amplitude was observed after a single session of training, and a decrease was observed after six sessions. For the ERD/ERS analysis, a significant change was observed only after the single training session in the beta ERD. In conclusion, the MRCP and ERD change as a result of motor training, but they are subject to a marked intra- and inter-subject variability.

  11. MR cholangiopancreatography: technique, potential indications, and diagnostic features of benign, postoperative, and malignant conditions

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Grossholz, M. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Mentha, G. [Department of Surgery, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Peyer, R. de [Division of Gastroenterology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland)

    1997-08-01

    The objective of this article is to review technical aspects, discuss potential clinical indications for MR cholangiopancreatography (MRCP) and demonstrate the spectrum of diagnostic findings in benign, postoperative, and malignant conditions. We describe our current imaging protocol in comparison with other available techniques. Using a non-breath-hold, heavily T2-weighted fast-spin-echo (FSE) sequence with or without respiratory gating we obtained coronal and axial source images and maximum intensity projections (MIPs) in 102 patients with suspected abnormalities of the biliary or pancreatic ducts. Based on this series we demonstrate the diagnostic appearance of a variety of benign, postoperative, and malignant conditions of the biliary and pancreatic ducts and discuss potential clinical indications for MRCP. The non-breath-hold FSE technique enables a consistent image quality even in patients who cannot cooperate well. Respiratory gating increased the rate of diagnostic examinations from 79 to 95 %. Acquisition of coronal and axial source images enables detection of bile duct stones as small as 2 mm, although calculi that are impacted and not surrounded by hyperintense bile may sometimes be difficult to detect. The MIP reconstructions help to determine the level of obstruction in malignant jaundice, delineate anatomical variants and malformations, and to diagnose inflammatory conditions, e. g., sclerosing cholangitis, the Mirizzi syndrome and inflammatory changes in the main pancreatic duct. The MRCP technique also correctly demonstrates the morphology of bilio-enteric or bilio-biliary anastomoses. Because MRCP provides sufficient diagnostic information in a wide range of benign and malignant biliary and pancreatic disorders, it could obviate diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in many clinical settings. The ERCP technique may be increasingly reserved for patients in whom nonsurgical interventional procedures are anticipated. (orig

  12. Classification of Hand Grasp Kinetics and Types Using Movement-Related Cortical Potentials and EEG Rhythms

    Directory of Open Access Journals (Sweden)

    Mads Jochumsen

    2017-01-01

    Full Text Available Detection of single-trial movement intentions from EEG is paramount for brain-computer interfacing in neurorehabilitation. These movement intentions contain task-related information and if this is decoded, the neurorehabilitation could potentially be optimized. The aim of this study was to classify single-trial movement intentions associated with two levels of force and speed and three different grasp types using EEG rhythms and components of the movement-related cortical potential (MRCP as features. The feature importance was used to estimate encoding of discriminative information. Two data sets were used. 29 healthy subjects executed and imagined different hand movements, while EEG was recorded over the contralateral sensorimotor cortex. The following features were extracted: delta, theta, mu/alpha, beta, and gamma rhythms, readiness potential, negative slope, and motor potential of the MRCP. Sequential forward selection was performed, and classification was performed using linear discriminant analysis and support vector machines. Limited classification accuracies were obtained from the EEG rhythms and MRCP-components: 0.48±0.05 (grasp types, 0.41±0.07 (kinetic profiles, motor execution, and 0.39±0.08 (kinetic profiles, motor imagination. Delta activity contributed the most but all features provided discriminative information. These findings suggest that information from the entire EEG spectrum is needed to discriminate between task-related parameters from single-trial movement intentions.

  13. Advantages of EEG phase patterns for the detection of gait intention in healthy and stroke subjects

    Science.gov (United States)

    Ioana Sburlea, Andreea; Montesano, Luis; Minguez, Javier

    2017-06-01

    Objective. One use of EEG-based brain-computer interfaces (BCIs) in rehabilitation is the detection of movement intention. In this paper we investigate for the first time the instantaneous phase of movement related cortical potential (MRCP) and its application to the detection of gait intention. Approach. We demonstrate the utility of MRCP phase in two independent datasets, in which 10 healthy subjects and 9 chronic stroke patients executed a self-initiated gait task in three sessions. Phase features were compared to more conventional amplitude and power features. Main results. The neurophysiology analysis showed that phase features have higher signal-to-noise ratio than the other features. Also, BCI detectors of gait intention based on phase, amplitude, and their combination were evaluated under three conditions: session-specific calibration, intersession transfer, and intersubject transfer. Results show that the phase based detector is the most accurate for session-specific calibration (movement intention was correctly detected in 66.5% of trials in healthy subjects, and in 63.3% in stroke patients). However, in intersession and intersubject transfer, the detector that combines amplitude and phase features is the most accurate one and the only that retains its accuracy (62.5% in healthy subjects and 59% in stroke patients) w.r.t. session-specific calibration. Significance. MRCP phase features improve the detection of gait intention and could be used in practice to remove time-consuming BCI recalibration.

  14. Movement-Related Cortical Potential Amplitude Reduction after Cycling Exercise Relates to the Extent of Neuromuscular Fatigue.

    Science.gov (United States)

    Spring, Jérôme Nicolas; Place, Nicolas; Borrani, Fabio; Kayser, Bengt; Barral, Jérôme

    2016-01-01

    Exercise-induced fatigue affects the motor control and the ability to generate a given force or power. Surface electroencephalography allows researchers to investigate movement-related cortical potentials (MRCP), which reflect preparatory brain activity 1.5 s before movement onset. Although the MRCP amplitude appears to increase after repetitive single-joint contractions, the effects of large-muscle group dynamic exercise on such pre-motor potential remain to be described. Sixteen volunteers exercised 30 min at 60% of the maximal aerobic power on a cycle ergometer, followed by a 10-km all-out time trial. Before and after each of these tasks, knee extensor neuromuscular function was investigated using maximal voluntary contractions (MVC) combined with electrical stimulations of the femoral nerve. MRCP was recorded during 60 knee extensions after each neuromuscular sequence. The exercise resulted in a significant decrease in the knee extensor MVC force after the 30-min exercise (-10 ± 8%) and the time trial (-21 ± 9%). The voluntary activation level (VAL; -6 ± 8 and -12 ± 10%), peak twitch (Pt; -21 ± 16 and -32 ± 17%), and paired stimuli (P100 Hz; -7 ± 11 and -12 ± 13%) were also significantly reduced after the 30-min exercise and the time trial. The first exercise was followed by a decrease in the MRCP, mainly above the mean activity measured at electrodes FC1-FC2, whereas the reduction observed after the time trial was related to the FC1-FC2 and C2 electrodes. After both exercises, the reduction in the late MRCP component above FC1-FC2 was significantly correlated with the reduction in P100 Hz (r = 0.61), and the reduction in the same component above C2 was significantly correlated with the reduction in VAL (r = 0.64). In conclusion, large-muscle group exercise induced a reduction in pre-motor potential, which was related to muscle alterations and resulted in the inability to produce a maximal voluntary contraction.

  15. Movement-related cortical potential amplitude reduction after cycling exercise relates to the extent of neuromuscular fatigue

    Directory of Open Access Journals (Sweden)

    Jérôme eSpring

    2016-06-01

    Full Text Available Exercise-induced fatigue affects the motor control and the ability to generate a given force or power. Surface electroencephalography allows researchers to investigate movement-related cortical potentials (MRCP, which reflect preparatory brain activity 1.5 seconds before movement onset. Although the MRCP amplitude appears to increase after repetitive single-joint contractions, the effects of large-muscle group dynamic exercise on such pre-motor potential remain to be described. Sixteen volunteers exercised 30 minutes at 60% of the maximal aerobic power on a cycle ergometer, followed by a 10-km all-out time trial. Before and after each of these tasks, knee extensor neuromuscular function was investigated using maximal voluntary contractions (MVC combined with electrical stimulations of the femoral nerve. MRCP was recorded during 60 knee extensions after each neuromuscular sequence.The exercise resulted in a significant decrease in the knee extensor MVC force after the 30-min exercise (-10±8% and the time trial (-21±9%. The voluntary activation level (VAL (-6±8% and -12±10%, peak twitch (Pt (-21±16% and -32±17% and paired stimuli (P100Hz (-7±11% and -12±13% were also significantly reduced after the 30-min exercise and the time trial. The first exercise was followed by a decrease in the MRCP, mainly above the mean activity measured at electrodes FC1-FC2, whereas the reduction observed after the time trial was related to the FC1-FC2 and C2 electrodes. After both exercises, the reduction in the late MRCP component above FC1-FC2 was significantly correlated with the reduction in P100Hz (r=0.61, and the reduction in the same component above C2 was significantly correlated with the reduction in VAL (r=0.64.In conclusion, large-muscle group exercise induced a reduction in pre-motor potential, which was related to muscle alterations and resulted in the inability to produce a maximal voluntary contraction.

  16. Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Mi-Jung; Kim, Myung-Joon [Yonsei University, College of Medicine, Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Seoul (Korea, Republic of); Severance Pediatric Liver Disease Research Group, Seoul (Korea, Republic of); Yoon, Choon-Sik [Yonsei University, College of Medicine, Department of Radiology, Gangnam Severance Hospital, Seoul (Korea, Republic of); Chung, Yong Eun [Yonsei University, College of Medicine, Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Seoul (Korea, Republic of); Han, Seok Joo [Yonsei University, College of Medicine, Department of Pediatric Surgery, Severance Children' s Hospital, Seoul (Korea, Republic of); Severance Pediatric Liver Disease Research Group, Seoul (Korea, Republic of); Koh, Hong [Yonsei University, College of Medicine, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Severance Children' s Hospital, Seoul (Korea, Republic of); Severance Pediatric Liver Disease Research Group, Seoul (Korea, Republic of)

    2011-04-15

    Biliary atresia (BA) is a progressive, obliterative cholangiopathy that occurs in neonates with hepatic portoenterostomy the treatment of choice, but early surgery is important for optimum outcomes. MRI, including MR cholangiopancreatography (MRCP) may be a diagnostically useful alternative to US, but the heavily T2-weighted sequences used include not only bile duct signals, but also other heterogeneously high signal intensities from surrounding structures. To evaluate the effects of gadolinium when used to decrease background signal intensity on T2-weighted MR cholangiopancreatography (MRCP) in infants and to evaluate the qualitative improvement of the depiction of the common bile duct (CBD) for evaluating neonatal cholestasis. Our Institutional Review Board approved this prospective study. MRCP was performed with gadopentetate dimeglumine injection using a 1.5-T scanner. Pre- and postcontrast MRCP images were compared. Forty-nine infants (male:female = 21:28; age 0-12 months, mean 2.3) were included. The final diagnoses were biliary atresia (BA) in 28 cases and non-BA in 21. Quantitative analysis was conducted using region-of-interest measurements of mean signal intensities of the liver, pancreatic head and gallbladder (if defined). Qualitative analysis was performed by four radiologists who subjectively scored image confidence in the presence of CBD on a 4-point scale (0 for definitely absent, 1 for probably absent, 2 for probably present, and 3 for definitely present). The signal-to-noise ratios were significantly decreased in the liver and pancreatic head after contrast medium enhancement (mean 5.7{yields}4.0 in liver and mean 44.9{yields}12.7 in the pancreatic head; P < 0.0001), and this finding was constant in both the BA and the non-BA group. The mean confidence score in the presence of CBD decreased in the BA group (0.9{yields}0.5; P < 0.0001), but did not change significantly in the non-BA group (2.0{yields}2.1; P = 0.459) after contrast medium

  17. Pancreatic morphological changes in long-term follow-up after initial episode of acute alcoholic pancreatitis.

    Science.gov (United States)

    Nikkola, Jussi; Rinta-Kiikka, Irina; Räty, Sari; Laukkarinen, Johanna; Lappalainen-Lehto, Riitta; Järvinen, Satu; Seppänen, Hanna; Nordback, Isto; Sand, Juhani

    2014-01-01

    The long-term morphological changes induced by a single episode of alcoholic pancreatitis are not known. Our aim was to study these morphological changes in secretin-stimulated magnetic resonance cholangiopancreatography (S-MRCP) after the first episode of alcohol-associated acute pancreatitis and to evaluate the risk factors and possible protective factors potentially associated with later chronic findings. We have previously reported 2-year follow-up results in pancreatic morphology. This study extends the follow-up to 9 years. In this prospective follow-up study, S-MRCP imaging was performed for 44 (41 M, 3 F; mean age, 46 (25-68) years) patients after their first episode of alcohol-associated pancreatitis. Pancreatic morphology was evaluated at 3 months and at 2, 7, and 9 years after hospitalization. Recurrent attacks of pancreatitis were studied and pancreatic function was monitored by laboratory tests. Patients' alcohol consumption was evaluated with questionnaires, laboratory markers, and self-estimated alcohol consumption via interview. Smoking and body mass index were annually recorded. At 3 months, 32 % of the patients had normal findings in S-MRCP, 52 % had acute, and 16 % had chronic changes. At 7 years, S-MRCP was performed on 36 patients with normal findings in 53 %, the rest (47 %) having chronic findings. Pancreatic cyst was present in 36 %, parenchymal changes in 28 %, and atrophy in 28 % of the cases. There were no new changes in the pancreas in the attending patients between 7 and 9 years (18 patients). Of the patients with only acute findings at 3 months, 60 % resolved to normal in 7 years, but the rest (40 %) showed chronic changes later on. The initial attack was mild in 65 %, moderate in 25 %, and severe in 10 % of the patients. Patients with mild first attack had fewer chronic changes at 7 years compared to patients with moderate or moderate and severe together (p = 0.03, p = 0.01). Of the patients in the

  18. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population

    Energy Technology Data Exchange (ETDEWEB)

    Buelow, Robin; Thiel, Robert; Thamm, Patrick; Messner, Philip; Hosten, Norbert; Kuehn, Jens-Peter [University Medicine, Ernst Moritz Arndt University Greifswald, Department of Radiology and Neuroradiology, Greifswald (Germany); Simon, Peter; Lerch, Markus M.; Mayerle, Julia [University Medicine, Ernst Moritz Arndt University Greifswald, Division of Gastroenterology and Department of Medicine A, Greifswald (Germany); Voelzke, Henry [University Medicine, Ernst Moritz Arndt University Greifswald, Institute for Community Medicine, Greifswald (Germany)

    2014-12-15

    To investigate the frequency of pancreatic duct (PD) variants and their effect on pancreatic exocrine function in a population-based study using non-invasive secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP). Nine hundred and ninety-five volunteers, 457 women and 538 men, aged 51.9 ± 13.4 years, underwent navigator-triggered, T2-weighted, 3D turbo spin echo MRCP on a 1.5 T system after 1 unit/kg secretin administration. Two readers evaluated images for PD variants. Pancreatic exocrine function and morphological signs of chronic pancreatitis such as abnormalities of the main PD, side branch dilatation, and pancreatic cysts were evaluated and related to PD variants using a Kruskal-Wallis test and post hoc analysis. Of all sMRCP, 93.2 % were of diagnostic quality. Interobserver reliability for detection of PD variants was found to be kappa 0.752 (95 %CI, 0.733 - 0.771). Normal PD variants were observed in 90.4 % (n = 838/927). Variants of pancreas divisum was identified in 9.6 % (n = 89/927). Abnormalities of the main PD, side branch dilatation, and pancreatic cysts were observed in 2.4 %, 16.6 %, and 27.7 %, respectively, and were not significantly different between pancreas divisum and non-divisum group (P = 0.122; P = 0.152; P = 0.741). There was no association between PD variants and pancreatic exocrine function (P = 0.367). PD variants including pancreas divisum are not associated with morphological signs of chronic pancreatitis or restriction of pancreatic exocrine function. (orig.)

  19. The effects of kinesio taping on potential in chronic low back pain patients anticipatory postural control and cerebral cortex.

    Science.gov (United States)

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-11-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using electromyography, and movement-related cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation was performed using a visual analogue scale and the Oswestry disability index. [Results] According to the analysis results for anticipatory postural control, there were significant decreases in the transversus abdominis (TrA) muscle and the external oblique muscle in both groups. Among them, the TrA of the experimental group exhibited the greatest differences. According to the results of a between-group comparison, there was significant difference in the TrA between the two groups. There was also a significant decrease in the MRCP of both groups. In particular, changes in the movement monitoring potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According to the between-group comparison, there were significant differences in MMP at F3, C3, and Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to CLBP patients reduced their pain and positively affected their anticipatory postural control and MRCP.

  20. Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer.

    Science.gov (United States)

    Langer, P; Kann, P H; Fendrich, V; Habbe, N; Schneider, M; Sina, M; Slater, E P; Heverhagen, J T; Gress, T M; Rothmund, M; Bartsch, D K

    2009-10-01

    Familial pancreatic cancer (FPC) accounts for approximately 3% of all pancreatic cancer (PC) cases. It has been suggested that high-risk individuals (HRIs) should be offered a screening programme. To evaluate the diagnostic yield of a prospective screening programme in HRIs from families with FPC over a period of 5 years. HRIs of families with FPC of the National German Familial Pancreatic Cancer Registry (FaPaCa) were counselled and enrolled in a prospective, board-approved PC screening programme. Screening included clinical examination, laboratory tests, endoscopic ultrasound (EUS) and MRI with magnetic resonance cholangiopancreaticography (MRCP) and MR angiography. Between June 2002 and December 2007, 76 HRIs of families with FPC took part in the screening programme with a total of 182 examination visits. Twenty-eight patients revealed abnormalities in EUS (n = 25) and/or MR/MRCP (n = 12). In 7 patients fine needle aspiration cytology was performed. Operative pancreatic explorations were performed in 7 individuals, resulting in limited resections in 6 cases. Histopathological examination of the resected specimens showed serous oligocystic adenomas (n = 3), pancreatic intraepithelial neoplasia 1 (PanIN1) lesions with lobular fibrosis (n = 1), PanIN2 lesions (n = 1) and PanIN1 lesion plus a gastric type intraductal papillary mucinous neoplasm (IPMN) (n = 1). In FPC an EUS/MR/MRCP-based screening programme leads to the detection of potential precursor lesions of PC. However, the yield of an extensive screening programme is low, especially since the tumourigenic value of low grade PanIN lesions is not yet defined. Taking into account the enormous psychological stress for the tested individual and the high costs, a general PC screening in HRIs is not justified.

  1. Optimal sequence for magnetic resonance cholangiopancreatography

    International Nuclear Information System (INIS)

    Kanzaki, Hiroshi; Akata, Soichi; Ozuki, Taizo; Abe, Kimihiko

    2001-01-01

    Magnetic resonance cholangiopancreatography (MRCP) has attracted attention as a useful examination for abnormalities of the pancreaticobiliary system, because it is a simple procedure. Since there are few detailed reports on optimal sequences for MRCP, we attempted to clarify the topic. The magnetic resonance imaging (MRI) equipment we used was a 1.0 Tesla super-conductive type. A fast spin echo (16 echo train) was used, and the echo space was set at 17 msec. TE was changed from 17 msec to 272 msec in 17 msec increments. TR was changed from 1,000 msec to 9,000 msec by 1,000 msec increments. Bile juice which had been collected from the PTCD tube of a patient with common bile duct cancer, was put in a test tube of 10 mm internal diameter. Saline was used as a substitute for pancreatic juice, because collection of pancreatic juice was difficult. Fat was used for contrast. Each signal intensity inside the test tube was measured and evaluated. We attempted to evaluate the signal of gastric juice by adding blueberry juice, making use of its manganese ion (Mn ++ ). With longer TR, the signal intensities of bile and pancreas juice increased. As TE became longer, the signal intensities of bile and pancreas juice decreased slightly, while that of fat decreased much more. In MRCP, it is necessary to set up a long TE to increase the relative signal intensity difference of fat in bile and pancreas juice. The signal intensity of gastric juice was made to disappear by the addition of blueberry juice diluted to a ratio of 1:3. (author)

  2. [Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system].

    Science.gov (United States)

    Peng, Cheng-hong; Zhao, Zhi-ming; Peng, Shu-you; Liu, Ying-bin; Wu, Yü-lian; Fang, He-qing; Jiang, Xian-chuan

    2005-01-01

    To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York. The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed. Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007). The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.

  3. Scoring system to preoperatively predict choledocholithiasis.

    Science.gov (United States)

    Kamath, Sheshang U; Dharap, Satish B; Kumar, Vineet

    2016-05-01

    The incidence of common bile duct (CBD) calculi has been reported to be 8 % to 20 % among the patients with cholelithiasis. Failure to detect CBD stones on the part of the surgeon not only fails to relieve symptoms but also subjects them to potentially life-threatening complications such as cholangitis, pancreatitis or obstructive jaundice. Modalities for detection of CBD stones have evolved over time from CBD exploration based on clinical and operative findings to intraoperative cholangiography (IOC), to endoscopic retrograde cholangiopancreaticography (ERCP) and, recently, to magnetic resonance cholangiopancreaticography (MRCP) and endoscopic ultrasonography (EUS). We felt a need for a scoring system to predict a patient population having a higher risk of choledocholithiasis so that these modern interventions can be selectively utilized. This study was performed in a tertiary care medical college hospital in a metropolitan city. This is a prospective observational study. All patients with symptomatic cholelithiasis admitted to the hospital were included. Patients were diagnosed as having choledocholithiasis either by ultrasonography (USG), computed tomography scan, MRCP, EUS or ERCP and were followed up for at least 6 weeks. The prevalence of choledocholithiasis among the 275 patients with symptomatic biliary colic in our study was 18.9 % (n = 77). On bivariate analysis, dilated bile duct on USG (>6 mm), raised total bilirubin, raised alkaline phosphatase (ALP), raised amylase, raised SGPT and SGOT were significantly associated with choledocholithiasis (p choledocholithiasis (p 6 mm), total bilirubin >2 mg/dL, ALP >190 IU/L and SGOT >40 IU/L. A positive predictive value of 3 or more factors was over 95 %, necessitating an endoscopic intervention. A negative predictive value of the absence of any factor was 100 %, which ruled out CBD calculi. If only one or two factors are positive, then further evaluation is recommended preferably using non

  4. Differences in visuo-motor control in skilled vs. novice martial arts athletes during sustained and transient attention tasks: a motor-related cortical potential study.

    Science.gov (United States)

    Sanchez-Lopez, Javier; Fernandez, Thalia; Silva-Pereyra, Juan; Martinez Mesa, Juan A; Di Russo, Francesco

    2014-01-01

    Cognitive and motor processes are essential for optimal athletic performance. Individuals trained in different skills and sports may have specialized cognitive abilities and motor strategies related to the characteristics of the activity and the effects of training and expertise. Most studies have investigated differences in motor-related cortical potential (MRCP) during self-paced tasks in athletes but not in stimulus-related tasks. The aim of the present study was to identify the differences in performance and MRCP between skilled and novice martial arts athletes during two different types of tasks: a sustained attention task and a transient attention task. Behavioral and electrophysiological data from twenty-two martial arts athletes were obtained while they performed a continuous performance task (CPT) to measure sustained attention and a cued continuous performance task (c-CPT) to measure transient attention. MRCP components were analyzed and compared between groups. Electrophysiological data in the CPT task indicated larger prefrontal positive activity and greater posterior negativity distribution prior to a motor response in the skilled athletes, while novices showed a significantly larger response-related P3 after a motor response in centro-parietal areas. A different effect occurred in the c-CPT task in which the novice athletes showed strong prefrontal positive activity before a motor response and a large response-related P3, while in skilled athletes, the prefrontal activity was absent. We propose that during the CPT, skilled athletes were able to allocate two different but related processes simultaneously according to CPT demand, which requires controlled attention and controlled motor responses. On the other hand, in the c-CPT, skilled athletes showed better cue facilitation, which permitted a major economy of resources and "automatic" or less controlled responses to relevant stimuli. In conclusion, the present data suggest that motor expertise

  5. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Schubert, Tilman B. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Basel University Hospital, Clinic of Radiology and Nuclear Medicine, Basel (Switzerland); Said, Adnan [University of Wisconsin-Madison, Department of Medicine, Madison, WI (United States); Mezrich, Joshua D. [University of Wisconsin-Madison, Department of Surgery, Madison, WI (United States); Reeder, Scott B. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University of Wisconsin-Madison, Department of Medicine, Madison, WI (United States); University of Wisconsin-Madison, Department of Biomedical Engineering, Madison, WI (United States); University of Wisconsin-Madison, Department of Medical Physics, Madison, WI (United States); University of Wisconsin-Madison, Department of Emergency Medicine, Madison, WI (United States)

    2017-10-15

    Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated. IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%. Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. (orig.)

  6. Optimal sequence for magnetic resonance cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Kanzaki, Hiroshi; Akata, Soichi; Ozuki, Taizo; Abe, Kimihiko [Tokyo Medical Coll. (Japan)

    2001-09-01

    Magnetic resonance cholangiopancreatography (MRCP) has attracted attention as a useful examination for abnormalities of the pancreaticobiliary system, because it is a simple procedure. Since there are few detailed reports on optimal sequences for MRCP, we attempted to clarify the topic. The magnetic resonance imaging (MRI) equipment we used was a 1.0 Tesla super-conductive type. A fast spin echo (16 echo train) was used, and the echo space was set at 17 msec. TE was changed from 17 msec to 272 msec in 17 msec increments. TR was changed from 1,000 msec to 9,000 msec by 1,000 msec increments. Bile juice which had been collected from the PTCD tube of a patient with common bile duct cancer, was put in a test tube of 10 mm internal diameter. Saline was used as a substitute for pancreatic juice, because collection of pancreatic juice was difficult. Fat was used for contrast. Each signal intensity inside the test tube was measured and evaluated. We attempted to evaluate the signal of gastric juice by adding blueberry juice, making use of its manganese ion (Mn{sup ++}). With longer TR, the signal intensities of bile and pancreas juice increased. As TE became longer, the signal intensities of bile and pancreas juice decreased slightly, while that of fat decreased much more. In MRCP, it is necessary to set up a long TE to increase the relative signal intensity difference of fat in bile and pancreas juice. The signal intensity of gastric juice was made to disappear by the addition of blueberry juice diluted to a ratio of 1:3. (author)

  7. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population

    International Nuclear Information System (INIS)

    Buelow, Robin; Thiel, Robert; Thamm, Patrick; Messner, Philip; Hosten, Norbert; Kuehn, Jens-Peter; Simon, Peter; Lerch, Markus M.; Mayerle, Julia; Voelzke, Henry

    2014-01-01

    To investigate the frequency of pancreatic duct (PD) variants and their effect on pancreatic exocrine function in a population-based study using non-invasive secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP). Nine hundred and ninety-five volunteers, 457 women and 538 men, aged 51.9 ± 13.4 years, underwent navigator-triggered, T2-weighted, 3D turbo spin echo MRCP on a 1.5 T system after 1 unit/kg secretin administration. Two readers evaluated images for PD variants. Pancreatic exocrine function and morphological signs of chronic pancreatitis such as abnormalities of the main PD, side branch dilatation, and pancreatic cysts were evaluated and related to PD variants using a Kruskal-Wallis test and post hoc analysis. Of all sMRCP, 93.2 % were of diagnostic quality. Interobserver reliability for detection of PD variants was found to be kappa 0.752 (95 %CI, 0.733 - 0.771). Normal PD variants were observed in 90.4 % (n = 838/927). Variants of pancreas divisum was identified in 9.6 % (n = 89/927). Abnormalities of the main PD, side branch dilatation, and pancreatic cysts were observed in 2.4 %, 16.6 %, and 27.7 %, respectively, and were not significantly different between pancreas divisum and non-divisum group (P = 0.122; P = 0.152; P = 0.741). There was no association between PD variants and pancreatic exocrine function (P = 0.367). PD variants including pancreas divisum are not associated with morphological signs of chronic pancreatitis or restriction of pancreatic exocrine function. (orig.)

  8. Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma

    International Nuclear Information System (INIS)

    Balci, N. Cem; Semelka, Richard C.

    2001-01-01

    This article presents imaging modalities in the diagnosis and staging of pancreatic ductal adenocarcinoma. Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) have the highest accuracy in detection of pancreatic cancer. MRI and EUS have similar accuracy in determining the local extent of pancreatic cancer. Angiography, computed tomography (CT) angiography and EUS are similarly accurate in evaluating peripancreatic vascular involvement. MRI is the superior method for detecting liver metastases and peritoneal implants of pancreatic ductal adenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are used to assess the biliary tract of patients with pancreatic cancer. Positron emission tomography (PET) is useful in distinguishing pancreatic cancer from focal pancreatic inflammation

  9. Pancreatic adenocarcinoma presenting as acute pancreatitis during pregnancy: clinical and radiologic manifestations.

    Science.gov (United States)

    Perera, Dinushi; Kandavar, Ramprasad; Palacios, Enrique

    2011-01-01

    Only seven cases of pancreatic adenocarcinoma diagnosed during pregnancy have been reported. In this article, we describe a case of pancreatic adenocarcinoma presenting clinically as acute pancreatitis in a pregnant patient. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) revealed a pancreatic mass with an inflammatory component and multiple hyperintense metastatic lesions in the liver. The patient was initially treated for biliary pancreatitis, and pancreatic cancer was not suspected given her young age and absence of risk factors. A diagnosis of pancreatic cancer in a pregnant patient requires a high index of suspicion, and pancreatitis can be a mode of presentation.

  10. Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Balci, N. Cem E-mail: ncbalci@hotmail.com; Semelka, Richard C

    2001-05-01

    This article presents imaging modalities in the diagnosis and staging of pancreatic ductal adenocarcinoma. Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) have the highest accuracy in detection of pancreatic cancer. MRI and EUS have similar accuracy in determining the local extent of pancreatic cancer. Angiography, computed tomography (CT) angiography and EUS are similarly accurate in evaluating peripancreatic vascular involvement. MRI is the superior method for detecting liver metastases and peritoneal implants of pancreatic ductal adenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are used to assess the biliary tract of patients with pancreatic cancer. Positron emission tomography (PET) is useful in distinguishing pancreatic cancer from focal pancreatic inflammation.

  11. [Intraductal papillary mucinous pancreas tumor].

    Science.gov (United States)

    Maev, I V; Kaziulin, A N; Kucheriavyĭ, Iu A

    2008-01-01

    Data of the literature on the epidemiology, patogenesis, diagnosis, peculiarities of the symptoms and the treatment of the intraduct papillar pancreatic tumor, are analyzed in this review. These tumors are rare, there are up to 1% of the exocrine pancreatic tumors. Intraduct proliferation of the mucin producing cells, that are disposed as papillars is typical of these tumors. There are the symptoms of the acute or chronic pancreatitis, sometimes the diagnosis of this tumor is accidental. The main diagnostic methods are ultrasound (US) and computed tomography (CT). Endoluminal ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are the main methods to reveal the intraduct growth. The surgical treatment is necessary for these patients.

  12. Magnetic resonance imaging of pancreaticobiliary diseases in children: from technique to practice

    International Nuclear Information System (INIS)

    Anupindi, Sudha A.; Chauvin, Nancy A.; Khwaja, Asef; Biko, David M.

    2016-01-01

    Magnetic resonance imaging is useful for evaluating pancreaticobiliary diseases in children after initial sonography, obviating the use of ionizing radiation or invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or transhepatic biliary procedures. Advanced MRI applications have improved depiction of pediatric pancreaticobiliary anatomy and have greatly impacted management of biliary and pancreatic diseases in children. In this article, we review current MRI and magnetic resonance cholangiopancreatography (MRCP) techniques and discuss their role in the assessment of common pancreatic and biliary disorders in children. (orig.)

  13. Obstructive Jaundice in Polycystic Liver Disease Related to Coexisting Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Spiros G. Delis

    2008-05-01

    Full Text Available Although jaundice rarely complicates polycystic liver disease (PLD, secondary benign or malignant causes cannot be excluded. In a 72-year-old female who presented with increased abdominal girth, dyspnea, weight loss and jaundice, ultrasound and computed tomography confirmed the diagnosis of PLD by demonstrating large liver cysts causing extrahepatic bile duct compression. Percutaneous cyst aspiration failed to relief jaundice due to distal bile duct cholangiocarcinoma, suspected by magnetic resonance cholangiopancreatography (MRCP and confirmed by endoscopic retrograde cholangiopancreatography (ERCP. Coexistence of PLD with distal common bile duct cholangiocarcinoma has not been reported so far.

  14. Choledochal cyst: diagnosis and surgical treatment.

    Science.gov (United States)

    Wolthuis, A M; Tollens, T; Aelvoet, C; Vanrijkel, J P

    2007-06-01

    A 20-year old woman with a 2-month history of epigastric pain, progressive jaundice and obstructive liver biochemistry underwent imaging of the biliary tract, carried out using ultrasonography, CT-scan and MRI. Abdominal ultrasound showed a dilation of the choledochal duct. CT-scan and MRI revealed a cystic dilation of the choledochal duct. Because of possible malignant degeneration, en-bloc cholecystectomy and resection of the cyst were performed, with Roux-en-Y hepaticojejunostomy reconstruction. This case demonstrates the diagnostic value of MRI and MRCP in a pathology that is rather rare in Western countries.

  15. Imaging of the normal and abnormal pancreaticobiliary system with single-shot MR cholangiopancreatography: a pictorial review

    International Nuclear Information System (INIS)

    Little, A. F.; Smith, P.J.; Lee, W.K.; Hennessy, O.F.; Lourensz, M.E.; Desmond, P.V.; Banting, S.W.

    1999-01-01

    Magnetic resonance cholangiopancreatography (MRCP) is a rapidly evolving non-invasive imaging modality that produces images of the pancreatic duct and binary tree without the need for intravenous or oral contrast. The images are equivalent to those from endoscopic retrograde cholangiopancreatography (ERCP), but the non-invasive acquisition avoids the morbidity and mortality associated with diagnostic ERCP. Magnetic resonance cholangiopancreatography is indicated in patients who require only a diagnostic ERCP, who fail an ERCP or who are unable to undergo ERCP due to altered post-surgical anatomy. Other evolving indications include triaging of patients with obstructive jaundice into percutaneous or endoscopic management drainage pathways depending on the site, length and nature of the duct obstruction, thereby potentially decreasing the number of failed or unsuccessful ERCP. Preoperative identification of anomalous binary anatomy and choledocholithiasis prior to laparoscopic cholecystectomy promise to modify the pre-operative and operative management of the patient in order to minimize the risk of duct injury and unnecessary intra-operative dissection and cholangiography. The advantages of the technique include its non-invasiveness, the absence of contrast administration, its relative operator independence and the ability to evaluate both sides of an obstructed duct, thereby accurately evaluating stricture morphology and length. The disadvantages of MRCP compared to ERCP include its lack of an immediate therapeutic solution to duct obstruction, procedural cost, unit availability and the inability to evaluate patients with pacemakers or ferromagnetic implants. Copyright (1999) Blackwell Science Pty Ltd

  16. MR cholangiopancreatography : comparison of breath-hold fast spin echo and respiratory triggered fast spin echo techniques

    International Nuclear Information System (INIS)

    Kim, Myeong Jin; Hong, Hye Suk; Chung, Jae Joon; Chung, Jae Bock; Yang, Hee Chul; Yoo, Hyung Sik; Lee, Jaong Tae

    1997-01-01

    To determine relative image qualities and to evaluate their ability to visualize biliary trees and pancreatic ducts, we compared the breath-hold fast echo (FSE) and respiratory-triggered FSE technique in magnetic resonance cholangiopancreatography (MRCP). Forty-seven patients with suspected of hepatic disease but no pancreatic or biliary ductal dilatation, as determined by other imaging techniques (group of non-pathologic pancreatobiliary tree), and seven with pancreatic or biliary disease (group of pathologic pancreatobiliary tree) underwent MRCP. Heavily T2-weighted FSE coronal images were obtained by both breath-hold and respiratory triggered techniques. These two images were 3 D-reconstructed using a maximal intensity projection algorithm. Three radiologists scored the image qualities of anatomic by the two techniques. For the visualization of extrahepatic bile ducts, the respiratory triggered FSE sequence was better than the breath-hold sequence; for the evaluation of both a non-dilated and dilated pancreatobiliary system, however, both techniques need further development. (author). 16 refs., 2 tabs., 4 figs

  17. Diffuse pancreatic ductal adenocarcinoma: Characteristic imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Jun [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Byun, Jae Ho [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of)], E-mail: jhbyun@amc.seoul.kr; Kim, Ji-Youn [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Kim, Myung-Hwan [Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Jang, Se Jin [Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of); Ha, Hyun Kwon; Lee, Moon-Gyu [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736 (Korea, Republic of)

    2008-08-15

    Purpose: To evaluate imaging findings of diffuse pancreatic ductal adenocarcinoma. Materials and methods: We included 14 patients (4 men and 10 women; mean age, 64.5 years) with diffuse pancreatic ductal adenocarcinoma on the basis of retrospective radiological review. Two radiologists retrospectively reviewed 14 CT scans in consensus with respect to the following: tumor site, peripheral capsule-like structure, dilatation of intratumoral pancreatic duct, parenchymal atrophy, and ancillary findings. Eight magnetic resonance (MR) examinations with MR cholangiopancreatography (MRCP) and seven endoscopic retrograde cholangiopancreatography (ERCP) were also reviewed, focusing on peripheral capsule-like structure and dilatation of intratumoral pancreatic duct. Results: CT revealed tumor localization to the body and tail in 11 (79%) patients and peripheral capsule-like structure in 13 (93%). The intratumoral pancreatic duct was not visible in 13 (93%). Pancreatic parenchymal atrophy was not present in all 14 patients. Tumor invasion of vessels was observed in all 14 patients and of neighbor organs in 8 (57%). On contrast-enhanced T1-weighted MR images, peripheral capsule-like structure showed higher signal intensity in five patients (71%). In all 11 patients with MRCP and/or ERCP, the intratumoral pancreatic duct was not dilated. Conclusion: Diffuse pancreatic ductal adenocarcinoma has characteristic imaging findings, including peripheral capsule-like structure, local invasiveness, and absence of both dilatation of intratumoral pancreatic duct and parenchymal atrophy.

  18. Latest advances in diagnosis and treatment of occult common bile duct stones

    Directory of Open Access Journals (Sweden)

    WANG Chao

    2017-07-01

    Full Text Available Occult common bile duct stones have no clinical symptoms and if it is not diagnosed or treated in time, it can cause unexplained abdominal pain after cholecystectomy or serious complications such as biliary pancreatitis and acute cholangitis, which may threaten patients′ lives. Proper diagnosis and treatment modalities can reduce postoperative complications, save medical resources, and reduce medical disputes. This article introduces the latest advances in the diagnosis and treatment of occult common bile duct stones, including the features and diagnostic efficacy of imaging examinations (abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography (MRCP, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP, intraoperative cholangiography, intraoperative laparoscopic ultrasonography, intraductal ultrasonography, and intraoperative choledochoscopy, as well as the effect of treatment modalities (endoscopic sphincterotomy (EST, laparoscopic common bile duct exploration (LCBDE, open common bile duct exploration, endoscopic papillary balloon dilatation, electrohydaulic lithotripsy, extracorporeal shockwave lithotripsy, litholysis, and laser lithotripsy. It is pointed out that the diagnosis and treatment of occult common bile duct stones should be treated differently according to risk stratification. Endoscopic ultrasonography or MRCP should be performed for patients with moderate risks or above, and their results are critical to the choice of surgical procedure. For treatment modality, LCBDE or ERCP/EST should be selected according to patients′ actual conditions.

  19. The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.

    Science.gov (United States)

    Macedo, Francisco Igor B; Casillas, Victor J; Davis, James S; Levi, Joe U; Sleeman, Danny

    2014-01-01

    Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

  20. Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients

    International Nuclear Information System (INIS)

    Dalal, Paras U.; Howlett, David C.; Sallomi, David F.; Marchbank, Nigel D.; Watson, Gillian M.T.; Marr, Amanda; Dunk, Arthur A.; Smith, Alastair D.

    2004-01-01

    Introduction: Magnetic resonance cholangiopancreatography (MRCP) has been demonstrated as a reliable, non-invasive means of biliary tract imaging among patients with suspected choledocholithiasis. The aim of this study was to establish the impact of intravenous glucagon administration (IVGA) upon visualisation of the common bile duct (CBD) and ampulla of Vater during MRCP. Materials and methods: Forty-two consecutive, non-diabetic subjects with a working diagnosis of symptomatic choledocholithiasis were scanned, pre- and post-IVGA using the half-Fourier, single shot, turbo-spin-echo (HASTE) sequence. Maximum intensity projections (optimised for the extra-hepatic biliary tree and ampulla of Vater) were reviewed blindly by three consultant radiologists. The CBD images were graded (0-3) according to the length of duct seen. The ampullary images were graded according to whether to it was visualised clearly (1), or not (0). Results: Following IVGA the CBD was visualised at grade 3 (75-100% of length seen) in 14 additional patients compared with images prior to IVGA. Furthermore, ampullary visualisation was considered diagnostic in 18 additional patients post-IVGA. No glucagon-associated adverse effects were observed. Conclusion: These results demonstrate that IVGA improved visualisation of the CBD and ampulla of Vater during magnetic resonance cholangiopanctreatography. This may reduce the requirement for repeat investigation or recourse to invasive diagnostic procedures (e.g. endoscopic retrograde cholangiopancreatography (ERCP))

  1. Diagnosis of common bile duct stones by MR imaging. Mainly MR cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Isomoto, Ichiro; Koshiishi, Takeshi [Saga National Hospital (Japan); Fukuda, Toshio; Hayashi, Kuniaki

    1998-09-01

    We evaluated the accuracy of MR imaging (MRI), mainly MR cholangiopancreatography (MRCP), in the diagnosis of choledocholithiasis in comparison with ultrasound (US), computed tomography (CT), direct cholangiography, and intravenous cholangiography (DIC). Thirty-seven patients with biliary disease diagnosed by surgery and direct cholangiography underwent MRI with T1-weighted images (T1-WI), T2-weighted images (T2-WI), and MRCP (source images and projection images). The rate of stone detection was evaluated for each MRI image and modality. Fifteen of 37 patients were found to have common bile duct stones at surgery. The depiction rate of T1-WI, T2-WI, source images, and projection images were 7%, 67%, 93%, and 53%, respectively. The depiction rate of MR, US, CT, direct cholangiography, and DIC were 100% (15/15), 25% (3/12), 64% (9/14), 71% (5/7), and 57% (4/7), respectively. In addition, there were two false-positive cases, one of duodenal diverticulum (Lemmel`s syndrome) and the other of hemobilia. MRI had a sensitivity of 100%, specificity of 91%, and accuracy of 94% in the diagnosis of common bile duct stones. In conclusion, MRI is useful for evaluating suspected choledocholithiasis. In spite of the high depiction rate of the source images, other images should also be taken into consideration in the diagnosis of choledocholithiasis. (author)

  2. Diagnosis of common bile duct stones by MR imaging. Mainly MR cholangiopancreatography

    International Nuclear Information System (INIS)

    Isomoto, Ichiro; Koshiishi, Takeshi; Fukuda, Toshio; Hayashi, Kuniaki

    1998-01-01

    We evaluated the accuracy of MR imaging (MRI), mainly MR cholangiopancreatography (MRCP), in the diagnosis of choledocholithiasis in comparison with ultrasound (US), computed tomography (CT), direct cholangiography, and intravenous cholangiography (DIC). Thirty-seven patients with biliary disease diagnosed by surgery and direct cholangiography underwent MRI with T1-weighted images (T1-WI), T2-weighted images (T2-WI), and MRCP (source images and projection images). The rate of stone detection was evaluated for each MRI image and modality. Fifteen of 37 patients were found to have common bile duct stones at surgery. The depiction rate of T1-WI, T2-WI, source images, and projection images were 7%, 67%, 93%, and 53%, respectively. The depiction rate of MR, US, CT, direct cholangiography, and DIC were 100% (15/15), 25% (3/12), 64% (9/14), 71% (5/7), and 57% (4/7), respectively. In addition, there were two false-positive cases, one of duodenal diverticulum (Lemmel's syndrome) and the other of hemobilia. MRI had a sensitivity of 100%, specificity of 91%, and accuracy of 94% in the diagnosis of common bile duct stones. In conclusion, MRI is useful for evaluating suspected choledocholithiasis. In spite of the high depiction rate of the source images, other images should also be taken into consideration in the diagnosis of choledocholithiasis. (author)

  3. Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients

    Energy Technology Data Exchange (ETDEWEB)

    Dalal, Paras U.; Howlett, David C. E-mail: david.howlett@esht.nhs.uk; Sallomi, David F.; Marchbank, Nigel D.; Watson, Gillian M.T.; Marr, Amanda; Dunk, Arthur A.; Smith, Alastair D

    2004-03-01

    Introduction: Magnetic resonance cholangiopancreatography (MRCP) has been demonstrated as a reliable, non-invasive means of biliary tract imaging among patients with suspected choledocholithiasis. The aim of this study was to establish the impact of intravenous glucagon administration (IVGA) upon visualisation of the common bile duct (CBD) and ampulla of Vater during MRCP. Materials and methods: Forty-two consecutive, non-diabetic subjects with a working diagnosis of symptomatic choledocholithiasis were scanned, pre- and post-IVGA using the half-Fourier, single shot, turbo-spin-echo (HASTE) sequence. Maximum intensity projections (optimised for the extra-hepatic biliary tree and ampulla of Vater) were reviewed blindly by three consultant radiologists. The CBD images were graded (0-3) according to the length of duct seen. The ampullary images were graded according to whether to it was visualised clearly (1), or not (0). Results: Following IVGA the CBD was visualised at grade 3 (75-100% of length seen) in 14 additional patients compared with images prior to IVGA. Furthermore, ampullary visualisation was considered diagnostic in 18 additional patients post-IVGA. No glucagon-associated adverse effects were observed. Conclusion: These results demonstrate that IVGA improved visualisation of the CBD and ampulla of Vater during magnetic resonance cholangiopanctreatography. This may reduce the requirement for repeat investigation or recourse to invasive diagnostic procedures (e.g. endoscopic retrograde cholangiopancreatography (ERCP))

  4. A COMPARATIVE STUDY OF THE IMAGING AND TREATMENT MODALITIES IN THE MANAGEMENT OF CHOLEDOCHOLITHIASIS

    Directory of Open Access Journals (Sweden)

    Harish

    2016-02-01

    Full Text Available AIM The objectives of this study are to compare the investigative modalities used in the diagnosis and to compare the treatment undertaken in the management of patients with choledocholithiasis. MATERIAL AND METHODS Data was collected in prefixed proforma in our hospital between April 2012 to Oct 2014 after considering inclusion and exclusion criteria.  Data regarding imaging studies for diagnosis of choledocholithiasis was collected.  After diagnosis, patients were subjected to different treatment modalities.  The outcomes, complications and morbidity of the procedures were compared analysed. RESULTS  Mean age was more than 50 years. Pain abdomen was the most common preventing complaint.  Ultrasound was the commonest imaging modality done with sensitivity of more than 60% in finding the CBD stone  CT and MRCP in diagnosis of choledocholithiasis were concerned and dilatation of the common bile duct was detected equally by both methods.  ERCP and surgical methods in form of laparoscopic or open surgery were different treatment modalities used; ERCP was the common treatment modality done. Open surgery and laparoscopic cholecystectomy were next commonest treatment modalities done respectively. CONCLUSIONS  Occurrence of choledocholithiasis increases with age.  USG is both cheap and effective with sensitivity more than 60% but MRCP is more preferable as a biliary imaging modality.  Choledochoduodenostomy is an optional method of management following CBD exploration while T-tube drainage and primary closure of the CBD following exploration have comparable results.

  5. Motor effort training with low exercise intensity improves muscle strength and descending command in aging

    Science.gov (United States)

    Jiang, Changhao; Ranganathan, Vinoth K.; Zhang, Junmei; Siemionow, Vlodek; Yue, Guang H.

    2016-01-01

    Abstract This study explored the effect of high mental effort training (MET) and conventional strength training (CST) on increasing voluntary muscle strength and brain signal associated with producing maximal muscle force in healthy aging. Twenty-seven older adults (age: 75 ± 7.9 yr, 8 women) were assigned into 1 of 3 groups: MET group—trained with low-intensity (30% maximal voluntary contraction [MVC]) physical exercise combined with MET, CST group—trained with high-intensity muscle contractions, or control (CTRL) group—no training of any kind. MET and CST lasted for 12 weeks (5 sessions/week). The participants’ elbow flexion strength of the right arm, electromyography (EMG), and motor activity-related cortical potential (MRCP) directly related to the strength production were measured before and after training. The CST group had the highest strength gain (17.6%, P strength gain (13.8%, P strength changes. Surprisingly, only the MET group demonstrated a significant augmentation in the MRCP (29.3%, P training combined with low-intensity physical exercise is an effective method for voluntary muscle strengthening and this approach is especially beneficial for those who are physically weak and have difficulty undergoing conventional strength training. PMID:27310942

  6. Radiological diagnosis and intervention of cholangiocarcinomas (CC); Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Zangos, S.; Eichler, K.; Gruber-Rouh, T.; Hammerstingl, R.M.; Weisser, P. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Trojan, J. [Frankfurt Univ. (Germany). Medizinische Klinik I: Gastroenterologie, Endokrinologie, Pneumologie/Allergologie

    2012-10-15

    To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 - 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37 - 84 % (depending on the location) for ultrasound, 79 - 94 % for computed tomography (CT), and 95 % for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI) - also known as chemoperfusion -, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.

  7. The role of multi-detector-row computed tomograph in the diagnosis of intraductal papillary-mucinous tumors of the pancreas in comparison to endoscopic retrograde pancreatography, endoscopic ultrasonography, magnetic resonance cholangiopancreatography

    International Nuclear Information System (INIS)

    Arikawa, Shunji; Uchida, Masafumi; Shinagawa, Masaharu

    2007-01-01

    Thirty patients with intraductal papillary-mucinous tumor (IPMT) of the pancreas underwent multidetector-row CT (MD-CT) in addition to endoscopic retrograde pancreatography (ERP), and, in 27 cases magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS). The usefulness of MD-CT was investigated by comparing various imaging methods of the communication from the main pancreatic duct (MPD) to patulous/bulging papilla in addition to the indices for benign or malignant disease, the degree of dilation of the MPD, localization and size of cystic lesions, and presence or absence of neoplastic lesions, such as thickened walls and septa, intramural nodule, solid mass. With MD-CT, dilation of the MPD and localization and size of cystic lesions were accurately assessed, even in patients with obstruction of the main pancreatic duct in whom ERP was difficult to perform regardless of the presence or absence of massive amount of mucus. MD-CT with reconstructive imaging, such as multiplanar reformation (MPR) imaging and curred planar reformation (CPR) imaging, allowed us to assess communication with the MPD and patulous/bulging papilla easier than MRCP. In our study, MD-CT was useful in the evaluation of thickened walls and septa that are predictive factors of malignancy in IPMT. (author)

  8. Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Bali, M.A.; Sztantics, A.; Metens, T.; Matos, C. [Universite Libre de Bruxelles, Department of Radiology, Hopital Erasme, Brussels (Belgium); Arvanitakis, M.; Delhaye, M.; Deviere, J. [Universite Libre de Bruxelles, Department of Gastroenterology, Hopital Erasme, Brussels (Belgium)

    2005-10-01

    The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP. (orig.)

  9. Pancreatitis: computed tomography and magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P.J.A.; Sheridan, M.B. [Dept. of Clinical Radiology, St. James' s University Hospital, Leeds (United Kingdom)

    2000-03-01

    The value of CT in management of severe acute pancreatitis is well established. Some, but not all, experimental studies suggest a detrimental effect of intravenous iodinated contrast agents in acute pancreatitis, but although initial clinical data tends to support this, the positive advantages of enhanced CT outweigh the possible risks. Magnetic resonance imaging has been shown to be as effective as CT in demonstrating the presence and extent of pancreatic necrosis and fluid collections, and probably superior in indicating the suitability of such collections for percutaneous drainage. Image-guided intervention remains a key approach in the management of severely ill patients, and the indications, techniques and results of radiological intervention are reviewed herein. Both CT and MRI can be used to diagnose advanced chronic pancreatitis, with the recent addition of MRCP as a viable alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Both MRCP and CT/MR imaging of the pancreatic parenchyma still have limitations in the recognition of the earliest changes of chronic pancreatitis - for which ERCP and tests of pancreatic function remain more sensitive - but the clinical significance of these minor changes remains contentious. (orig.)

  10. Contrast-Enhanced Magnetic Resonance Cholangiography: Practical Tips and Clinical Indications for Biliary Disease Management

    Directory of Open Access Journals (Sweden)

    Stefano Palmucci

    2017-01-01

    Full Text Available Since its introduction, MRCP has been improved over the years due to the introduction of several technical advances and innovations. It consists of a noninvasive method for biliary tree representation, based on heavily T2-weighted images. Conventionally, its protocol includes two-dimensional single-shot fast spin-echo images, acquired with thin sections or with multiple thick slabs. In recent years, three-dimensional T2-weighted fast-recovery fast spin-echo images have been added to the conventional protocol, increasing the possibility of biliary anatomy demonstration and leading to a significant benefit over conventional 2D imaging. A significant innovation has been reached with the introduction of hepatobiliary contrasts, represented by gadoxetic acid and gadobenate dimeglumine: they are excreted into the bile canaliculi, allowing the opacification of the biliary tree. Recently, 3D interpolated T1-weighted spoiled gradient echo images have been proposed for the evaluation of the biliary tree, obtaining images after hepatobiliary contrast agent administration. Thus, the acquisition of these excretory phases improves the diagnostic capability of conventional MRCP—based on T2 acquisitions. In this paper, technical features of contrast-enhanced magnetic resonance cholangiography are briefly discussed; main diagnostic tips of hepatobiliary phase are showed, emphasizing the benefit of enhanced cholangiography in comparison with conventional MRCP.

  11. The use of endoscopic ultrasonography in the diagnosis of the causes of common bile duct dilation

    International Nuclear Information System (INIS)

    Sajewicz, Z.; Wozniak-Stolarska, B.; Salomon, A.; Poniewierka, E.; Kempinski, R.

    2006-01-01

    Background. Ultrasonography (US) does not come up to the expectations in the diagnosis of the causes of common bile duct (CBD) dilation. Objectives. An assessment of the usefulness of endoscopic ultrasonography (EUS) in the diagnosis of the causes of CBD dilation. Material and Methods. The authors examined 30 persons (16 females and 14 males) with CBD dilated > 7 mm in US. In these patients the authors performed EUS with the usage of Pentax FG-38UX echoendoscope of 5-10 MHz frequency connected with EUB 6000 Hitachi ultrasonograph looking for the cause of CBD dilation. Findings gathered were verified with the usage of endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP). Results. In 16 patients the authors found stones in CBD. In ERCP or MRCP the frequency of CBD stones was a bit higher. In these examinations CBD stones were found in 18 patients. The authors found out that pancreatic head carcinoma was the cause of CBD dilation in 8 patients; in 2 patients the authors diagnosed ampullary carcinoma and in 1 patient - carcinoma of distal part of CBD. In 1 patient the authors pointed out a benign stricture of CBD with dilation above the stricture. Conclusions. EUS is a useful diagnosing method of the causes of CBD dilation. (authors)

  12. Does Courvoisier's sign stand the test of time?

    International Nuclear Information System (INIS)

    Murphy, K.; McLaughlin, P.; O'Connor, B.R.; Breen, M.; O'Súilleabháin, C.; MacEneaney, P.; Maher, M.M.

    2012-01-01

    Aim: To investigate the validity of Courvoisier's sign, in the age of cross-sectional imaging and image analysis software by objectively measuring gallbladder volumes at magnetic resonance cholangiopancreatography (MRCP) in patients with and without biliary obstruction and to assess whether gallbladder volume is more significantly increased in patients with gallstone-related rather than non-gallstone-related biliary obstruction. Materials and methods: All MCRP investigations that were performed at a tertiary hepatobiliary centre over a 2-year period were analysed. The information recorded included the presence or absence of gallbladder stones as well as the presence and type of common bile duct (CBD) disease. Gallbladder volume was calculated from MRCP studies using image analysis software. Results: Three hundred and ninety-four of 645 examined MRCPs (61.1%) were eligible for analysis. A statistically significant difference in mean gallbladder volume existed between the summated obstructive and non-obstructive groups (p < 0.001). In addition, a significant difference existed in mean gallbladder volume between those with CBD stones and non-gallstone CBD obstruction (p = 0.03). Conclusion: A significant difference was observed in gallbladder volumes in the group with biliary obstruction from choledocholithiasis compared with the group with biliary obstruction from other causes. Thus, objective measurement of gallbladder volume from modern cross-sectional imaging studies appears to validate Courvoisier's sign as a valuable clinical sign, which could be applied to modern imaging studies in distinguishing different causes of biliary obstruction in the jaundiced patient.

  13. A Review of Techniques for Detection of Movement Intention Using Movement-Related Cortical Potentials

    Directory of Open Access Journals (Sweden)

    Aqsa Shakeel

    2015-01-01

    Full Text Available The movement-related cortical potential (MRCP is a low-frequency negative shift in the electroencephalography (EEG recording that takes place about 2 seconds prior to voluntary movement production. MRCP replicates the cortical processes employed in planning and preparation of movement. In this study, we recapitulate the features such as signal’s acquisition, processing, and enhancement and different electrode montages used for EEG data recoding from different studies that used MRCPs to predict the upcoming real or imaginary movement. An authentic identification of human movement intention, accompanying the knowledge of the limb engaged in the performance and its direction of movement, has a potential implication in the control of external devices. This information could be helpful in development of a proficient patient-driven rehabilitation tool based on brain-computer interfaces (BCIs. Such a BCI paradigm with shorter response time appears more natural to the amputees and can also induce plasticity in brain. Along with different training schedules, this can lead to restoration of motor control in stroke patients.

  14. Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results

    International Nuclear Information System (INIS)

    Bali, M.A.; Sztantics, A.; Metens, T.; Matos, C.; Arvanitakis, M.; Delhaye, M.; Deviere, J.

    2005-01-01

    The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP. (orig.)

  15. Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications

    International Nuclear Information System (INIS)

    Holzapfel, K.; Breitwieser, C.; Rummeny, E.J.; Gaa, J.; Prinz, C.

    2007-01-01

    Magnetic resonance cholangiopancreaticography (MRCP) with heavily T2-weighted RARE and HASTE sequences has become an important imaging modality for the morphologic evaluation of intra- and extrahepatic bile ducts. However, for the diagnosis of functional biliary disorders, cholangiopancreaticography (ERCP) and endoscopic manometry, two invasive techniques with considerable morbidity and mortality, remain the standard. Biliary scintigraphy, secretin-stimulated MRCP, and secretin-stimulated endoscopic ultrasound have not proven to be sufficient to replace these techniques as they lack diagnostic accuracy and correlate poorly with manometry results. Contrast-enhanced magnetic resonance cholangiography (CE-MRC) uses hepatocyte specifically contrast agents that are eliminated by the biliary system. Therefore, these substances can serve as biliary contrast agents in T1-weighted MR imaging. This method makes a noninvasive functional evaluation of the hepatobiliary system possible. In the present article, our preliminar experience with Gd-EOB-DTPA-enhanced MRC is summarized and potential clinical applications of this method are discussed. Additionally, the article reviews publications evaluating a possible benefit of CE-MRC with other hepathobiliary contrast agents such as mangafodipir trisodium. (orig.)

  16. Role of secretin-enhanced magnetic resonance cholangiopancreatography in the evaluation of patients following pancreatojejunostomy.

    Science.gov (United States)

    Anis, Munazza; Mortele, Koenraad

    2013-01-01

    This study was conducted to assess the role of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in the evaluation of patients following pancreatico-jejunal anatomosis. S-MRCP studies (n = 83) performed at Brigham and Women's Hospital between 1/2005 and 7/2005 were retrospectively reviewed. Among these, there were 13 patients (10 females, 3 males; mean age = 45 years, range = 18-74 years) who were evaluated with S-MRCP following pancreatojejunal anatomosis. Single-shot fast spin-echo T2-weighted thick slab dynamic MRCP images obtained before and every minute (for 10 min) after IV injection of secretin (2 mcg/kg body weight of SecreFloTM IV over 1 min) were reviewed retrospectively and independently by 3 readers. Image analysis included measurement of the main pancreatic duct (MPD) diameter and subjective assessment of the grade of visualization of the MPD remnant. The amount of jejunal fluid and visualization of the pancreatico-jejunal anatomosis pre-and post-secretin were also documented. Direct correlation with endoscopic retrograde cholangiopancreatography (ERCP) finding was available in six of the 13 cases. The MPD diameter and MPD remnant visualization improved post-secretin for 1/3 readers. The number of pancreatico-jejunal anastomoses and the amount of jejunal fillings pre-and post-secretin was seen to improve significantly for 1 of the 3 readers. For Reader 1, the mean MPD diameter in the body of the pancreas, on the pre-and post-secretin image, was 3.2 ± 1.3 mm and 3.8 ± 1.9 mm, respectively. There was no statistical difference in the values pre- and post-secretin in the MPD diameter (P = 0.07), MPD visualization (P = 0.16) and the number of pancreatico-jejunal anastomoses seen (P = 0.125 5/13 pre- and 9/13 post-secretin). Statistical significance was seen in the amount of jejunal filling (P = 0.01) after secretin. For Reader 2, the MPD diameter pre-and post-secretin was 4 ± 2 and 3.9 ± 2.1 mm, respectively (P = 0.89). The MPD

  17. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

    Science.gov (United States)

    Haavik, Heidi; Niazi, Imran Khan; Jochumsen, Mads; Sherwin, Diane; Flavel, Stanley; Türker, Kemal S.

    2016-01-01

    This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes. In experiment one, transcranial magnetic stimulation input–output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN). The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input–output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are

  18. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles.

    Science.gov (United States)

    Haavik, Heidi; Niazi, Imran Khan; Jochumsen, Mads; Sherwin, Diane; Flavel, Stanley; Türker, Kemal S

    2016-12-23

    This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes. In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN). The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are

  19. MR imaging of primary sclerosing cholangitis - Additional value of diffusion-weighted imaging and ADC measurement

    Energy Technology Data Exchange (ETDEWEB)

    Djokicc Kovac, Jelena [Center for Radiology and Magnetic Resonance Imaging, Clinical Center Serbia, Belgrade (Serbia)], e-mail: jelenadjokic2003@yahoo.co.uk; Maksimovic, Ruzica [Center for Radiology and Magnetic Resonance Imaging, Clinical Center Serbia, Belgrade (Serbia); Faculty of Medicine, Univ. of Belgrade, Belgrade (Serbia); Jesic, Rada [Clinic for Gastroenterohepatology, Clinical Center Serbia, Belgrade (Serbia); Faculty of Medicine, Univ. of Belgrade, Belgrade (Serbia); Stanisavljevic, Dejana [Inst. for Statistics, Faculty of Medicine, Univ. of Belgrade, Belgrade (Serbia); Kovac, Bojan [Military Medical Academy, Belgrade (Serbia)

    2013-04-15

    Background: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease with chronic inflammation and progressive destruction of biliary tree. Magnetic resonance (MR) examination with diffusion-weighted imaging (DWI) allows analysis of morphological liver parenchymal changes and non-invasive assessment of liver fibrosis. Moreover, MR cholangiopancreatography (MRCP), as a part of standard MR protocol, provides insight into bile duct irregularities. Purpose: To evaluate MR and MRCP findings in patients with primary sclerosing cholangitis and to determine the value of DWI in the assessment of liver fibrosis. Material and Methods: The following MR findings were reviewed in 38 patients: abnormalities in liver parenchyma signal intensity, changes in liver morphology, lymphadenopathy, signs of portal hypertension, and irregularities of intra- and extrahepatic bile ducts. Apparent diffusion coefficient (ADC) was calculated for six locations in the liver for b = 800 s/mm{sup 2}. Results: T2-weighted hyperintensity was seen as peripheral wedge-shaped areas in 42.1% and as periportal edema in 28.9% of patients. Increased enhancement of liver parenchyma on arterial-phase imaging was observed in six (15.8%) patients. Caudate lobe hypertrophy was present in 10 (26.3%), while spherical liver shape was noted in 7.9% of patients. Liver cirrhosis was seen in 34.2% of patients; the most common pattern was micronodular cirrhosis (61.5%). Other findings included lymphadenopathy (28.9%), signs of portal hypertension (36.7%), and bile duct irregularities (78.9%). The mean ADCs (x10{sup -3} mm{sup 2}/s) were significantly different at stage I vs. stages III and IV, and stage II vs. stage IV. No significant difference was found between stages II and III. For prediction of stage {>=}II and stage {>=}III, areas under receiver-operating characteristic curves were 0.891 and 0.887, respectively. Conclusion: MR with MRCP is a necessary diagnostic procedure for diagnosis of PSC and

  20. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

    Directory of Open Access Journals (Sweden)

    Heidi Haavik

    2016-12-01

    Full Text Available This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP amplitudes. In experiment one, transcranial magnetic stimulation input–output (TMS I/O curves for an upper limb muscle (abductor pollicus brevis; APB were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP, late bereitschafts potential (LBP and also for peak negativity (PN. The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input–output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle

  1. The role of diagnostic radiology in pancreatitis

    International Nuclear Information System (INIS)

    Elmas, Nevra

    2001-01-01

    Acute pancreatitis is a frequent inflammatory and necrotic process of pancreas and peripancreatic field. To detect the presence of infected or sterile necrotic components and hemorrhage of the pancreatic paranchyma is important for therapeutic approach. Chronic pancreatitis is characterized by irreversible exocrine dysfunction, progressive loss of pancreatic tissue and morphological changes of the pancreatic canal. Imaging modalities play a primary role in the management of both acute and chronic pancreatitis. CT and MR imaging confirm the diagnosis and detect the severity of disease. In chronic pancreatitis, MRCP after Secretin administration, Spiral CT and endoscopic US seems to replace diagnostic ERCP. However differentiation of pseudotumor of chronic pancreatitis from the pancreatic carcinoma is difficult with either imaging modalities

  2. A study of diagnostic imaging in pancreatic trauma

    International Nuclear Information System (INIS)

    Hirota, Masashi; Kanazumi, Naohito; Kato, Koichi; Eguchi, Takehiko; Kobayashi, Hironobu; Suzuki, Yuichi; Kimura, Jiro; Ishii, Masataka

    2002-01-01

    Pancreatic trauma treatment depends on pancreatic ductal injury. We examined the usefulness and problems of diagnostic imaging, such as enhanced CT, ERP, and CT after ERP, in pancreatic trauma. Subjects were 12 patients with pancreatic trauma treated in our hospital between April 1993 and March 2000. Enhanced CT was performed in 6 patients undergoing diagnostic imagings and ERP in 4 of the 6. Overall diagnostic accuracy of pancreatic ductal injury in enhanced CT was 16.7% and accuracy in ERP with CT after ERP was 100%. Intraoperative diagnosis of main pancreatic ductal injury was difficult in 1 of 2 patients in whom ERP failed. The importance of preoperative diagnostic imaging is thus clear. We expect that MRCP, recently evaluated in pancreatic disease diagnosis, will become a new pancreatic trauma modality. (author)

  3. Ampulla of Vater: Comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy

    International Nuclear Information System (INIS)

    Kim, Tae Un; Kim, Suk; Lee, Jun Woo; Woo, Sung Koo; Lee, Tae Hong; Choo, Ki Seok; Kim, Chang Won; Kim, Gwang Ha; Kang, Dae Hwan

    2008-01-01

    Endoscopic retrograde cholangiopancreaticography with or without an endoscopic biopsy is the method for making a definitive diagnosis of disease in or around the ampulla of Vater. However, the endoscopic findings of neoplastic and non-neoplastic conditions involving the perimapullary area may be similar and an endoscopic assessment is not entirely reliable for diagnosis. Recent MR and MRCP can allow the detection of lesions in a small complex structure such as the ampulla of Vater, and distinguish between an ampullary from periampullary lesion. This article reviews the normal anatomy of the ampulla of Vater, describes the role of MR in the detection and characterization of the lesion in or around the ampulla of Vater, and attempts to correlate them with ERCP

  4. Ampulla of Vater: Comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Un [Department of Diagnostic Radiology, Pusan National University Hospital, Busan 602-739 (Korea, Republic of); Kim, Suk [Department of Diagnostic Radiology, Pusan National University Hospital, Busan 602-739 (Korea, Republic of)], E-mail: kimsuk@medigate.net; Lee, Jun Woo; Woo, Sung Koo; Lee, Tae Hong; Choo, Ki Seok; Kim, Chang Won [Department of Diagnostic Radiology, Pusan National University Hospital, Busan 602-739 (Korea, Republic of); Kim, Gwang Ha; Kang, Dae Hwan [Department of Gastrointestinal Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739 (Korea, Republic of)

    2008-04-15

    Endoscopic retrograde cholangiopancreaticography with or without an endoscopic biopsy is the method for making a definitive diagnosis of disease in or around the ampulla of Vater. However, the endoscopic findings of neoplastic and non-neoplastic conditions involving the perimapullary area may be similar and an endoscopic assessment is not entirely reliable for diagnosis. Recent MR and MRCP can allow the detection of lesions in a small complex structure such as the ampulla of Vater, and distinguish between an ampullary from periampullary lesion. This article reviews the normal anatomy of the ampulla of Vater, describes the role of MR in the detection and characterization of the lesion in or around the ampulla of Vater, and attempts to correlate them with ERCP.

  5. Papel da ranitidina como meio de aprimorar a qualidade do exame de colangiopancreatografia por ressonância magnética The role of ranitidine in the enhancement of imaging quality in magnetic resonance cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Lucas Rios Torres

    2013-04-01

    Full Text Available OBJETIVO: Avaliar o impacto da ranitidina por via oral na qualidade do exame de colangiopancreatografia por ressonância magnética (CPRM. MATERIAIS E MÉTODOS: Trinta e dois pacientes realizaram CPRM com aquisições 3D e 2D, com três estratégias de supressão do sinal líquido gastrintestinal: a apenas em jejum; b 12 horas após ingerir 300 mg de ranitidina; c após a ingestão de solução de gadolínio. Três observadores avaliaram os estudos, atentos para o grau de visualização da árvore biliopancreática. Foi medida a concordância interobservador com o teste kappa. A diferença entre técnicas e formas de aquisição foi avaliada pela média da soma dos escores de graduação. RESULTADOS: As três estratégias de supressão do sinal líquido gastrintestinal apresentaram elevada reprodutibilidade. A supressão do sinal líquido gastrintestinal com a ranitidina foi semelhante ao jejum e ambas foram piores do que a solução de gadolínio. As aquisições 3D superaram a 2D apenas na visualização do ducto cístico e da vesícula biliar, sendo inferior ou equivalente nos demais segmentos ductais biliopancreáticos. CONCLUSÃO: O uso da ranitidina não parece justificado para aprimorar a avaliação da árvore biliopancreática em exames de CPRM. A CPRM 2D apenas em jejum permite a visualização ductal com elevada qualidade e reprodutibilidade na maioria dos casos.OBJECTIVE: To assess the impact of oral ranitidine on the imaging quality in magnetic resonance cholangiopancreatography (MRCP. MATERIALS AND METHODS: Thirty-two patients underwent MRCP with 3D and 2D acquisitions, and three strategies for suppression of the gastrointestinal fluid signal: a only at fasting; b 12 hours after ingestion of 300 mg ranitidine; c after oral administration of gadolinium solution. Three observers reviewed the images with a focus on the degree of visualization of the biliopancreatic tree. The interobserver agreement was evaluated with the kappa test

  6. Discussion of difficult problems of early diagnosis of pancreatic cancer

    Directory of Open Access Journals (Sweden)

    GUO Xiaozhong

    2014-08-01

    Full Text Available Pancreatic cancer is a common malignant neoplasm of the pancreas with an extremely high mortality. Currently, the early diagnosis of pancreatic cancer is still not ideal. Attention should be paid to some clinical warning symptoms, such as unexplained abdominal and back pain, jaundice, and unexpected diabetes. Additionally, the combined use of CA19-9, CEA, and other tumor markers, the attention to biochemical indicators, the detection of mutation in KAI1 or p53 gene, and the exploration of the value of miRNA in clinical diagnosis are of great significance. On the other hand, ultrasound, CT, MRCP, ERCP, PET-CT, and other imaging methods, as well as effective collection of cytology specimens, should be performed. Thus, there is hope for the early diagnosis of pancreatic cancer.

  7. A child with chromosome 22q11.2 deletion syndrome and a bilobed gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, James R.; Macken, Marian B. [Dalhousie University, Department of Radiology, Halifax, Nova Scotia (Canada); Schmidt, Matthias H. [Dalhousie University, Department of Radiology, Halifax, Nova Scotia (Canada); IWK Health Centre, Department of Diagnostic Imaging, 5850/5980 University Ave., P.O. Box 9700, Halifax, Nova Scotia (Canada); Morley, Charlotte; Cummings, Elizabeth A. [Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia (Canada)

    2007-02-15

    We present an 11-year-old girl with a chromosome 22q11.2 microdeletion, velocardiofacial syndrome (VCFS), and a bilobed gallbladder as an incidental finding on abdominal sonography. The finding was confirmed by magnetic resonance cholangiopancreatography (MRCP).This is the first report of a gallbladder anomaly associated with a chromosome 22q11.2 deletion and the second report of a biliary tract anomaly associated with a mutation in the chromosome 22q11 region. We suggest that close attention be paid to the anatomy of the biliary tree in patients with mutations in the chromosome 22q11 region. Further study is warranted to determine the range and prevalence of biliary tract anomalies in this population. (orig.)

  8. Diagnosis and differential diagnosis of biliary diseases; Diagnose und Differentialdiagnose von Gallenwegserkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Juchems, Markus; Brams, Hans-Juergen [Universitaetsklinikum Ulm (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie

    2009-09-15

    Diseases of the gallbladder and the bile duct system can generally be divided in congenital and acquired diseases. Important congenital diseases are biliary atresia and choledochal cysts. Acquired diseases can be divided in gallstone diseases, inflammatory diseases and neoplastic diseases. Imaging of the biliary system should include the gallbladder as well as the intra- and extrahepatic bile ducts. Radiologic examinations include the transabdominal ultrasound, which has a high value in acute disease and computed tomography as a widely available cross sectional imaging modality. Magnetic resonance imaging did greatly benefit from the development of MR cholangiography (MRC). MR including MRC or MRCP (MR cholangiopancreatography) as it is called if the pancreatic duct is imaged simultaneously can be considered as a first line, non invasive imaging modality. Especially for imaging of the biliary tree, it is superior to CT and sonography. (orig.)

  9. The role of diagnostic radiology in pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Elmas, Nevra E-mail: elmas@med.ege.edu.tr

    2001-05-01

    Acute pancreatitis is a frequent inflammatory and necrotic process of pancreas and peripancreatic field. To detect the presence of infected or sterile necrotic components and hemorrhage of the pancreatic paranchyma is important for therapeutic approach. Chronic pancreatitis is characterized by irreversible exocrine dysfunction, progressive loss of pancreatic tissue and morphological changes of the pancreatic canal. Imaging modalities play a primary role in the management of both acute and chronic pancreatitis. CT and MR imaging confirm the diagnosis and detect the severity of disease. In chronic pancreatitis, MRCP after Secretin administration, Spiral CT and endoscopic US seems to replace diagnostic ERCP. However differentiation of pseudotumor of chronic pancreatitis from the pancreatic carcinoma is difficult with either imaging modalities.

  10. Rationale diagnostic approach to biliary tract imaging

    International Nuclear Information System (INIS)

    Helmberger, H.; Huppertz, A.; Ruell, T.; Zillinger, C.; Ehrenberg, C.; Roesch, T.

    1998-01-01

    Since the introduction of MR cholangiography (MRC) diagnostic imaging of the biliary tract has been significantly improved. While percutaneous ultrasonography is still the primary examination, computed tomography (CT), conventional magnetic resonance imaging (MRI), as well as the direct imaging modalities of the biliary tract - iv cholangiography, endoscopic-retrograde-cholangiography (ERC), and percutaneous-transhepatic-cholangiography (PTC) are in use. This article discusses the clinical value of the different diagnostic techniques for the various biliary pathologies with special attention to recent developments in MRC techniques. An algorithm is presented offering a rational approach to biliary disorders. With further technical improvement shifts from ERC(P) to MRC(P) for biliary imaging could be envisioned, ERCP further concentrating on its role as a minimal invasive treatment option. (orig.) [de

  11. Spontaneous biliary peritonitis: Is bed side diagnosis possible?

    Directory of Open Access Journals (Sweden)

    Vijai Datta Upadhyaya

    2013-01-01

    Full Text Available Background: Spontaneous biliary peritonitis is a rare cause of acute abdomen. In spontaneous biliary peritonitis there is perforation in the wall of the extra-hepatic or intra-hepatic duct occurs without any traumatic or iatrogenic injury and have been described more often in neonates. The symptoms may be acute or insidious delaying the diagnosis. Present manuscript deals with diagnosis and management of these cases. Materials and Methods: This is a prospective study and all patients of suspected biliary peritonitis presented during Dec 2010 to Feb 2012 were included in the study. After preliminary investigations in all patients abdominal paracentesis was done and in cases where intra-abdominal fluid bilirubin level was several fold higher than serum bilirubin level were subjected to exploratory laparotomy. Further investigation like T-tube cholangiogram and magnetic resonance cholangiopancreatography (MRCP was done to rule out choledochal cyst before leveling these cases as SPBD. Results: A total of 6 patients were included in present series commonest presenting symptom was progressive abdominal distension without signs of overt peritonitis followed by progressive jaundice, fever and abdominal pain. On exploration site of perforation was observed in 50% of cases and in 50% of cases bile duct was not dilated. Second surgery was not required in 34% of cases. There was no mortality or significant morbidity in our series. Conclusion: Spontaneous perforation of bile duct is rare disease and high index of suspicion is required for diagnosis. Simple bed side test can help in diagnosis but T tube cholangiogram or MRCP are must to rule out choledochal cyst.

  12. [Symptoms, diagnosis and treatment of pancreaticobiliary maljunction associated with congenital cystic dilatation of bile duct].

    Science.gov (United States)

    Funabiki, T; Matsubara, T; Ochiai, M

    1996-08-01

    The concept of congenital biliary dilatation (CBD) was established by Alonso-Lej whose classification has been widely accepted and become a standard. Todani, Komi and several investigators then added additional subclassifications and/or made a proposal of new classification. The trias, abdominal pain, abdominal mass and jaundice, had been characteristically found in these cases, but recently asymptomatic cases are often found. Many reports have shown that the cases with cystic dilation of the biliary duct frequently associated with biliary carcinoma and pancreaticobiliary maljunction (PBM), an anomalous union of pancreatic duct with biliary tree since the Rabbit's first report. Whereas extracorporeal ultrasound and CT scan are minimally invasive diagnostic procedures for these cases, a direct cholangiography, ERCP and PTC are the diagnostic procedures that make a definite diagnosis for the appropriate treatment. Recently, endoscopic ultrasound (EUS), helical CT and magnetic resonance cholangiopan-creatography (MRCP) have drawn an attention since these methods are less invasive than those ever being used. In particular, MRCP will be suitable for the screening of preoperative examination. Whereas cystoduodenostomy used to be performed in the past for these cases, the resection of dilatted bule duct along with the diversion of bile from pancreatic juice should be performed to prevent biliary carcinoma. Cholecystectomy along with the resection of bile duct and the biliary diversion from pancreatic juice should also be performed for cases of PBM without CBD because mutagenicity of bile mixed with pancreatic juice and K-ras point mutation in noncancerous bile duct epithelium in cases of PBM without CBD were demonstrated.

  13. Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: accuracy of existing guidelines and the impact of laboratory trends.

    Science.gov (United States)

    Adams, Megan A; Hosmer, Amy E; Wamsteker, Erik J; Anderson, Michelle A; Elta, Grace H; Kubiliun, Nisa M; Kwon, Richard S; Piraka, Cyrus R; Scheiman, James M; Waljee, Akbar K; Hussain, Hero K; Elmunzer, B Joseph

    2015-07-01

    Existing guidelines aim to stratify the likelihood of choledocholithiasis to guide the use of ERCP versus a lower-risk diagnostic study such as EUS, MRCP, or intraoperative cholangiography. To assess the performance of existing guidelines in predicting choledocholithiasis and to determine whether trends in laboratory parameters improve diagnostic accuracy. Retrospective cohort study. Tertiary-care hospital. Hospitalized patients presenting with suspected choledocholithiasis over a 6-year period. Assessment of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, its component variables, and laboratory trends in predicting choledocholithiasis. The presence of choledocholithiasis confirmed by EUS, MRCP, or ERCP. A total of 179 (35.9%) of the 498 eligible patients met ASGE high-probability criteria for choledocholithiasis on initial presentation. Of those, 99 patients (56.3%) had a stone/sludge on subsequent confirmatory test. Of patients not meeting high-probability criteria on presentation, 111 (34.8%) had a stone/sludge. The overall accuracy of the guidelines in detecting choledocholithiasis was 62.1% (47.4% sensitivity, 73% specificity) based on data available at presentation. The accuracy was unchanged when incorporating the second set of liver chemistries obtained after admission (63.2%), suggesting that laboratory trends do not improve performance. Retrospective study, inconsistent timing of the second set of biochemical markers. In our cohort of patients, existing choledocholithiasis guidelines lacked diagnostic accuracy, likely resulting in overuse of ERCP. Incorporation of laboratory trends did not improve performance. Additional research focused on risk stratification is necessary to meet the goal of eliminating unnecessary diagnostic ERCP. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  14. Diseases of the hepatobiliary system as a cause of acute abdomen; Erkrankungen des hepatobiliaeren Systems als Ursache des akuten Abdomens

    Energy Technology Data Exchange (ETDEWEB)

    Schima, W.; Eisenhuber-Stadler, E. [Krankenhaus Goettlicher Heiland, Abteilung fuer Radiologie und bildgebende Diagnostik, Wien (Austria); Koelblinger, C.; Kulinna-Cosentini, C.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2010-03-15

    Diseases of the liver and biliary system are common causes of acute abdominal pain and gallstone disease predisposes to cholecystitis and cholangiolithiasis. Sonography is the method of choice for the assessment of cholecystitis, whereas magnetic resonance cholangiopancreaticography (MRCP) is the standard technique to detect stones in the common bile duct. Multi-detector computed tomography (MDCT) is ideal for detection of associated complications, including abscess formation and gall stone ileus. Pyogenic, amebic and fungal liver abscesses are reliably diagnosed with MDCT which can also be used for interventional radiologic therapy of liver abscesses by percutaneous aspiration or drainage procedures. The second most common cause of liver rupture after blunt trauma is spontaneous rupture of hypervascular liver tumors (i.e., HCC, adenoma, angiosarcoma) and due to medical procedures. Multi-phase contrast-enhanced MDCT can reliably detect active bleeding to guide further therapy in these cases. (orig.) [German] Die Cholezystitis ist eine der haeufigsten Ursachen fuer ein akutes Abdomen. Waehrend die Sonographie die Methode der Wahl zum Nachweis einer Cholezystolithiasis und Cholezystitis ist, steht bei der Entwicklung von Komplikationen die Multidetektorcomputertomographie (MDCT) diagnostisch im Vordergrund. Die Magnetresonanzcholangiopankreatikographie (MRCP) hat einen hohen Stellenwert bei der Abklaerung der Cholangiolithiasis, v. a. bei der Differenzialdiagnose zu anderen Ursachen einer Cholestase. Die Diagnose bakterieller, Amoeben- oder fungaler Leberabszesse kann mittels Sonographie oder MDCT rasch gestellt werden, wobei diese Methoden auch fuer die interventionelle radiologische Therapie von Leberabszessen (Punktion oder Drainage) gut geeignet sind. Die mehrphasige, kontrastmittelverstaerkte MDCT ist die Methode der Wahl fuer den Nachweis von Leberinfarkten oder -rupturen, da bei diesen Erkrankungen bzw. Verletzungsfolgen die Darstellung der

  15. Pancreatic MRI for the surveillance of cystic neoplasms: Comparison of a short with a comprehensive imaging protocol

    Energy Technology Data Exchange (ETDEWEB)

    Pozzi-Mucelli, Raffaella Maria; Kartalis, Nikolaos [C1-46 Karolinska University Hospital, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, Stockholm (Sweden); Rinta-Kiikka, Irina [Tampere University Hospital, Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere (Finland); Wuensche, Katharina [St. Olavs University Hospital, Department of Radiology, Trondheim (Norway); Laukkarinen, Johanna [Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere (Finland); Labori, Knut Joergen [Oslo University Hospital, Department of Hepato-Pancreato-Biliary Surgery, Oslo (Norway); Aanonsen, Kim [Oslo University Hospital, Department of Gastroenterology, Oslo (Norway); Verbeke, Caroline [Oslo University Hospital, Institute of Clinical Medicine, Oslo (Norway); Karolinska University Hospital, Department of Pathology, Stockholm (Sweden); Del Chiaro, Marco [Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Stockholm (Sweden)

    2017-01-15

    The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ∼ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ∼ 8 min). Mean values of largest cyst/main pancreatic duct diameter (D{sub C}/D{sub MPD}) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MN{sub C}/MN{sub MPD}), inter-observer agreement and cost differences between SP/CP were calculated. For D{sub C} and D{sub MPD}, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MN{sub C} and MN{sub MPD}, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost. For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol. (orig.)

  16. KINESTHETIC IMAGERY TRAINING OF FORCEFUL MUSCLE CONTRACTIONS INCREASES BRAIN SIGNAL AND MUSCLE STRENGTH

    Directory of Open Access Journals (Sweden)

    Wan X Yao

    2013-09-01

    Full Text Available The purpose of this study was to compare the effect of training using internal imagery (IMI; also known as kinesthetic imagery or first person imagery with that of external imagery (EMI; also known as third-person visual imagery of strong muscle contractions on voluntary muscle strengthening. Eighteen young, healthy subjects were randomly assigned to one of three groups (6 in each group: internal motor imagery (IMI, external motor imagery (EMI, or a no-practice control (CTRL group. Training lasted for 6 weeks (~15 min/day, 5 days/week. The participants’ right arm elbow-flexion strength, muscle electrical activity and movement-related cortical potential (MRCP were evaluated before and after training. Only the IMI group showed significant strength gained (10.8% while the EMI (4.8% and CTRL (-3.3% groups did not. Only the IMI group showed a significant elevation in MRCP on scalp locations over both the primary motor (M1 and supplementary motor cortices (EMI group over M1 only and this increase was significantly greater than that of EMI and CTRL groups. These results suggest that training by IMI of forceful muscle contractions was effective in improving voluntary muscle strength without physical exercise. We suggest that the IMI training likely strengthened brain-to-muscle (BTM command that may have improved motor unit recruitment and activation, and led to greater muscle output. Training by internal motor imagery of forceful muscle contractions may change the activity level of cortical motor control network, which may translate into greater descending command to the target muscle and increase its strength.

  17. Kinesthetic imagery training of forceful muscle contractions increases brain signal and muscle strength.

    Science.gov (United States)

    Yao, Wan X; Ranganathan, Vinoth K; Allexandre, Didier; Siemionow, Vlodek; Yue, Guang H

    2013-01-01

    The purpose of this study was to compare the effect of training using internal imagery (IMI; also known as kinesthetic imagery or first person imagery) with that of external imagery (EMI; also known as third-person visual imagery) of strong muscle contractions on voluntary muscle strengthening. Eighteen young, healthy subjects were randomly assigned to one of three groups (6 in each group): internal motor imagery (IMI), external motor imagery (EMI), or a no-practice control (CTRL) group. Training lasted for 6 weeks (~15 min/day, 5 days/week). The participants' right arm elbow-flexion strength, muscle electrical activity, and movement-related cortical potential (MRCP) were evaluated before and after training. Only the IMI group showed significant strength gained (10.8%) while the EMI (4.8%) and CTRL (-3.3%) groups did not. Only the IMI group showed a significant elevation in MRCP on scalp locations over both the primary motor (M1) and supplementary motor cortices (EMI group over M1 only) and this increase was significantly greater than that of EMI and CTRL groups. These results suggest that training by IMI of forceful muscle contractions was effective in improving voluntary muscle strength without physical exercise. We suggest that the IMI training likely strengthened brain-to-muscle (BTM) command that may have improved motor unit recruitment and activation, and led to greater muscle output. Training by IMI of forceful muscle contractions may change the activity level of cortical motor control network, which may translate into greater descending command to the target muscle and increase its strength.

  18. Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization

    Energy Technology Data Exchange (ETDEWEB)

    Manfredi, Riccardo; Ventriglia, Anna; Mehrabi, Sara; Boninsegna, Enrico; Pozzi Mucelli, Roberto [University of Verona, Department of Radiology, Verona (Italy); Mantovani, William [Provincial Health Services, Department of Public Health and Prevention, Trento (Italy); Zamboni, Giuseppe [University of Verona, Department of Pathology, Verona (Italy); Salvia, Roberto [University of Verona, Department of Surgery, Verona (Italy)

    2015-04-01

    To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas. This retrospective study had institutional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the macroscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct. Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p < 0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p = 0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p < 0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p < 0.0001). Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p = 0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p < 0.0001). Macrocystic pattern, enhancement of a peripheral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs. (orig.)

  19. Magnetic Resonance-Assisted Imaging of Slow Flow in the Pancreatic and Common Bile Duct in Healthy Volunteers

    International Nuclear Information System (INIS)

    Hellund, J.C.; Storaas, T.; Gjesdal, K.I.; Klow, N.E.; Geitung, J.T.

    2007-01-01

    Background: Magnetic resonance cholangiopancreaticography (MRCP) is commonly used to evaluate the pancreatic (PD) and common bile duct (CBD), and the addition of secretin is used to obtain functional information (S-MRCP). Neither method gives any information on flow velocities within the ducts. Purpose: To evaluate a new, MRI diffusion-based, slow-flow-sensitive sequence for the detection of slow flow changes in the PD and CBD. Material and Methods: Seven healthy volunteers were examined. A modified single-shot turbo spin-echo sequence was used to detect slow flow changes. Three b factors (0, 6, and 12 s/mm 2 ) were used. The flow sensitivity was applied in two directions, vertically and horizontally. Scanning was performed before and after glucagon was given, and again after an intravenous injection of secretin. The sequence gives signal loss from a duct when flow increases, and such changes were recorded. Results: All images showed the PD with b = 0 (no flow sensitization). After administration of glucagon, artifacts from bowel movements were reduced and visibility of the PD was improved at both b = 6 and b 12. Significant reduction of the visibility of the PD, indicating increased flow, was recorded both at b = 6 and b = 12 after the administration of secretin. There were no changes in the visibility of the CBD. Conclusion: This study shows that MRI-based detection of slow flow changes inside the PD is possible. Due to the sequence's high sensitivity to any motion, further studies are required before adopting the method for clinical use

  20. ROLE OF MULTIDETECTO R ROW COMPUTED TOMOG RAPHY IN EVALUATION OF BILIAR Y TRACT OBSTRUCTIVE JAUNDICE

    Directory of Open Access Journals (Sweden)

    Akshaya Reddy

    2015-03-01

    Full Text Available INTRODUCTION: Obstructive jaundice is a type of jaundice in which there is blockage of flow of bile from the liver to the intestine resulting in redirection of excess bile and it’s by - products like bilirubin into the blood. It can lead to complications lik e ascending cholangitis, hepatorenal syndrome and malabsorption, hence requiring urgent surgical intervention. The role of a radiologist therefore is important in early diagnosis and in accurately delineating the level and the cause of obstruction, thus he lping in staging as well as preoperative assessment of tumor resectability. The search for noninvasive diagnostic tools is an emerging medical need, in order to avoid invasive, costly and physician - intensive procedures such as endoscopic retrograde cholang iopancreatography (ERCP . (1 Ultrasound is a non - invasive and cost effective imaging technique available for evaluating biliary tract obstruction. Ultrasound demonstrates the presence of biliary tract obstruction by identifying dilated bile ducts but has a sensitivity of 55% - 95% and specificity of 71% - 96 % . (2 The role of magnetic resonance cholangiography (MRCP is well established in this field as the most reliable noninvasive technique . (3 However, some drawbacks, such as contraindication in patients with pacemakers and ferromagnetic implants, for claustrophobic patients, long examination times exceeding 30 minutes and limited availability of scanners still limit its use. MRCP is expensive and has limitations such as interference from intraluminal gas, pneumobilia and flow artifacts. (4 In the past, axial conventional CT could not provide adequate information of biliary abnormalities since the total depiction of these ducts was not suitable for evaluation in axial planes . (5 MDCT's ability to obtain volume dataset with sub - millimeter spatial resolution allows the optimal display of bile duct by using multiplanar reconstruction (MPR and minimal intensity projection (Min

  1. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    International Nuclear Information System (INIS)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A.; Rambhatla, Siri J.; Sreedharan, Ram R.

    2015-01-01

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  2. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    Energy Technology Data Exchange (ETDEWEB)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A. [University of Pennsylvania Perelman School of Medicine, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Rambhatla, Siri J. [Beth Israel Medical Center, Department of Pediatrics, Newark, NJ (United States); Sreedharan, Ram R. [University of Pennsylvania, Departments of Gastroenterology, Hepatology and Nutrition, The Children' s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (United States)

    2015-08-15

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  3. Hepatocellular carcinoma: Role of imaging diagnostics in detection, intervention and follow-up; Das hepatozellulaere Karzinom. Rolle der Bildgebung zur Detektion, Therapieplanung und Therapiekontrolle

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Eichler, K.; Zangos, S.; Mack. M.; Hammerstingl, R. [Institut fuer Diagnostische und Interventionelle Radiologie, J.W. Goethe Universitaet Frankfurt am Main (Germany)

    2002-11-01

    Demonstration of techniques and clinical value of imaging diagnostics for screening, detection, interventional follow-up and therapy control of hepatocellular carcinoma (HCC). Diagnostic techniques for screening, detection and differential diagnosis of HCC are presented using color-coded duplex sonography (US), computer tomography (CT) and contrast-enhanced magnetic resonance techniques like MRI, MR angiography and MR cholangiopancreaticography (MRCP). Therapy control with imaging was performed for surgical methods like resection and liver transplantation as for well as transarterial chemoembolization (TACE), radiofrequency ablation (RF) and laser-induced thermotherapy (LITT). In screening, HCC color-coded duplex sonography reveals a sensitivity from 45 to 92% and a specificity from 78 to 90% when liver cirrhosis is present. The diagnostic results of CT were further improved with the newly developed techniques of multislice CT. The highest diagnostic accuracy can currently be achieved using contrast-enhanced MRI with a sensitivity from 82 to 96%. TACE presents a palliative therapy concept; MR-guided LITT and radiofrequency ablation are used as thermoablative methods for local therapy and the therapy control is based on the above imaging techniques. Contrast-enhanced MRI proves to be the superior imaging technique for the early diagnosis, differential diagnosis and follow-up of hepatocellular carcinoma. (orig.) [German] Zielsetzung: Vorstellung der Methodik und klinischen Wertigkeit der bildgebenden Diagnostik zu Screening, Detektion, Interventionsplanung und Therapiekontrolle des hepatozellulaeren Karzinoms (HCC). Diagnostische Untersuchungstechniken werden diskutiert wie farbkodierte Duplexsonographie, Computertomographie (CT, MSCT) und kontrastmittelverstaerkte Magnetresonanzverfahren (MRT, MRA und MRCP). Die Therapiekontrolle mittels Bildgebung erfolgt im Rahmen des Einsatzes chirurgischer Therapieverfahren wie Resektion und Lebertransplantation sowie der

  4. An unfortunate case of acquired hemochromatosis: a case report review of the clinical presentation, diagnosis, management, and prognosis

    Directory of Open Access Journals (Sweden)

    Tariq A

    2016-12-01

    Full Text Available Anam Tariq,1 Kevin Westra,2 Arben Santo3 1Department of Internal Medicine, Pinnacle Health Internal Medicine, 2Department of Gastroenterology, Harrisburg Gastroenterology, Harrisburg, PA, 3Department of Pathology, Virginia College of Osteopathic Medicine-Virginia Tech, Blacksburg, VA, USA Background: While blood transfusions are commonly used for prophylaxis and treatment for acute chest syndromes and strokes in sickle cell patients, accumulation of excess iron resulting in secondary hemochromatosis remains a rare disease. Chelation is the mainstay for preventing and treating iron overload to deter potential end-organ damages; it is rare when therapy fails. Case report: A 52-year-old African American woman with chronic anemia secondary to sickle cell anemia and history of multiple blood transfusions presented with elevated serum ferritin (8000 ng/mL and bilirubin (16.8 mg/dL. She had no previous personal or family history of liver disease. A magnetic resonance cholangiopancreatography (MRCP and a liver biopsy confirmed the secondary hemochromatosis with marked fibrosis and 4+ iron deposits, but since she was therapeutically on deferasirox, her treatment regimen involved only closer monitoring. Her hemochromatosis led to readmission within a year for rapid progression of cardiac and hepatic failure. Conclusion: Since chronically transfused sickle cell patients are at a significantly higher risk of mortality due to the secondary hemochromatosis and end-stage organ damage, knowledge of prophylactic iron chelation is important. Minimizing unnecessary transfusions should be strongly emphasized to reduce the sequelae as iron burden remains a threat. The effectiveness of iron-chelating therapy is best monitored via periodic magnetic resonance imaging, liver transaminases, bilirubin, creatinine, ferritin, and cardiac function tests. Despite the prophylactic treatment and quarterly blood work, in this case the initial presentation did not correlate with

  5. Analysis of electrical and magnetic bio-signals associated with motor performance and fatigue

    Science.gov (United States)

    Yao, Bing

    This dissertation reports findings centered principally on comprehensive research related to human bio-signals (EEG, MEG, EMG and fMRI) acquired during repetitive maximal voluntary contractions (MVC) that induced severe fatigue. Fatigue is a common experience that reduces productivity and quality of life and increases chances of injury. Although abundant information has been gained in the last several decades regarding muscular and spinal-level mechanisms of muscle fatigue, very little is known about how cortical centers control and respond to fatigue. The main purpose of this study was to examine the fatigue effects on the central nervous system by analyzing the bio-signals collected in the designed experiments. Healthy human subjects were asked to perform a series of repetitive handgrip MVCs with their dominant hand until exhaustion. Handgrip forces, electrical activity (EMG) from primary and non-primary muscles, and EEG, MEG, or fMRI signals from different locations of the brain were recorded simultaneously. The time series data were segmented into several physiologically meaningful epochs (time phases), from rest to preparation to movement execution/sustaining. A series of studies, including motor-related cortical potential (MRCP) analysis, power spectrum analysis, time-frequency (spectrogram) analysis of EEG, EEG source localization and nonlinear analysis (fractal dimension and largest Lyapunov exponent), and fMRI analysis, was applied to the data. We hypothesized that the fatigue effects would act differently on brain signals of different phases. The MRCP results showed that the negative potential (NP) related to motor task preparation only had minimal changes with fatigue. The power of all EEG frequencies did not alter significantly during the preparation phase but decreased significantly during the sustained phase of the contraction. The fractal dimension and the largest Lyapunov exponent decreased significantly during the sustained phase as fatigue

  6. Hepatocellular carcinoma with bile duct tumor thrombi: Correlation of magnetic resonance imaging features to histopathologic manifestations

    International Nuclear Information System (INIS)

    Liu Qingyu; Chen Jianyu; Li Haigang; Liang Biling; Zhang Lei; Hu Tao

    2010-01-01

    Purpose: This study was to analyze the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) with bile duct tumor thrombi, and explore their correlations to histopathology to improve the accuracy of diagnosis. Materials and methods: 21 patients with pathologically confirmed HCC with bile duct tumor thrombi was performed with a superconducting 1.5-T MR imager within two weeks before operation. Magnetic resonance cholangiopancreatography (MRCP) was performed on 18 patients. Images were retrospectively assessed for the size, location and MRI manifestations of HCC lesions and associated bile duct tumor thrombi. The differentiation of HCC lesions and the pathologic changes of bile duct tumor thrombi were retrospectively analyzed under microscope. Results: The average diameter of HCC lesions was 5.8 ± 2.8 cm, and ≤5.0 cm in nine cases. Capsule formation was observed on MRI or pathology in 4 cases of HCC (19%). Of the 21 cases with bile duct tumor thrombi, 20 were clearly presented on MRI as cord-like or columnar masses in the bile duct with proximal cholangiectasis. The tumor thrombi showed slightly hypointense on T1WI and slightly hyperintense on T2WI. On enhanced scan, three cases of tumor thrombi, which were mainly consisted of necrotic tissue, did not show enhancement; 17 cases, which were mainly consisted of cancer cells, showed mild or moderate enhancement. On magnetic resonance cholangiopancreatogram (MRCP), 14 cases of tumor thrombi presented as filling defect in the bile duct, abrupt obstruction of the bile duct, and cholangiectasis above the obstruction; four presented as dilated intra-hepatic bile ducts with missing common bile duct. Of the 21 patients, 16 had biliary hemorrhage; three also had tumor thrombi in the portal vein. Seventeen of the 21 HCC with biliary thrombi were poorly differentiated, unencapsulated and with an invasive growth. Nineteen of 21 bile duct tumor thrombi did not invade the bile duct wall and could be easily

  7. Fluorocholangiography: reincarnation in the laparoscopic era-evaluation of intra-operative cholangiography in 3635 laparoscopic cholecystectomies.

    Science.gov (United States)

    Nassar, Ahmad H M; Mirza, Ahmad; Qandeel, Haitham; Ahmed, Zubir; Zino, Samer

    2016-05-01

    The introduction of laparoscopic cholecystectomy (LC) resulted in the decline of routine intra-operative cholangiography (IOC). Common bile duct stones are being diagnosed preoperatively using magnetic resonance cholangiopancreatography (MRCP). We aim to evaluate the use and benefits of IOC during laparoscopic biliary surgery at a high-volume biliary surgery unit. Prospective data from 4088 patients undergoing LC over 22 years were analysed. Referral protocols allow one firm to receive the great majority of biliary emergencies and all suspected ductal stones. All patients with gall stones on ultrasound scanning, fit for surgery, will undergo LC during the index admission. MRCP and ERCP are not part of preoperative investigation. A four-port LC is performed with a size 5Fr ureteric catheter within an open cannula to obtain an IOC through right sub-costal port. Of 4088 patients, IOC was attempted in 3691 (90.2 %) and 3635 had a successful IOC (98.4 %). 75 % were females. The mean age was 59 years. Patients presented with one or more of the following: chronic biliary pain in 60 %, acute pain 26.7 %, acute cholecystitis 8.4 %, gallstone pancreatitis 7.8 % and jaundice with or without cholangitis in 19.2 %. A total of 1328 patients (36.5 %) had risk factors for CBD stones. The IOC was abnormal in 975 cases (26.8 %), recording 1599 abnormalities. IOC identified 774 patients with CBD stones (21.3 %), including previously unsuspected CBD stones in 4.7 %. IOC was false negative in 20 cases (0.5 %) found to have stones on basket exploration. A decision not to perform IOC in 453 cases (11 %) was made preoperatively in 74.2 % and intra-operatively in 12.3 %. IOC can be safely and routinely performed in LC. It helps to identify CBD stones, even in patients with no known risk factors, delineate bile duct anatomy and facilitate single-stage management of CBD stones.

  8. Movement-related cortical potentials in paraplegic patients: abnormal patterns and considerations for BCI-rehabilitation

    Directory of Open Access Journals (Sweden)

    Ren eXu

    2014-08-01

    Full Text Available Non-invasive EEG-based Brain-Computer Interfaces (BCI can be promising for the motor neuro-rehabilitation of paraplegic patients. However, this shall require detailed knowledge of the abnormalities in the EEG signatures of paraplegic patients. The association of abnormalities in different subgroups of patients and their relation to the sensorimotor integration are relevant for the design, implementation and use of BCI systems in patient populations. This study explores the patterns of abnormalities of movement related cortical potentials (MRCP during motor imagery tasks of feet and right hand in patients with paraplegia (including the subgroups with/without central neuropathic pain and complete/incomplete injury patients and the level of distinctiveness of abnormalities in these groups using pattern classification. The most notable observed abnormalities were the amplified execution negativity and its slower rebound in the patient group. The potential underlying mechanisms behind these changes and other minor dissimilarities in patients’ subgroups, as well as the relevance to BCI applications, are discussed. The findings are of interest from a neurological perspective as well as for BCI-assisted neuro-rehabilitation and therapy.

  9. Laparoscopic double cholecystectomy for duplicated gallbladder: A case report

    Directory of Open Access Journals (Sweden)

    Mohammud G. Musleh

    Full Text Available Introduction: Duplication of the gallbladder (GB is a very rare surgical encounter affecting 1 in 4000–5000 population that often eludes detection on preoperative ultrasonography, and might increase operative difficulty and risk. The H-type anomaly is the most common whereby each GB drains into the common bile duct via a separate cystic duct. Presentation of case: We report a young female patient with symptomatic gallstones who was incidentally found to have abnormal biliary anatomy on a CT colonography and an H-type duplication of the GB on MRCP. A challenging laparoscopic double cholecystectomy was performed uneventfully. Discussion: Gallbladder duplication can be classified as a type-I anomaly (partiality split primordial gallbladder, a type-II anomaly (two separate gallbladders, each with their own cystic duct or a rare type-III anomaly (triple gallbladders draining by 1–3 separate cystic ducts.Such anatomical variations are associated with increased operative difficulty and risks, including conversion to open cholecystectomy and common bile duct injury. Conclusion: A young female patient was pre-operatively diagnosed with a Harlaftis’s type-II GB anomaly. Each gallbladder was drained by a distinct cystic duct (H-type anomaly. A laparoscopic cholecystectomy was performed with no complications afterwards. Awareness of this rare anomaly might require intraoperative cholangiography when initially suspected during a cholecystectomy to facilitate anatomical recognition and avoid missing a symptomatic pathologic GB and the need for a repeat cholecystectomy. Keywords: Double gallbladder, Laparoscopic cholecystectomy, Intraoperative cholangiography

  10. Detection of movement intention from single-trial movement-related cortical potentials

    Science.gov (United States)

    Niazi, Imran Khan; Jiang, Ning; Tiberghien, Olivier; Feldbæk Nielsen, Jørgen; Dremstrup, Kim; Farina, Dario

    2011-10-01

    Detection of movement intention from neural signals combined with assistive technologies may be used for effective neurofeedback in rehabilitation. In order to promote plasticity, a causal relation between intended actions (detected for example from the EEG) and the corresponding feedback should be established. This requires reliable detection of motor intentions. In this study, we propose a method to detect movements from EEG with limited latency. In a self-paced asynchronous BCI paradigm, the initial negative phase of the movement-related cortical potentials (MRCPs), extracted from multi-channel scalp EEG was used to detect motor execution/imagination in healthy subjects and stroke patients. For MRCP detection, it was demonstrated that a new optimized spatial filtering technique led to better accuracy than a large Laplacian spatial filter and common spatial pattern. With the optimized spatial filter, the true positive rate (TPR) for detection of movement execution in healthy subjects (n = 15) was 82.5 ± 7.8%, with latency of -66.6 ± 121 ms. Although TPR decreased with motor imagination in healthy subject (n = 10, 64.5 ± 5.33%) and with attempted movements in stroke patients (n = 5, 55.01 ± 12.01%), the results are promising for the application of this approach to provide patient-driven real-time neurofeedback.

  11. Hepatic involvement of Langerhans cell histiocytosis in children - imaging findings of computed tomography, magnetic resonance imaging and magnetic resonance cholangiopancreatography

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    Shi, Yingyan; Qiao, Zhongwei; Gong, Ying; Yang, Haowei; Li, Guoping; Pa, Mier [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Xia, Chunmei [Shanghai Medical College of Fudan University, Physiology and Pathophysiology Department, Shanghai (China)

    2014-06-15

    Langerhans cell histiocytosis is a rare disease that occurs mainly in children, and hepatic involvement is generally a poor prognostic factor. To describe CT and MRI findings of hepatic involvement of Langerhans cell histiocytosis in children, especially the abnormal bile duct manifestation on magnetic resonance cholangiopancreatography (MRCP). Thirteen children (seven boys, six girls; mean age 28.9 months) were diagnosed with disseminated Langerhans cell histiocytosis. They underwent CT (n = 5) or MRI (n = 4), or CT and MRI examinations (n = 4) to evaluate the liver involvement. Periportal abnormalities presented as band-like or nodular lesions on CT and MRI in all 13 children. The hepatic parenchymal lesions were found in the peripheral regions of the liver in seven children, including multiple nodules on MRI (n = 6), and cystic-like lesions on CT and MRI (n = 3). In 11 of the 13 children the dilatations of the bile ducts were observed on CT and MRI. Eight of the 13 children underwent MR cholangiopancreatography, which demonstrated stenoses or segmental stenoses with slight dilatation of the central bile ducts, including the common hepatic duct and its first-order branches. The peripheral bile ducts in these children showed segmental dilatations and stenoses. Stenosis of the central bile ducts revealed by MR cholangiopancreatography was the most significant finding of liver involvement in Langerhans cell histiocytosis in children. (orig.)

  12. Percutaneous management of bile duct injury after laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.

    2012-01-01

    Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.

  13. Painless Jaundice Caused by Clonorchis sinensis Infection: A Case Report.

    Science.gov (United States)

    Hao, Yuhua; Bao, Wanguo; Jin, Meishan; Li, Yuxiang; Wang, Feng

    2016-06-01

    A man with only yellowing of the skin and eye sclera was diagnosed with clonorchiasis, which rarely manifested jaundice as the initial symptom. However, because of a lack of evidence for a diagnostic gold standard, the time until definitive diagnosis was more than a week. The diagnostic process relied on inquiring about the patient's history, including the place of residence, dietary habits, and symptoms, as well as on serological findings, an imaging examination, and pathological findings. MRCP and CT results showed mild dilatation of intrahepatic ducts and increased periductal echogenicity. The eggs were ultimately found in stool by water sedimentation method after the negative report through direct smear. DNA sequencing of PCR production of the eggs demonstrated 98-100% homology with ITS2 of Clonorchis sinensis. After anti-parasite medical treatment, the patient's symptoms were gradually relieved. Throughout the diagnostic procedure, besides routine examinations, the sedimentation method or concentration method could be used as a sensitive way for both light and heavy C. sinensis infection in the definite diagnosis.

  14. Comparison of ultrasound evaluation of patients of obstructive jaundice with endoscopic retrograde cholangio-pancreatography findings

    International Nuclear Information System (INIS)

    Farrukh, S.Z.U.I.; Siddiqui, A.R.; Haqqi, S.A.; Muhammad, A.J.

    2017-01-01

    Ultrasonography has proven to be quite effective in differentiating hepatocellular from obstructive cause of jaundice in various studies. This study was conducted with the aim to determine the efficacy of ultrasonography and Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in the diagnosis of obstructive reason of jaundice. Methods: In this descriptive case series, 200 patients with >15 years age of either gender with cholestatic liver enzymes were included, i.e., those patients who had an ultrasound prior to ERCP at the department of gastroenterology of Patel Hospital, Karachi. Patients known to have liver disease with cholestatic jaundice had imaging other than ultrasound were excluded. The results of ultrasonography and ERCPs were compared in particularly looking for the cause of obstruction. Results: Out of total 200 patients, mean age was 41.22+-12.46 years with 107 (53.5 percent) females. Ability of ultrasound in correctly diagnosing obstructive reason for stone CBD was found to be 72.5 percent, dilated CBD without reason 41.7 percent, proximal obstruction, 63.15 percent, distal CBD obstruction 60 percent, and sludge 66.7 percent. Overall ability of ultrasound in correctly diagnosing the cause of obstruction was 64.17 percent. Conclusion: Ultrasound is recommended as the initial examination, which provides a guide to choose patients for either a more advanced non-invasive imaging like MRCP or to an invasive procedure like ERCP. (author)

  15. A brain-controlled lower-limb exoskeleton for human gait training

    Science.gov (United States)

    Liu, Dong; Chen, Weihai; Pei, Zhongcai; Wang, Jianhua

    2017-10-01

    Brain-computer interfaces have been a novel approach to translate human intentions into movement commands in robotic systems. This paper describes an electroencephalogram-based brain-controlled lower-limb exoskeleton for gait training, as a proof of concept towards rehabilitation with human-in-the-loop. Instead of using conventional single electroencephalography correlates, e.g., evoked P300 or spontaneous motor imagery, we propose a novel framework integrated two asynchronous signal modalities, i.e., sensorimotor rhythms (SMRs) and movement-related cortical potentials (MRCPs). We executed experiments in a biologically inspired and customized lower-limb exoskeleton where subjects (N = 6) actively controlled the robot using their brain signals. Each subject performed three consecutive sessions composed of offline training, online visual feedback testing, and online robot-control recordings. Post hoc evaluations were conducted including mental workload assessment, feature analysis, and statistics test. An average robot-control accuracy of 80.16% ± 5.44% was obtained with the SMR-based method, while estimation using the MRCP-based method yielded an average performance of 68.62% ± 8.55%. The experimental results showed the feasibility of the proposed framework with all subjects successfully controlled the exoskeleton. The current paradigm could be further extended to paraplegic patients in clinical trials.

  16. Hepatic involvement of Langerhans cell histiocytosis in children - imaging findings of computed tomography, magnetic resonance imaging and magnetic resonance cholangiopancreatography

    International Nuclear Information System (INIS)

    Shi, Yingyan; Qiao, Zhongwei; Gong, Ying; Yang, Haowei; Li, Guoping; Pa, Mier; Xia, Chunmei

    2014-01-01

    Langerhans cell histiocytosis is a rare disease that occurs mainly in children, and hepatic involvement is generally a poor prognostic factor. To describe CT and MRI findings of hepatic involvement of Langerhans cell histiocytosis in children, especially the abnormal bile duct manifestation on magnetic resonance cholangiopancreatography (MRCP). Thirteen children (seven boys, six girls; mean age 28.9 months) were diagnosed with disseminated Langerhans cell histiocytosis. They underwent CT (n = 5) or MRI (n = 4), or CT and MRI examinations (n = 4) to evaluate the liver involvement. Periportal abnormalities presented as band-like or nodular lesions on CT and MRI in all 13 children. The hepatic parenchymal lesions were found in the peripheral regions of the liver in seven children, including multiple nodules on MRI (n = 6), and cystic-like lesions on CT and MRI (n = 3). In 11 of the 13 children the dilatations of the bile ducts were observed on CT and MRI. Eight of the 13 children underwent MR cholangiopancreatography, which demonstrated stenoses or segmental stenoses with slight dilatation of the central bile ducts, including the common hepatic duct and its first-order branches. The peripheral bile ducts in these children showed segmental dilatations and stenoses. Stenosis of the central bile ducts revealed by MR cholangiopancreatography was the most significant finding of liver involvement in Langerhans cell histiocytosis in children. (orig.)

  17. Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy

    Science.gov (United States)

    Jiang, Yuan-Hui; Zhang, An-Hong; Zhou, Shao-Jun

    2017-01-01

    Abstract Rationale: Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood. Patient concerns: A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016. Diagnoses: Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD). Interventions: During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate. Outcomes: After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse. Lessons: This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as “pancreatogenic choledocholithiasis,” and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause. PMID:29145338

  18. Choledocholithiasis: Evolving standards for diagnosis and management

    Science.gov (United States)

    Freitas, Marilee L; Bell, Robert L; Duffy, Andrew J

    2006-01-01

    Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones. The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation. PMID:16718834

  19. Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm

    Directory of Open Access Journals (Sweden)

    Christian L. Horn

    2017-01-01

    Full Text Available A 26-year-old female, thirteen months postpartum, presented to the emergency department for four weeks of epigastric abdominal pain, pruritus, new onset jaundice, and 11.3 kgs (25 lbs unintentional weight loss. On examination, she was afebrile, tachycardic, alert, and oriented and had jaundice with scleral icterus. Labs were significant for undetectable TSH, FT4 that was too high to measure, and elevated total bilirubin, direct bilirubin, alkaline phosphatase, and transaminases. Abdominal ultrasound revealed cholelithiasis without biliary ductal dilation. Treatment for presumed thyroid storm was initiated. Further work-up with magnetic resonance cholangiopancreatography (MRCP revealed an obstructing cholelith within the distal common bile duct. With the presence of choledocholithiasis explaining the jaundice and abdominal pain, plus the absence of CNS alterations, the diagnosis of thyroid storm was revised to thyrotoxicosis complicated by choledocholithiasis. Endoscopic retrograde cholangiopancreatogram (ERCP with sphincterotomy was performed to alleviate the biliary obstruction, with prompt symptomatic improvement. Thyroid storm is a rare manifestation of hyperthyroidism with a high rate of morbidity and mortality. The diagnosis of thyroid storm is based on clinical examination, and abnormal thyroid function tests do not correlate with disease severity. Knowledge of the many manifestations of thyroid storm will facilitate a quick and accurate diagnosis and treatment.

  20. Assessment of indicators for predicting choledocholithiasis before laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Alam, Mohammed K.

    1998-01-01

    The objective of this report was to study the sensitivity of indicators used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy. A retrospective study was conducted on 104 patients who successfully underwent endoscopic retrograde cholangiopancreatogram (ERCP) before laparoscopic cholecysectomy at Riyadh Medical Complex between 1992 and 1994 (1412H-1414H). Six indicators --- jaundice, biliary pancreatitis, stones in bile duct on sonography, dilated bile duct (>7mm) on ultrasonography, dilated bile duct with deranged liver function test and deranged liver function test without jaundice ---were used for suspecting choledocholithiasis and endoscopic removal before laparoscopic cholecystectomy. Ultrasound correctly predicted bile duct stone in 75%, followed by dilated bile duct with deranged liver function test (46%). Clinical jaundice and biliary pancreatitis were equally sensitive indicators (42% each). Sensitivity of only dilated bile duct on ultrasonography in predicting duct stone was 36%. Deranged liver function without jaundice was the least sensitive (22%) of the predictors. Overall, these indicators correctly diagnosed bile duct stones in 34% of patients. Until laparoscopic exploration of bile duct or a noninvasive technique, such as magnetic resonance cholangiopancreatogram (MRCP), is widely available, these predictors will help in selecting patients with bile duct stones for preoperative removal. Other workers have suggested combining these indicators to improve the predictive value. (author)

  1. Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy: A case report.

    Science.gov (United States)

    Jiang, Yuan-Hui; Zhang, An-Hong; Zhou, Shao-Jun

    2017-11-01

    Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood. A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016. Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD). During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate. After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse. This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as "pancreatogenic choledocholithiasis," and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause.

  2. Functional hepatobiliary MR imaging in children

    Energy Technology Data Exchange (ETDEWEB)

    Tamrazi, Anobel; Vasanawala, Shreyas S. [Stanford University, Department of Radiology, Stanford, CA (United States)

    2011-10-15

    Clinical application efforts for the hepatocyte-specific MRI contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) have mainly been directed toward detection and characterization of various hepatic masses in the adult population. Here we report our initial experience with Gd-EOB-DTPA for evaluating congenital and acquired hepatobiliary pathologies in the pediatric population. Twenty-one consecutive children receiving Gd-EOB-DTPA for functional hepatobiliary evaluation at our institution were retrospectively identified with IRB approval. The use of Gd-EOB-DTPA was classified in each case as definite, potential, or no clinical utility, focusing on the clinical value gained beyond traditional noncontrast fluid-sensitive MR cholangiopancreatography (FS-MRCP) and other imaging modalities. Definite added value of Gd-EOB-DTPA was found in 12 patients, with potential value in 4 patients, and no value in 5 patients. Benefit was seen in cases of iatrogenic and non-iatrogenic biliary strictures, perihepatic fluid collections for biliary leak, hepatobiliary dysfunction in the absence of hyperbilirubinemia, and in the functional exclusion of cystic duct occlusion that can be seen in acute cholecystitis. This is the first reported series of children with Gd-EOB-DTPA and this early work suggests potential pediatric applications. (orig.)

  3. A complication of xanthogranulomatous cholecystitis with Mirizzi syndrome.

    Science.gov (United States)

    Zhang, H-Y; Cao, X-D; Chen, J-J; Luo, Y-Q; Wang, X-C

    2015-05-01

    A patient had right upper quadrant pain with sclera was transferred from emergency room to the hospital, she was proposed to have acute cholecystitis, gallstones, obstructive jaundice, and a four-year history of gallbladder stones. The NMR results showed that the gallbladder was significantly enlarged and the gallbladder wall was thickening irregularly. The liver morphology was not abnormal except with extensive intrahepatic bile duct dilatation. The MRCP results demonstrated that the intrahepatic bile ducts were significant expanded. The ERCP results showed that duodenal stenosis and extra-hepatic bile duct stenosis. We placed a plastic stent of 8.5Fr and 12 cm in length in the hepatic duct, and after biliary plastic stent placement, jaundice was rapidly reduced and liver function was improved significantly. A surgery was performed and the final pathologic diagnosis is a complication of Xanthogranulomatous cholecystitis with Mirizzi syndrome. After the surgery of cholecystectomy and a bile duct repair were performed, the patient was recovered well. Conclusively, if a patient was diagnosed as biliary stricture, a biliary metal stent should not be placed until pathological diagnosis of malignancy.

  4. AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya

    Directory of Open Access Journals (Sweden)

    Yiming Gao

    2011-01-01

    Full Text Available AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.

  5. A case of Fasciola hepatica infection mimicking cholangiocarcinoma and ITS-1 sequencing of the worm.

    Science.gov (United States)

    Kang, Bong Kyun; Jung, Bong-Kwang; Lee, Yoon Suk; Hwang, In Kyeom; Lim, Hyemi; Cho, Jaeeun; Hwang, Jin-Hyeok; Chai, Jong-Yil

    2014-04-01

    Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.

  6. Motor effort training with low exercise intensity improves muscle strength and descending command in aging.

    Science.gov (United States)

    Jiang, Changhao; Ranganathan, Vinoth K; Zhang, Junmei; Siemionow, Vlodek; Yue, Guang H

    2016-06-01

    This study explored the effect of high mental effort training (MET) and conventional strength training (CST) on increasing voluntary muscle strength and brain signal associated with producing maximal muscle force in healthy aging. Twenty-seven older adults (age: 75 ± 7.9 yr, 8 women) were assigned into 1 of 3 groups: MET group-trained with low-intensity (30% maximal voluntary contraction [MVC]) physical exercise combined with MET, CST group-trained with high-intensity muscle contractions, or control (CTRL) group-no training of any kind. MET and CST lasted for 12 weeks (5 sessions/week). The participants' elbow flexion strength of the right arm, electromyography (EMG), and motor activity-related cortical potential (MRCP) directly related to the strength production were measured before and after training. The CST group had the highest strength gain (17.6%, P boarder-line significance level (12.11%, P = 0.061) and that for CTRL group was only 4.9% (P = 0.539). These results suggest that high mental effort training combined with low-intensity physical exercise is an effective method for voluntary muscle strengthening and this approach is especially beneficial for those who are physically weak and have difficulty undergoing conventional strength training.

  7. A solid pseudopapillary neoplasm of the pancreas in a man presenting with acute pancreatitis: A case report.

    Science.gov (United States)

    Chikuie, Emi; Fukuda, Saburo; Tazawa, Hirofumi; Nishida, Toshihiro; Sakimoto, Hideto

    2017-01-01

    A solid pseudopapillary neoplasm (SPN) of the pancreas is rare neoplasm that occurs predominantly in young women. The clinical presentation of SPNs is nonspecific, but acute pancreatitis is rare in the reported literature. A 36-year-old man was referred to our hospital because of upper abdominal pain and elevation of serum amylase. A computed tomography (CT) scan showed swelling of the pancreas body and a poorly enhanced and indistinct mass in the pancreas body. He was diagnosed with acute pancreatitis. The symptom was improved with conservative treatment, but acute pancreatitis recurred twice during a period of 2 months. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the MPD adjacent to the mass. Distal pancreatectomy was performed because the mass in the pancreas body seemed to cause repeated acute pancreatitis and malignant pancreatic cancer could not be excluded. Immunohistochemically, a diagnosis of SPN of the pancreas was made from the resected specimen. To the best our knowledge, only 6 cases have been reported in the literature concerning the SPN presenting with acute pancreatitis. We report a man with a small SPN of the pancreas presenting with acute pancreatitis and mimicking pancreatic cancer. We should be aware that this rare pancreatic tumor can become a cause of acute pancreatitis. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience

    Directory of Open Access Journals (Sweden)

    Fransisca J. Siahaya

    2013-01-01

    Full Text Available Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.

  9. Electrocorticographic Temporal Alteration Mapping: A Clinical Technique for Mapping the Motor Cortex with Movement-Related Cortical Potentials.

    Science.gov (United States)

    Wu, Zehan; Xie, Tao; Yao, Lin; Zhang, Dingguo; Sheng, Xinjun; Farina, Dario; Chen, Liang; Mao, Ying; Zhu, Xiangyang

    2017-01-01

    We propose electrocorticographic temporal alteration mapping (ETAM) for motor cortex mapping by utilizing movement-related cortical potentials (MRCPs) within the low-frequency band [0.05-3] Hz. This MRCP waveform-based temporal domain approach was compared with the state-of-the-art electrocorticographic frequency alteration mapping (EFAM), which is based on frequency spectrum dynamics. Five patients (two epilepsy cases and three tumor cases) were enrolled in the study. Each patient underwent intraoperative direct electrocortical stimulation (DECS) procedure for motor cortex localization. Moreover, the patients were required to perform simple brisk wrist extension task during awake craniotomy surgery. Cross-validation results showed that the proposed ETAM method had high sensitivity (81.8%) and specificity (94.3%) in identifying sites which exhibited positive DECS motor responses. Moreover, although the sensitivity of the ETAM and EFAM approaches was not significantly different, ETAM had greater specificity compared with EFAM (94.3 vs. 86.1%). These results indicate that for the intraoperative functional brain mapping, ETAM is a promising novel approach for motor cortex localization with the potential to reduce the need for cortical electrical stimulation.

  10. Electrocorticographic Temporal Alteration Mapping: A Clinical Technique for Mapping the Motor Cortex with Movement-Related Cortical Potentials

    Directory of Open Access Journals (Sweden)

    Zehan Wu

    2017-06-01

    Full Text Available We propose electrocorticographic temporal alteration mapping (ETAM for motor cortex mapping by utilizing movement-related cortical potentials (MRCPs within the low-frequency band [0.05-3] Hz. This MRCP waveform-based temporal domain approach was compared with the state-of-the-art electrocorticographic frequency alteration mapping (EFAM, which is based on frequency spectrum dynamics. Five patients (two epilepsy cases and three tumor cases were enrolled in the study. Each patient underwent intraoperative direct electrocortical stimulation (DECS procedure for motor cortex localization. Moreover, the patients were required to perform simple brisk wrist extension task during awake craniotomy surgery. Cross-validation results showed that the proposed ETAM method had high sensitivity (81.8% and specificity (94.3% in identifying sites which exhibited positive DECS motor responses. Moreover, although the sensitivity of the ETAM and EFAM approaches was not significantly different, ETAM had greater specificity compared with EFAM (94.3 vs. 86.1%. These results indicate that for the intraoperative functional brain mapping, ETAM is a promising novel approach for motor cortex localization with the potential to reduce the need for cortical electrical stimulation.

  11. Assessment at UK medical schools varies substantially in volume, type and intensity and correlates with postgraduate attainment.

    Science.gov (United States)

    Devine, Oliver Patrick; Harborne, Andrew Christopher; McManus, I C

    2015-09-11

    In the United Kingdom (UK), medical schools are free to develop local systems and policies that govern student assessment and progression. Successful completion of an undergraduate medical degree results in the automatic award of a provisional licence to practice medicine by the General Medical Council (GMC). Such a licensing process relies heavily on the assumption that individual schools develop similarly rigorous assessment policies. Little work has evaluated variability of undergraduate medical assessment between medical schools. That absence is important in the light of the GMC's recent announcement of the introduction of the UKMLA (UK Medical Licensing Assessment) for all doctors who wish to practise in the UK. The present study aimed to quantify and compare the volume, type and intensity of summative assessment across medicine (A100) courses in the United Kingdom, and to assess whether intensity of assessment correlates with the postgraduate attainment of doctors from these schools. Locally knowledgeable students in each school were approached to take part in guided-questionnaire interviews via telephone or Skype(TM). Their understanding of assessment at their medical school was probed, and later validated with the assessment department of the respective medical school. We gathered data for 25 of 27 A100 programmes in the UK and compared volume, type and intensity of assessment between schools. We then correlated these data with the mean first-attempt score of graduates sitting MRCGP and MRCP(UK), as well as with UKFPO selection measures. The median written assessment volume across all schools was 2000 min (mean = 2027, SD = 586, LQ = 1500, UQ = 2500, range = 1000-3200) and 1400 marks (mean = 1555, SD = 463, LQ = 1200, UQ = 1800, range = 1100-2800). The median practical assessment volume was 400 min (mean = 472, SD = 207, LQ = 400, UQ = 600, range = 200-1000). The median intensity (minutes per mark ratio) of summative written assessment was 1.24 min per mark

  12. Ductal adenocarcinoma and unusual differential diagnosis; Duktales Adenokarzinom und ungewoehnliche Differenzialdiagnosen

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    Haage, P.; Schwartz, C.A.; Scharwaechter, C. [Universitaet Witten/Herdecke, Zentrum fuer Radiologie HELIOS Universitaetsklinikum Wuppertal, Wuppertal (Germany)

    2016-04-15

    Ductal pancreatic adenocarcinoma is by far the most common solid tumor of the pancreas. It has a very poor prognosis, especially in the more advanced stages which are no longer locally confined. Due to mostly unspecific symptoms, imaging is key in the diagnostic process. Because of the widespread use of imaging techniques, incidental findings are to a greater extent discovered in the pancreas, which subsequently entail further work-up. Ductal pancreatic adenocarcinoma can be mimicked by a large number of different lesions, such as anatomical variants, peripancreatic structures and tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Additionally, a number of precursor lesions can be differentiated. The correct classification is thus important as an early diagnosis of ductal pancreatic adenocarcinoma is relevant for the prognosis and because the possibly avoidable treatment is very invasive. All major imaging techniques are principally suitable for pancreatic imaging. In addition to sonography of the abdomen, usually the baseline diagnostic tool, computed tomography (CT) with its superior spatial resolution, magnetic resonance imaging (MRI) with its good soft tissue differentiation capabilities, possibly in combination with MR cholangiopancreatography (MRCP), endosonography with its extraordinary spatial resolution, conceivably with additional endoscopic retrograde CP or the option of direct biopsy and finally positron emission tomography CT (PET-CT) as a molecular imaging tool are all particularly useful modalities. The various techniques all have its advantages and disadvantages; depending on the individual situation they may need to be combined. (orig.) [German] Das duktale Adenokarzinom ist der weitaus haeufigste solide Tumor des Pankreas. Die Prognose ist sehr schlecht, insbesondere bei fortgeschrittenen, nicht mehr lokal begrenzten Tumoren. Bei meist unspezifischen geringen Beschwerden kommt der

  13. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences.

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    Sonja Kinner

    Full Text Available Preoperative evaluation of potential living liver donors (PLLDs includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w and Gd-EOB-DTPA enhanced T1-weighted (T1w magnetic resonance cholangiography (MRC techniques in the evaluation of PLLDs.30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany using (A 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo fat saturated (fs in axial plane, (B 2D T2w HASTE fs thick slices in coronal plane, (C free breathing 3D T2w TSE (turbo spin echo RESTORE (high-resolution navigator corrected plus (D maximum intensity projections (MIPs, (E T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions plus (F MIPs and (G T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G and with (H inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated.Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622-0.804.3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.

  14. Pancreatic changes in patients with primary sclerosing cholangitis: MR cholangiopancreatography and MRI findings

    International Nuclear Information System (INIS)

    Ozkavukcu, Esra; Erden, Ayse; Erden, Ilhan

    2009-01-01

    Purpose: To evaluate the possible pancreatic changes and their frequencies in patients with primary sclerosing cholangitis (PSC) on MR cholangiopancreatography (MRCP), and conventional abdominal MRI. Materials and Methods: Patient group consisted of 29 PSC (13 male, 16 female) cases, whereas cohort 1 consisted of 12 female patients with primary biliary cirrhosis, and cohort 2 consisted of 17 patients (6 male, 11 female) with non-immune chronic liver disease. Two radiologists retrospectively evaluated the MR examinations paying special attention to the pancreatic size (atrophy or enlargement), T1- and T2-signal intensity of the pancreas, focal pancreatic lesion, capsule-like rim, peripancreatic edema or fluid, fascial thickening, and pancreatic ducts (dilatation or narrowing). The results are expressed as percentages. Three groups were compared using Pearson chi-square test for each feature. However, only p-value for 'dilatation of the pancreatic duct' was determined, whereas p-value could not be calculated because of the insufficient number of subjects/sequences for the other features. Results: Twelve PSC patients (41.3%) had pancreatic abnormalities. The most common pancreatic changes in PSC patients were decreased T1-signal intensity (44%) and dilatation of the pancreatic duct (13.8%), respectively. Increased T2-signal intensity was also shown in 2 PSC patients (6.9%). Conclusion: Even PSC patients without any sign of pancreatitis, can show MR changes in the pancreatic parenchyma or the pancreatic duct. The etiologies of these changes, and whether they are unique to PSC, are still controversial. Histopathological studies bringing light to these pancreatic changes are needed.

  15. Comparison of spatial filters and features for the detection and classification of movement-related cortical potentials in healthy individuals and stroke patients

    Science.gov (United States)

    Jochumsen, Mads; Niazi, Imran Khan; Mrachacz-Kersting, Natalie; Jiang, Ning; Farina, Dario; Dremstrup, Kim

    2015-10-01

    Objective. The possibility of detecting movement-related cortical potentials (MRCPs) at the single trial level has been explored for closing the motor control loop with brain-computer interfaces (BCIs) for neurorehabilitation. A distinct feature of MRCPs is that the movement kinetic information is encoded in the brain potential prior to the onset of the movement, which makes it possible to timely drive external devices to provide sensory feedback according to the efferent activity from the brain. The aim of this study was to compare methods for the detection (different spatial filters) and classification (features extracted from various domains) of MRCPs from continuous electroencephalography recordings from executed and imagined movements from healthy subjects (n = 24) and attempted movements from stroke patients (n = 6) to optimize the performance of MRCP-based BCIs for neurorehabilitation. Approach. The MRCPs from four cue-based tasks were detected with a template matching approach and a set of spatial filters, and classified with a linear support vector machine using the combination of temporal, spectral, time-scale, or entropy-based features. Main results. The best spatial filter (large Laplacian spatial filter (LLSF)) resulted in a true positive rate of 82 ± 9%, 78 ± 12% and 72 ± 9% (with detections occurring ˜200 ms before the onset of the movement) for executed, imagined and attempted movements (stroke patients). The best feature combination (temporal and spectral) led to pairwise classification of 73 ± 9%, 64 ± 10% and 80 ± 12%. When the detection was combined with classification, 60 ± 10%, 49 ± 10% and 58 ± 10% of the movements were both correctly detected and classified for executed, imagined and attempted movements. A similar performance for detection and classification was obtained with optimized spatial filtering. Significance. A simple setup with an LLSF is useful for detecting cued movements while the combination of features from the time

  16. Recurrent acute pancreatitis: an approach to diagnosis and management.

    Science.gov (United States)

    Kedia, Saurabh; Dhingra, Rajan; Garg, Pramod Kumar

    2013-01-01

    Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%-25% of cases of AP. The causes of idiopathic RAP (IRAP) can be mechanical, toxic-metabolic, anatomical, or miscellaneous. Microlithiasis commonly reported from the West is not a common cause of IRAP among Indian patients. Pancreas divisum (PD) is now believed as a cofactor, the main factor being associated genetic mutations. The role of Sphincter of Oddi dysfunction (SOD) as a cause of IRAP remains controversial. Malignancy should be ruled out in any patient with IRAP > 50 years of age. Early CP can present initially as RAP. The work-up of patients with IRAP includes a detailed history and investigations. Primary investigations include liver function tests (LFT), serum calcium and triglyceride, abdominal ultrasonography (USG) and contrast-ehhanced computed tomography (CECT) abdomen. Endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and possibly endoscopic retrograde cholangiopancreatography (ERCP) are indicated in the secondary phase if the work-up is negative after the primary investigations. EUS is advised usually 6-8 weeks after an acute episode. Treatment of patients with IRAP is aimed at the specific aetiology. In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

  17. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.

    Science.gov (United States)

    Zhang, Rongchun; Luo, Hui; Pan, Yanglin; Zhao, Lina; Dong, Junqiang; Liu, Zhiguo; Wang, Xiangping; Tao, Qin; Lu, Guohua; Guo, Xuegang

    2015-10-01

    Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking. To investigate the DBR rate in patients with recurrent CBDS after ERCP. A prospective case-control study. A tertiary center. During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded. Standard barium meal examination, MRCP, and enhanced abdominal CT. DBR. Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences. Small sample size. DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. ( NCT02329977.) Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  18. Roux-en-Y drainage of a pancreatic fistula for disconnected pancreatic duct syndrome after acute necrotizing pancreatitis.

    Science.gov (United States)

    Pearson, Erik G; Scaife, Courtney L; Mulvihill, Sean J; Glasgow, Robert E

    2012-01-01

    After acute necrotizing pancreatitis (ANP), a pancreatic fistula may occur from disconnected pancreatic duct syndrome (DPDS) where a segment of the pancreas is no longer in continuity with the main pancreatic duct. To study the outcome of patients treated using Roux-Y pancreatic fistula tract-jejunostomy for DPDS after ANP. Between 2002 and 2011, patients treated for DPDS in the setting of endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopanreatography (MRCP) documented main pancreatic duct disruption with Roux-Y pancreatic fistula tract-jejunostomy. In all, seven patients with DPDS were treated. The median age was 62 years (range 49-78) and five were men. The cause of ANP was gallstones (2), alcohol (1), ERCP (1) and idiopathic (3). Pancreatic necrosectomy was done in six patients. Time from onset of pancreatitis to fistula drainage was 270 days (164-365). Pancreatic fistulae arose from DPDS in the head/neck (4) and body/tail (3). Patients had a median fistula output of 140 ml (100-200) per day before surgery. The median operative time was 142 min (75-367) and estimated blood loss was 150 ml (25 to 500). Patients began an oral diet on post-operative day 4 (3-6) and were hospitalized for a median of 7 days (5-12). The median follow-up was 264 days (29-740). Subsequently, one patient required a distal pancreatectomy. After surgery, three patients required oral hypoglycaemics. No patient developed pancreatic exocrine insufficiency. Internal surgical drainage using Roux-en-Y pancreatic fistula tract-jejunostomy is a safe and definitive treatment for patients with DPDS. © 2011 International Hepato-Pancreato-Biliary Association.

  19. Pancreatic changes in patients with primary sclerosing cholangitis: MR cholangiopancreatography and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ozkavukcu, Esra [Ankara University School of Medicine, Department of Radiology, Ankara Universitesi Tip Fakueltesi, Cebeci Hastanesi, Cebeci, Ankara 06100 (Turkey)], E-mail: eozkavukcu@gmail.com; Erden, Ayse; Erden, Ilhan [Ankara University School of Medicine, Department of Radiology, Ankara Universitesi Tip Fakueltesi, Cebeci Hastanesi, Cebeci, Ankara 06100 (Turkey)

    2009-04-15

    Purpose: To evaluate the possible pancreatic changes and their frequencies in patients with primary sclerosing cholangitis (PSC) on MR cholangiopancreatography (MRCP), and conventional abdominal MRI. Materials and Methods: Patient group consisted of 29 PSC (13 male, 16 female) cases, whereas cohort 1 consisted of 12 female patients with primary biliary cirrhosis, and cohort 2 consisted of 17 patients (6 male, 11 female) with non-immune chronic liver disease. Two radiologists retrospectively evaluated the MR examinations paying special attention to the pancreatic size (atrophy or enlargement), T1- and T2-signal intensity of the pancreas, focal pancreatic lesion, capsule-like rim, peripancreatic edema or fluid, fascial thickening, and pancreatic ducts (dilatation or narrowing). The results are expressed as percentages. Three groups were compared using Pearson chi-square test for each feature. However, only p-value for 'dilatation of the pancreatic duct' was determined, whereas p-value could not be calculated because of the insufficient number of subjects/sequences for the other features. Results: Twelve PSC patients (41.3%) had pancreatic abnormalities. The most common pancreatic changes in PSC patients were decreased T1-signal intensity (44%) and dilatation of the pancreatic duct (13.8%), respectively. Increased T2-signal intensity was also shown in 2 PSC patients (6.9%). Conclusion: Even PSC patients without any sign of pancreatitis, can show MR changes in the pancreatic parenchyma or the pancreatic duct. The etiologies of these changes, and whether they are unique to PSC, are still controversial. Histopathological studies bringing light to these pancreatic changes are needed.

  20. The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Bosboom, D. [Department of Radiology, University Medical Center St Radboud, Postbus 9101, Route 667, 6500 HB Nijmegen (Netherlands); Braam, A.W.E. [Department of Pediatric Surgery, University Medical Center St Radboud, Postbus 9101, Route 815, 6500 HB Nijmegen (Netherlands); Blickman, J.G. [Department of Radiology, University Medical Center St Radboud, Postbus 9101, Route 667, 6500 HB Nijmegen (Netherlands); Wijnen, R.M.H. [Department of Pediatric Surgery, University Medical Center St Radboud, Postbus 9101, Route 815, 6500 HB Nijmegen (Netherlands)]. E-mail: R.Wijnen@kchir.umcn.nl

    2006-07-15

    Background: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. Method: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. Results: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. Conclusion: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.

  1. Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy

    Directory of Open Access Journals (Sweden)

    Eva Barreiro-Alonso

    Full Text Available Objectives: Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. Materials and methods: Prospective observational study conducted at a tertiary hospital (Hospital de Cabueñes. Gijón, Asturias. Spain from July to November 2014. The study has consecutively included inpatients suffering from ABEP who: a had suffered a previous episode of mild acute gallstone pancreatitis or cholecystitis at least 2 weeks before readmission; and b had not undergone cholecystectomy despite the lack of contraindications. Results: During the research period, 9 patients (7 females and 2 males with a mean age of 65.3 years (standard deviation [SD] 19.2 were readmitted. The median number of days between the previous episode of ABEP or cholecystitis and the readmission was 114 days (interquartile range [IQR] 111.0. Reported median overall length of hospital stay was 10 days (IQR = 2.0. Patients underwent a mean of 2.8 (SD = 1.2 ultrasound scans, 1.3 (SD = 0.9 abdominal and pelvic CT, 0.8 (SD = 1.0 MRCP and 0.2 (SD = 0.4 ERCP. The mean cost per patient for each readmission, including hospital stay (143.0 €/day, Emergency Service (332.31 € and tests performed was 2,381.70 €/patient. Conclusions: Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.

  2. Rare but Lethal Hepatopathy-Sickle Cell Intrahepatic Cholestasis and Management Strategies.

    Science.gov (United States)

    Malik, Aamir; Merchant, Chandni; Rao, Mana; Fiore, Rosemary P

    2015-11-28

    Sickle cell disease can affect the liver by way of the disease process, including sickling in hepatic sinusoids, as well as its treatment, including repeated blood transfusions leading to hemosiderosis and hepatitis. Sickle cell intrahepatic cholestasis (SCIC) is an extreme variant of sickle cell hepatopathy, and is associated with high fatality. We present the case of a 31-year-old man with past medical history of sickle cell disease and cholecystectomy who was admitted with uncomplicated vaso occlusive crisis and during the hospital stay developed fever, upper abdominal pain, and jaundice. There was an accelerated rise in total bilirubin to 50 mg/dL, direct bilirubin 38 mg/dL, and Cr 3.0 mg/dL. Hb was 6.4 g/dL, reticulocyte count 16%, ALT 40 IU/L, AST 155 IU/L, ALP 320 IU/L, and LDH 475 IU/L. Hepatitis panel was negative and MRCP showed normal caliber of the common bile duct, with no obstruction. Exchange transfusion of 9 units of packed red blood cells led to great improvement in his condition. SCIC, unlike the other sickle cell hepatopathies, requires urgent and vigorous exchange transfusion. Renal impairment in SCIC has not been well studied but usually is reversible with the hepatic impairment, as in this case. Unresolved renal impairment requires dialysis and is associated with poor outcome. There is limited data on use of hydroxyurea to prevent SCIC, and liver transplant is associated with high mortality. A timely diagnosis of SCIC and appropriate management is life-saving.

  3. Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia.

    Science.gov (United States)

    Sevinç, B; Karahan, Ö; Bakdik, S; Aksoy, N; Eryilmaz, M A

    2015-01-01

    With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR. A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days. It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Laparoscopic management of CBD stones: an Indian experience.

    Science.gov (United States)

    Chander, Jagdish; Vindal, Anubhav; Lal, Pawanindra; Gupta, Nikhil; Ramteke, Vinod Kumar

    2011-01-01

    Common bile duct stones (CBDS) that are seen in the Asian population are very different from those seen in the west. It is not infrequent to see multiple, large, and impacted stones and a hugely dilated CBD. Many of these patients have been managed by open CBD exploration (OCBDE), even after the advent of laparoscopic cholecystectomy (LC), because these large stones pose significant challenges for extraction by endoscopic retrograde cholangiopancreatography. This series presents the largest experience of managing CBDS using a laparoscopic approach from Indian subcontinent. Between 2003 and 2009, 150 patients with documented CBDS were treated laparoscopically at a tertiary care hospital in New Delhi. Of these, 4 patients were managed through transcystic route and 140 through the transcholedochal route. There were 34 men and 116 women patients with age ranging from 15 to 72 years. The mean size of the CBD on ultrasound was 11.7 ± 3.7 mm and on MRCP 13.8 ± 4.7 mm. The number of stones extracted varied from 1 to 70 and the size of the extracted stones from 5 to 30 mm. The average duration of surgery was 139.9 ± 26.3 min and the mean intraoperative blood loss was 103.4 ± 85.9 ml. There were 6 conversions to open procedures, 1 postoperative death (0.7%), and 23 patients (15%) had nonfatal postoperative complications. Three patients had retained stones (2%) and one developed recurrent stone (0.7%). Even in patients with multiple, large, and impacted CBDS, there is scope for a minimally invasive procedure with its attendant benefits in the form of laparoscopic CBD exploration (LCBDE).

  5. Treatment of Duodenal Duplication by Trans-umbilical Exploratory Minimal Laparotomy

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    Li-Lan Chiang

    2009-08-01

    Full Text Available Duodenal duplication cysts are rare congenital lesions. Their presentation is often non-specific and physical examination and laboratory studies usually reveal no abnormal findings. The diagnosis of duodenal duplication cysts can thus be challenging and relies on ultrasonography, barium swallow, contrast enhanced computed tomography (CT, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography (MRCP. The management of duodenal duplication cyst is surgical. Laparotomy is usually necessary, and complete resection is the management goal. Subtotal excision with stripping of the mucosa due to close involvement of the pancreatobiliary tree, and endoscopic resection have Duodenal duplication cysts are rare congenital lesions usually diagnosed in infancy, although they may present in adulthood. Prenatal diagnosis is difficult, and postnatal diagnosis relies on ultrasonography, barium swallow, contrast-enhanced computerized tomography, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography. A female newborn was diagnosed with an abdominal cyst (size around 6 ×; 5 × 4 cm at gestational age (GA 24 weeks, by regular prenatal examination. After her birth at GA 37 weeks, we performed abdominal ultrasonography and MRI, but there was no definite diagnosis. The usual management of an abdominal cyst involves resection by laparotomy (requiring a large incision or laparoscopy (requiring several small incisions. We performed an exploratory trans-umbilical minimal laparotomy excision for surgery, and the pathology revealed duodenal duplication. In our case, there was no recurrence of the cyst after 18 months follow-up, and the operation scar was almost undetectable. Trans-umbilical minimal laparotomy excision may be considered as an alternative choice for the management of abdominal and duodenal duplication cysts.

  6. Current trends in the management of Mirizzi Syndrome

    Science.gov (United States)

    Chen, Hang; Siwo, Ernest Amos; Khu, Megan; Tian, Yu

    2018-01-01

    Abstract Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. This paper reviews these new diagnostic modalities and treatment approaches for the management of Mirizzi Syndrome. An online search language was performed using PubMed and Web of Science for literature published in English between 2012 and 2017 using the search terms “Mirizzi Syndrome” and “Mirizzi.” In total, 16 case series and 11 case reports were identified and analyzed. The most frequently used diagnostic modalities were ultrasound, computed tomography (CT); magnetic resonance cholangiopancreaticography (MRCP); endoscopic retrograde cholangiopancreaticography (ERCP). A combination of ≥2 diagnostic modalities was frequently used to detect Mirizzi Syndrome. Literature shows that the specific type of Mirizzi Syndrome determined the type of treatment chosen. Open surgery was the preferred option, although there are documented cases of the use of minimally-invasive techniques, even in advanced cases. Laparoscopic, endoscopic or robot-assisted surgery, used individually or in combination with lithotripsy, were all associated with a favorable outcome. As yet, there are no internationally-accepted guidelines for the management of Mirizzi Syndrome. Laparotomy is the preferred surgical technique of choice, although an increasing number of surgeons are beginning to opt for minimally-invasive techniques. The number of papers in the existing literature describing diagnostic and treatment procedures is relatively small at present, thus making it difficult to reasonably propose an evidence-based standard of care for Mirizzi Syndrome. PMID:29369192

  7. High-resolution magnetic resonance cholangiography (MRC) with adaptive averaging: diagnostic performance evaluation

    International Nuclear Information System (INIS)

    Sala, E.; Graves, M.J.; Abubacker, Z.; Kershaw, L.E.; Black, R.T.; Skinner, J.; Beavon, R.; Lomas, D.J.

    2006-01-01

    Aim: To evaluate the diagnostic performance of an interactive, adaptively averaged (AA) two-dimensional (2D) magnetic resonance cholangiography (MRC) technique in patients with suspected biliary disease by comparison to the standard MRC technique. Materials and methods: The AA 2D MRC method registers the images after acquisition, allowing summation of multiple images to improve the signal:noise ratio (SNR) and thereby potentially improve the visualization of bile ducts. One hundred and twenty-eight patients underwent both 2D conventional and AA magnetic resonance cholangiopancreatography (MRCP). Twenty-seven patients were excluded from the analysis as AA images could not be properly obtained due to technical failures. All examinations were performed using a 1.5 T whole-body MR system and a four-channel torso phased array coil. Images of 101 patients were adaptively averaged using an in-house developed program written in IDL. Two readers qualitatively evaluated the studies in consensus, blinded to acquisition details and without knowledge of clinical information. Results: The AA technique was significantly better than the conventional 2D MRC for the visualization of the second-order branch intrahepatic ducts (p < 00001). Overall, there was no significant difference in the diagnostic confidence between two techniques (p = 0.12). However, the AA technique showed a trend towards more confident diagnosis of biliary strictures (p = 0.055), likely due to better diagnostic confidence in identifying second order branch intrahepatic duct strictures (p = 0.054). Conclusion: Excluding those patients those patients in whom either satisfactory respiratory gating or a suitable kernel placement was not achieved, AA 2D MRC demonstrated a significant improvement in visualization of intrahepatic duct branches compared to standard MRC

  8. Comparative accuracy of CT, dual-echo MRI and MR spectroscopy for preoperative liver fat quantification in living related liver donors

    Directory of Open Access Journals (Sweden)

    Ruchi Rastogi

    2016-01-01

    Full Text Available Background: It is of significant importance to assess the extent of hepatic steatosis in living donor liver transplant (LDLT surgery to ensure optimum graft regeneration as well as donor safety. Aim: To establish the accuracy of non-invasive imaging methods including computed tomography (CT, dual-echo in- and opposed-phase magnetic resonance imaging (MRI, and MR spectroscopy (MRS for quantification of liver fat content (FC in prospective LDLT donors with histopathology as reference standard. Settings and Design: This retrospective study was conducted at our institution on LDLT donors being assessed for biliary and vascular anatomy depiction by Magnetic Resonance Cholangiopancreatography (MRCP and CT scan, respectively, between July 2013 and October 2014. Materials and Methods: Liver FC was measured in 73 donors by dual-echoT1 MRI and MRS. Of these, CT liver attenuation index (LAI values were available in 62 patients. Statistical Analysis: CT and MRI FC were correlated with histopathological reference standard using Spearman correlation coefficient. Sensitivity, specificity, positive predictive value, negative predicative value, and positive and negative likelihood ratios with 95% confidence intervals were obtained. Results: CT LAI, dual-echo MRI, and MRS correlated well with the histopathology results (r = 0.713, 0.871, and 0.882, respectively. An accuracy of 95% and 96% was obtained for dual-echo MRI and MRS in FC estimation with their sensitivity being 97% and 94%, respectively. False-positive rate, positive predictive value (PPV, and negative predicative value (NPV were 0.08, 0.92, and 0.97, respectively, for dual-echo MRI and 0.03, 0.97, and 0.95, respectively, for MRS. CT LAI method of fat estimation has a sensitivity, specificity, PPV, and NPV of 73%, 77.7%, 70.4%, and 80%, respectively. Conclusion: Dual-echo MRI, MRS, and CT LAI are accurate measures to quantify the degree of hepatic steatosis in LDLT donors, thus reducing the need for

  9. MR cholangiopancreatography of pancreaticobiliary diseases: Comparison of single-shot RARE and multislice HASTE sequences

    Energy Technology Data Exchange (ETDEWEB)

    Morrin, Martina M.; Farrell, Richard J.; McEntee, Gerry; MacMathuna, Padraic; Stack, John P.; Murrah, John G

    2000-11-01

    AIMS: We prospectively compared two breath-hold magnetic resonance cholangiopancreatography (MRCP) sequences: single-shot rapid acquisition with relaxation enhancement (RARE) and multislice half-Fourier acquisition single-shot turbo spin echo (HASTE) in imaging the pancreaticobiliary system. PATIENTS AND METHODS: The diagnostic accuracy of single-shot RARE and multislice HASTE was studied in 34 subjects who had undergone conventional cholangiopancreatography. Overall image quality, duct conspicuity, image artifact, signal intensity and contrast-to-noise ratios were assessed independently by two radiologists who were unaware of the underlying diagnosis. RESULTS: Both sequences had comparable diagnostic accuracy regarding a normal biliary system, choledocholithiasis, extra-hepatic and intra-hepatic strictures. Single-shot RARE was superior to multislice HASTE in diagnosing a normal pancreatic system, pancreatic and intrahepatic duct strictures, while providing significantly better image quality (mean {+-} SE 3.7 {+-} 0.07 vs 3.3 {+-} 0.08: P = 0.02) and significantly less image artifact (mean {+-} SE 3.6 {+-} 0.07 vs 3.2 {+-} 0.08:P = 0.01). Single-shot RARE provided significantly better duct conspicuity regarding the pancreatic duct within the body (2.7 {+-} 0.2 vs 2.1 {+-} 0.2: P = 0.003) and tail (2.4 {+-} 0.2 vs 1.6 {+-} 0.2;P = 0.0001), as well as the intrahepatic ducts (3.0 {+-} 0.1 vs 2.6 {+-} 0.1: P = 0.004) but there was no significant difference regarding the remainder of the biliary tree. CONCLUSION: Single-shot RARE provides superior image quality, duct conspicuity with the added advantage of less image artifact and shorter acquisition time. However, volume averaging can cause common bile duct stones to be missed. Therefore, multislice HASTE sequences should still be acquired if choledocholithiasis is suspected. Larger studies are required to assess the diagnostic efficacy of single-shot RARE sequences in pancreatic duct and intra-hepatic duct disease

  10. Computed tomography of pancreatic tumors; Computertomographie bei Pankreastumoren

    Energy Technology Data Exchange (ETDEWEB)

    Grenacher, L.; Klauss, M. [Radiologische Klinik, Universitaetsklinikum Heidelberg (Germany). Abt. Diagnostische und Interventionelle Radiologie

    2009-02-15

    darueber hinaus ideal zur Detektion neuroendokriner Tumoren, Metastasen und zur Differenzierung zystischer Tumoren wie Pseudozysten, mikrozystischen Zystadenomen und intraduktalen papillaer-muzinoesen Neoplasien (IPMN). Zwar ist die sichere Einschaetzung letzterer zwischen benigne, Borderline und maligner Transformation nicht immer moeglich, allerdings koennen indirekte Hinweise aufgrund der hohen Ortsaufloesung wie Wandknoetchen, Gangweite und Verbindungen zum Ductus pancreaticus oft detektiert werden, die so vergleichbare Ergebnisse zur MRT mit der Magnetresonanz-Cholangiopankreatikographie (MRCP) liefern. Die MDCT ist zusaetzlich ein ideales Verfahren zur Beurteilung der lokalen Tumorsituation unter neoadjuvanter oder adjuvanter Therapie. (orig.)