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Kierans AS, Costello J, Qayyum A, Taouli B, Venkatesh SK, Yoon JH, Bali MA, Bolan CW, Lee JM, Marks RM, El Homsi M, Miller FH. Imaging cholangiocarcinoma: CT and MRI techniques. Abdom Radiol (NY) 2024:10.1007/s00261-024-04216-9. [PMID: 38916614 DOI: 10.1007/s00261-024-04216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 06/26/2024]
Abstract
Cross-sectional imaging plays a crucial role in the detection, diagnosis, staging, and resectability assessment of intra- and extrahepatic cholangiocarcinoma. Despite this vital function, there is a lack of standardized CT and MRI protocol recommendations for imaging cholangiocarcinoma, with substantial differences in image acquisition across institutions and vendor platforms. In this review, we present standardized strategies for the optimal imaging assessment of cholangiocarcinoma including contrast media considerations, patient preparation recommendations, optimal contrast timing, and representative CT and MRI protocols with individual sequence optimization recommendations. Our recommendations are supported by expert opinion from members of the Society of Abdominal Radiology's Disease-Focused Panel (DFP) on Cholangiocarcinoma, encompassing a broad array of institutions and practice patterns.
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Affiliation(s)
- Andrea S Kierans
- Department of Radiology, Weill Cornell Medical College, 1305 York Ave, New York, NY, 10021, USA.
| | - James Costello
- Department of Radiology, Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aliya Qayyum
- Department of Radiology, Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, and BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Maria A Bali
- Department of Radiology, Institute Jules Bordet, Brussels, Belgium
| | | | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Robert M Marks
- Department of Radiology, University California San Diego, San Diego, CA, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank H Miller
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Zhu JH, Zhao SL, Kang Q, Zhu Y, Liu LX, Zou H. Classification of anatomical morphology of cystic duct and its association with gallstone. World J Gastrointest Surg 2024; 16:307-317. [PMID: 38463380 PMCID: PMC10921219 DOI: 10.4240/wjgs.v16.i2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored. AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones. METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis. RESULTS Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones. CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
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Affiliation(s)
- Jia-Hai Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Song-Ling Zhao
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Qiang Kang
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Ya Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Li-Xin Liu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming 650106, Yunnan Province, China
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Singh BJ, Samee A, Jain A, Sarathy K. Ureter as the Content in a Large Inguino Scrotal Hernia: A Diagnostic Dilemma for Unprepared Surgeons. Cureus 2023; 15:e45106. [PMID: 37842384 PMCID: PMC10569231 DOI: 10.7759/cureus.45106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
We present a case of a 60-year-old gentleman, who was referred for an inguinal hernia repair. A previous CT scan had reported a right pelvic kidney and the presence of the right ureter in the hernial sac. He had no urinary symptoms and there was no biochemical evidence of compromised renal function. A renogram showed partial obstruction with an equally split function. The findings were discussed in a urological multi-disciplinary team (MDT) meeting. A ureteric stent was advised to assist in the identification of the ureter during the surgery. The patient had intraoperative stenting of the right ureter, followed by successful repair of the hernia. Six weeks later, the stent was removed, and the patient continues to remain well. Follow-up blood results showed normal renal functions.
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Affiliation(s)
- Bal Jaskaran Singh
- General and Colorectal Surgery, Northern Care Alliance NHS Trust, Manchester, GBR
| | - Abdus Samee
- Department of Surgery, Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Oldham, GBR
| | - Arun Jain
- Department of Urology, Manchester Foundation Trust, Manchester, GBR
| | - Kasturi Sarathy
- Department of Surgery, Northern Care Alliance NHS Trust, Manchester, GBR
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Renzulli M, Brandi N, Brocchi S, Balacchi C, Lanza C, Pettinari I, Stefanini B, Carrafiello G, Piscaglia F, Golfieri R, Marasco G. Association between anatomic variations of extrahepatic and intrahepatic bile ducts: Do look up! J Anat 2023; 242:683-694. [PMID: 36670522 PMCID: PMC10008292 DOI: 10.1111/joa.13808] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/22/2023] Open
Abstract
Biliary anatomic variations are usually asymptomatic, but they may cause problems in diagnostic investigations and interventional and surgical procedures, increasing both their technical difficulty and their postoperative complication rates. The aim of the present study was to evaluate the prevalence of anatomic variations in the intrahepatic biliary ducts (IHBD) in relation to demographical and clinical characteristics in a large study population requiring magnetic resonance cholangiopancreatography (MRCP) for various clinical conditions. The possible association between IHBD and extrahepatic biliary ducts (EHBD) variants was then explored. From January 2017 to May 2019, 1004 patients underwent MRCP. Demographical and clinical data were collected. IHBD and EHBD anatomy were recorded and the EHBD anatomy was classified using both qualitative and quantitative classifications. The presence of a type 3 EHBD variant (an abnormal proximal cystic duct [CD] insertion) in both qualitative and quantitative classifications and an intrapancreatic CD were associated with the presence of IHBD variants at univariate analysis (p = 0.008, p = 0.019, and p = 0.001, respectively). The presence of a posterior or medial insertion of the CD into the EHBD was a strong predictive factor of the presence of IHBD variants both at uni- and multivariate analysis (p = 0.002 and p = 0.003 for posterior insertion and p = 0.002 and p = 0.002 for medial insertion, respectively). The presence of gallstones on MRCP resulted in a strong predictor of the presence of an anatomical variant of the IHBD both at uni- and multivariate analysis (p = 0.027 and p = 0.046, respectively). In conclusion, the presence of a type 3 variant of the EHBD, an intrapancreatic CD and, especially, a posterior/medial CD insertion into the EHBD represent predictive factors of the concomitant presence of IHBD variants, thus radiologists must be vigilant when encountering these EHBD configurations and always remember to "look up" at the IHBD. Finally, the presence of an IHBD variant is a strong predictive factor of gallstones.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carolina Lanza
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Pettinari
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Bernardo Stefanini
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giampaolo Carrafiello
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Marasco
- Internal Medicine and Digestive Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Natarajan A, Phansalkar DS, Kurian G, R. MR, T. PP, Jayabalan J. Combined Use of Negative Oral Contrast and Ranitidine for Magnetic Resonance Cholangiopancreatography: A Randomized Controlled Trial. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1750138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Objective Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging modality to study pancreaticobiliary tree. The primary aim of this study was to compare the image quality of MRCP obtained with the use of ferric ammonium chloride (negative oral contrast) with that of combined use of ferric ammonium chloride and ranitidine (administered orally). Secondary aim was to determine the interobserver agreement between the assessing radiologists.
Materials and Methods The study was a single-center randomized-controlled trial. The patients were randomized into two groups. One group received ranitidine orally and ferric ammonium chloride (Dexorange) and the other group received only the ferric ammonium chloride. The images were qualitatively analyzed independently by the two blinded radiologists. Two scoring systems were used for grading the diagnostic quality of the images: the gastrointestinal tract signal intensity score (range: 1–4) and the structure visibility score (range: 0–3). The mean score of contrast effect and image effect of the two groups were compared by using Mann–Whitney U test. A p-value < 0.05 was considered statistically significant. Interobserver agreement was studied using Cohen kappa coefficient.
Results A total of 93 patients were eligible for the study. Forty-one patients were randomly assigned to the group that received only negative oral contrast and 52 group that received both ranitidine and negative oral contrast. The mean score of the images obtained with using both ranitidine and negative oral contrast was significantly higher when compared with the other group (3.02 vs. 2.7) (p-value = 0.018). However, there was no significant difference in mean structure visualization score of various parts of the pancreaticobiliary system. The interobserver agreement between the two readers in our study was acceptable.
Conclusion Combined use of hematinic syrup and ranitidine increases the image quality by improving the suppression of gastrointestinal fluid signal as compared with the use of only hematinic syrup as negative oral contrast.
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Affiliation(s)
- Aravintho Natarajan
- Department of Radiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Dilip S. Phansalkar
- Department of Radiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - George Kurian
- Department of Gastroenterology (Retired), Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mithun Raj R.
- Department of Radiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Preeth Pany T.
- Department of Radiology, Pondicherry Institute of Medical Sciences, Puducherry, India
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Licciardi G, Rizzo D, Ravera E, Fragai M, Parigi G, Luchinat C. Not only manganese, but fruit component effects dictate the efficiency of fruit juice as an oral magnetic resonance imaging contrast agent. NMR IN BIOMEDICINE 2022; 35:e4623. [PMID: 34595785 PMCID: PMC9285043 DOI: 10.1002/nbm.4623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Several fruit juices are used as oral contrast agents to improve the quality of images in magnetic resonance cholangiopancreatography. They are often preferred to conventional synthetic contrast agents because of their very low cost, natural origin, intrinsic safety, and comparable image qualities. Pineapple and blueberry juices are the most employed in clinical practice due to their higher content of manganese(II) ions. The interest of pharmaceutical companies in these products is testified by the appearance in the market of fruit juice derivatives with improved contrast efficacy. Here, we investigate the origin of the contrast of blueberry juice, analyze the parameters that can effect it, and elucidate the differences with pineapple juice and manganese(II) solutions. It appears that, although manganese(II) is the paramagnetic ion responsible for the contrast, it is the interaction of manganese(II) with other juice components that modulates the efficiency of the juice as a magnetic resonance contrast agent. On these grounds, we conclude that blueberry juice concentrated to the same manganese concentration of pineapple juice would prove a more efficient contrast agent than pineapple juice.
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Affiliation(s)
- Giulia Licciardi
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
| | - Domenico Rizzo
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
| | - Enrico Ravera
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
| | - Marco Fragai
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
| | - Giacomo Parigi
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), Department of Chemistry “Ugo Schiff”University of FlorenceSesto FiorentinoItaly
- Consorzio Interuniversitario Risonanze Magnetiche Metallo Proteine (CIRMMP)Sesto FiorentinoItaly
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Renzulli M, Caretti D, Pettinari I, Biselli M, Brocchi S, Sergenti A, Brandi N, Golfieri R. Optimization of pineapple juice amount used as a negative oral contrast agent in magnetic resonance cholangiopancreatography. Sci Rep 2022; 12:531. [PMID: 35017599 PMCID: PMC8752728 DOI: 10.1038/s41598-021-04609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/28/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the potential variability of Manganese (Mn2+) in commercial pineapple juice (PJ) produced in different years and to identify the optimal Mn2+ concentration in the correct amount of PJ to be administered prior to Magnetic Resonance Cholangiopancreatography (MRCP) in order to suppress the gastroduodenal (GD) liquid signal. The Mn2+ concentration in PJ produced in different years was defined using Atomic Absorption Spectrometry. The optimal Mn2+ concentration and the amount of PJ, were estimated in an in-vitro analysis, and were then prospectively tested in a population of patients who underwent MRCP. The results were compared with those achieved with the previous standard amount of PJ used in a similar population. The concentrations of Mn2+ in commercial PJ produced in different years did not differ. A total amount of 150 ml (one glass) of PJ having a high Mn2+ content (2.37 mg/dl) was sufficient for the suppression of the GD liquid signal, despite the additional dilution caused by GD liquids since it led to a final concentration of Mn2+ of 0.5-1.00 mg/dl. The optimized single-dose oral administration of 150 ml (approximately one glass) of PJ having a high Mn2+ concentration prior to MRCP was adequate to guarantee the correct amount of Mn2+ to suppress the GD signal.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia.
| | - Daniele Caretti
- "Toso Montanari" Industrial Chemistry Department, University of Bologna, Bologna, Italy
| | - Irene Pettinari
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Maurizio Biselli
- Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Alessandro Sergenti
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
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A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation. J Gastrointest Surg 2021; 25:2268-2279. [PMID: 33269458 PMCID: PMC8484130 DOI: 10.1007/s11605-020-04852-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knowledge regarding biliary anatomy and its variations, including the cystic duct (CD), is important in the pre-surgical setting and for predicting biliary diseases. However, no large series has focused on CD evaluation using a quantitative analysis. The primary aim of this prospective study was to create a 'taxonomic' classification of CD anatomy in a large cohort of subjects who underwent magnetic resonance cholangiopancreatography (MRCP). The secondary aim was to evaluate the correlations between extrahepatic bile duct (EHBD) variants and biliary diseases. METHODS We enrolled patients who underwent MRCP for different clinical indications from January 2017 to May 2019. Demographical, anatomical and clinical data were evaluated using statistical analyses, as appropriate. The anatomical assessment of EHBD was performed using the standard classification for CD in low, medium, and high insertions, and the lengths of CD to the duodenal papilla (DP), and EHBD was determined to conduct a new quantitative analysis. RESULTS The final study population comprised 1004 subjects. A new classification for EHBD as per the percentile distribution of the ratio CDDP/EHBD was designed, and the following categories were obtained: type 1 (below the 25th percentile) for CDDP/EHBD ratio ≤ 50%; type 2 (25th to 75th percentile) for CDDP/EHBD ratio 51-75% and type 3 (above the 75th percentiles) for CDDP/EHBD ratio > 75%. Type 1 of the new classification of CD implantation was significantly superior in terms of the detection of low, medial and intra-pancreatic CD that was significantly correlated with a high risk of choledochal lithiasis in comparison with the standard classification (P < 0.001). CONCLUSIONS The new classification of CD implantation enables identification of the vast majority of intra-pancreatic CDs that are correlated with a high risk of choledochal lithiasis in a single category (type 1) that is easy to identify using imaging.
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Renzulli M, Marzocchi G, Vara G, Corcioni B, Ierardi AM, Gaudiano C, Golfieri R. Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report. J Med Case Rep 2020; 14:202. [PMID: 33109265 PMCID: PMC7592555 DOI: 10.1186/s13256-020-02521-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background The herniation of the ureter into the inguinal canal is a rare condition, but probably underreported. Acquired nephroptosis could cause herniation of the ureter and, therefore, when diagnosed, a full study of the urinary tract should be performed especially in patients with inguinal hernia. Case presentation We present the case of an 86-year-old white man with a herniated ureter likely caused by acquired nephroptosis presenting with acute urinary retention, documented with magnetic resonance imaging for the first time. Conclusions The Fast Imaging Employing Steady State Acquisition sequence on magnetic resonance imaging, for many reasons, could allow correct evaluation of the urinary tract, especially in cases of renal dysfunction that contraindicate the use of intravenous contrast agents.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Guido Marzocchi
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
| | - Beniamino Corcioni
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Anna Maria Ierardi
- Unit of Radiology, IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Caterina Gaudiano
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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10
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Renzulli M, Pagano N, Golfieri R. Pancreas divisum inversus. Clin Anat 2020; 33:646-652. [PMID: 31576611 DOI: 10.1002/ca.23475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 12/26/2022]
Abstract
Pancreatic duct variations are usually diagnosed incidentally, in particular when using magnetic resonance cholangiopancreatography (MRCP), the most accurate imaging modality for depicting the pancreatic ductal system. However, the frequency and the embryologic development of pancreatic variants have not been well investigated. The purpose of this prospective study was to investigate the frequency of pancreatic ductal variants, providing potential explanations of their embryologic basis. The pancreatic ductal anatomies of 202 patients with mean ± standard deviation (SD) age of 54 ± 27 years, 56% females, who underwent MRCP for different indications between April 2018 and March 2019, were prospectively collected. Normal pancreatic ductal variants were identified in 196 cases (97%), and variants of pancreas divisum in six cases (3%). In the type C variant of the normal pancreatic anatomy, found in 3% of the cases, the dorsal duct was joined to the ventral duct while the accessory duct did not communicate with the dorsal duct. Unlike the classic type C variant, in our cases, the accessory pancreatic duct (APD) was long (mean ± SD of 58 ± 8.5 mm) and originated in the lower portion of the pancreatic head, caudally to the duct of Wirsung. This was a new subtype of the type C variant or a new variant, which could be called "pancreas divisum inversus"; the APD could be called the isolated duct of Santorini. Reporting this new variant could increase knowledge regarding the pancreatic anatomy in order to avoid misdiagnosis and to help in better understanding pancreatic diseases and their relative treatment. Clin. Anat., 33:646-652, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nico Pagano
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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