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Reporting standards for primary sclerosing cholangitis using MRI and MR cholangiopancreatography: guidelines from MR Working Group of the International Primary Sclerosing Cholangitis Study Group. Eur Radiol 2021; 32:923-937. [PMID: 34363134 DOI: 10.1007/s00330-021-08147-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic inflammatory disorder affecting the bile ducts and is characterized by biliary strictures, progressive liver parenchymal fibrosis, and an increased risk of hepatobiliary malignancies primarily cholangiocarcinoma (CCA). PSC may lead to portal hypertension, liver decompensation, and liver failure with the need for liver transplantation. Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) are considered the imaging standard for diagnosis and follow-up in patients with PSC. Currently, there are no universally accepted reporting standards and definitions for MRI/MRCP features. Controversies exist about the definition of a high-grade stricture and there is no widely agreed approach to their management. The members of the MRI working group of the International Primary Sclerosing Cholangitis Study Group (IPSCSG) sought to define terminologies and reporting standards for describing MRI/MRCP features that would be applied to diagnosis and surveillance of disease progression, and potentially for evaluating treatment response in clinical trials. In this extensive review, the technique of MRI/MRCP and assessment of image quality for the evaluation of PSC is briefly described. The definitions and terminologies for severity and length of strictures, duct wall thickening and hyperenhancement, and liver parenchyma signal intensity changes are outlined. As CCA is an important complication of PSC, standardized reporting criteria for CCA developing in PSC are summarized. Finally, the guidelines for reporting important changes in follow-up MRI/MRCP studies are provided. KEY POINTS: • Primary sclerosing cholangitis is a chronic inflammatory disorder affecting the bile ducts, causing biliary strictures and liver fibrosis and an increased risk of cholangiocarcinoma. • This consensus document provides definitions and suggested reporting standards for MRI and MRCP features of primary sclerosing cholangitis, which will allow for a standardized approach to diagnosis, assessment of disease severity, follow-up, and detection of complications. • Standardized definitions and reporting of MRI/MRCP features of PSC will facilitate comparison between studies, promote longitudinal assessment during management, reduce inter-reader variability, and enhance the quality of care and communication between health care providers.
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Living Donor Liver Transplantation: Overview, Imaging Technique, and Diagnostic Considerations. AJR Am J Roentgenol 2019; 213:54-64. [PMID: 30973783 DOI: 10.2214/ajr.18.21034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this article is to discuss the process of becoming a liver donor, describe the surgical methods used for transplantation, and critically review preoperative and intraoperative imaging techniques. CONCLUSION. Radiologists play a vital role in ensuring the safety of living liver donors; however, consensus guidelines do not exist for imaging protocol or reporting. Standardization would provide more consistent image quality across centers, improve communication with the transplant team, and facilitate data mining for quality assurance and research.
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Nayman A, Özbek O, Erol S, Karakuş H, Kaya HE. Magnetic resonance cholangiopancreatography evaluation of intrahepatic bile duct variations with updated classification. Diagn Interv Radiol 2017; 22:489-494. [PMID: 27538048 DOI: 10.5152/dir.2016.16051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Preoperative detection of intrahepatic bile duct (IHBD) variations is essential to reduce surgical morbidity and mortality rates. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive and reliable method for demonstrating the normal IHBD anatomy and its variations. This retrospective study aimed to identify and classify novel variations, except those already reported in the literature, using MRCP. METHODS MRCP examinations, which were conducted in two different centers in the last five years, were retrospectively evaluated. IHBD variations were recorded with respect to the Yoshida classification. In addition, newly detected variations that were not included in this classification were identified and classified. RESULTS MRCP examinations of 2624 patients were screened, and 2143 were determined to be eligible for evaluation. Of 2143 patients, 987 were males (average age, 54±18 years) and 1156 were females (mean age, 57±17 years). In this study, 10 novel variations that were not included in the Yoshida classification were identified in 14 patients. CONCLUSION MRCP is an effective, reliable, and noninvasive imaging method for evaluating the IHBD anatomy and its variations. Novel variations described in this study may help to better understand the biliary anatomy.
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Affiliation(s)
- Alaaddin Nayman
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey.
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MR cholangiography in potential liver donors: quantitative and qualitative improvement with administration of an oral effervescent agent. J Magn Reson Imaging 2017; 46:1656-1663. [DOI: 10.1002/jmri.25715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/07/2017] [Indexed: 11/07/2022] Open
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5
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Brügel M, Gaa J. Gallbladder and Biliary Tree. Diagn Interv Radiol 2016. [DOI: 10.1007/978-3-662-44037-7_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Arrivé L, Hodoul M, Arbache A, Slavikova-Boucher L, Menu Y, El Mouhadi S. Magnetic resonance cholangiography: Current and future perspectives. Clin Res Hepatol Gastroenterol 2015; 39:659-64. [PMID: 26275724 DOI: 10.1016/j.clinre.2015.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 02/04/2023]
Abstract
Magnetic resonance cholangiography (MRC) has become the standard of reference for imaging of the biliary ducts. The use of three-dimensional (3D) sequences has resulted in improved spatial resolution with virtually isotropic voxel and improved signal/noise ratio. In addition to MRC images, 3D fat suppressed T1-weighted MR images should be systematically obtained to search for intrahepatic calculi. MRC plays a major role in the diagnosis of cholangiocarcinoma and assessment of its resectability. With modern MR systems the performance of MR is basically the same that of CT for evaluation of arterial and portal vein extent. MRC is a key imaging modality for the diagnosis of primary sclerosing cholangitis. Different imaging patterns may be observed including multifocal intra- and extrahepatic strictures alternating with slightly dilated ducts. Focal signal abnormality of the liver parenchyma and focal parenchymal atrophy represent the consequences of biliary duct obstruction on liver parenchyma. Diagnosis of biliary lithiasis is performed by combination of MRC and T1-weighted MR imaging. MRC can be performed for the diagnosis of secondary cholangitis including ascending cholangitis, ischemic cholangitis and IgG4-related sclerosing cholangitis. Hepatobiliary contrast agents could be used for demonstrating the site of biliary duct leakage after surgery and for functional imaging. MR imaging can also be used to determine the prognosis of PSC. The inherent limitations of MRC of bile ducts are still the suboptimal spatial resolution for evaluation of distal intrahepatic biliary ducts.
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Affiliation(s)
- Lionel Arrivé
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Marianne Hodoul
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Antoune Arbache
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Lucie Slavikova-Boucher
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Yves Menu
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Sanaâ El Mouhadi
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Zhou P, Li T, Su R, Gong Z. Effects of thienorphine on contraction of the guinea pig sphincter of Oddi, choledochus and gall bladder. Eur J Pharmacol 2014; 737:22-8. [PMID: 24830319 DOI: 10.1016/j.ejphar.2014.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 02/07/2023]
Abstract
Opioid analgesics are widely believed to cause spasm of the bile duct sphincter and so impede bile flow. Thienorphine is a partial opioid agonist that is a good candidate for the treatment of opioid dependence; however, to date, no studies have reported the effects of thienorphine on the function of the biliary tract. This study examined the in vivo effects of thienorphine on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder and on bile flow. The area under the curve (AUC) of isolated sphincter of Oddi was not influenced by thienorphine or buprenorphine, whereas morphine increased the AUC of the isolated sphincter of Oddi in a concentration-dependent manner. Thienorphine and buprenorphine concentration-dependently decreased the AUC of isolated choledochus, while morphine increased the AUC of isolated choledochus. Thienorphine had no effect on the contractile amplitude or basal tension of isolated gall bladder muscle strips. In contrast, buprenorphine and morphine increased the contractile basal tension of isolated gall bladder muscle strips in a concentration-dependent manner. Thienorphine (0.01-1.0mg/kg) had no significant inhibitory effect on bile flow. However, morphine (1.0-10mg/kg) and buprenorphine (1.0mg/kg) significantly inhibited bile flow. The maximum inhibition of bile flow by buprenorphine was 63.9±12.9% and by morphine was 74.1±11.3%. In summary, thienorphine has little influence on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder or on bile flow, which may result in a lack of adverse biliary colic effects.
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Affiliation(s)
- Peilan Zhou
- Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing 100850, China.
| | - Tingting Li
- Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing 100850, China.
| | - Ruibin Su
- Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing 100850, China.
| | - Zehui Gong
- Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing 100850, China.
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Common bile duct dilatation in drug users with chronic hepatitis C is associated with current methadone use. J Addict Med 2014; 8:53-8. [PMID: 24394497 DOI: 10.1097/adm.0000000000000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Dilatation of the common bile duct (CBD) can be an ominous sign for malignancy of the pancreatobiliary tract; however, it has also been described as a presumably harmless side effect of opioid use. We investigated the prevalence and determinants of CBD dilatation among drug users receiving methadone maintenance therapy in the Netherlands. METHODS A cross-sectional study was conducted in a prospectively studied and well-defined cohort of drug users with chronic hepatitis C virus infection, attending the Public Health Service of Amsterdam, the Netherlands. Patients underwent abdominal ultrasonography as part of pretreatment screening. A multivariable logistic regression model was used to analyze potential demographic and drug use-related determinants of radiological CBD dilatation. RESULTS Between September 2004 and December 2011, 222 hepatitis C virus-infected drug users were evaluated. Dilatation of the CBD was found in 50 of 222 patients (22.5%), with a median diameter of 8.0 mm (interquartile range, 7.0 to 10.0; n = 43). Dilatation was associated with current use of methadone (adjusted odds ratio = 20.50; 95% confidence interval, 2.79 to 2.61 × 10(3)), independent of the current methadone dose, and with age per 10-year increase (adjusted odds ratio = 1.68; 95% confidence interval, 1.06 to 2.71). Regular use of heroin in the 6 months before ultrasonography was not found to be associated with dilatation. CONCLUSIONS Dilatation of the CBD is common in drug users under methadone treatment and seems to be a harmless side effect of opioid agonists.
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Agrawal MD, Mennitt KW, Zhang H, Samstein B, Kato T, Emond JC, Dutruel SP, Thimmappa ND, Prince MR. Morphine three-dimensional T1 gadoxetate MR cholangiography of potential living related liver donors. J Magn Reson Imaging 2013; 39:584-9. [PMID: 23723095 DOI: 10.1002/jmri.24188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 04/02/2013] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess low-dose morphine for distension and improved visualization of intrahepatic bile ducts on T1 MR cholangiography (MRC) in preoperative imaging of potential liver donors. MATERIALS AND METHODS Sixty-nine consecutive potential living related liver donors (mean age, 39 years; age range, 20 to 59 years) referred for pre-transplant MRI evaluation were evaluated without (n=30) or with (n=39) intravenous morphine injection (0.04 mg/kg). Morphine was injected pre-MRI while establishing intravenous access to allow ∼1 h for biliary distension before T1 MRC. Three radiologists reviewed intrahepatic biliary branch order visualization, common bile duct (CBD) diameter, and overall image quality. In 25 patients undergoing liver donation surgery, T1 MRC findings were correlated with intraoperative findings. This retrospective study was approved by the institutional review board. RESULTS Biliary visualization was improved post-morphine administration with biliary duct branch order visualization score of 3.2 and 3.3 at 45 and 60 min, respectively, compared with 2.7 without morphine (P<0.002); CBD diameter measured 5.3 and 5.5 versus 4.1 mm (P<0.005), and overall image quality score was 2.4 and 2.6 versus 1.8 (P<0.0006). Operative notes confirmed T1 MRC findings in 6/11 donors without morphine and 14/14 donors with morphine. CONCLUSION Intravenous low-dose morphine distends and improves visualization of bile ducts on T1 gadoxetate MRC.
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Affiliation(s)
- Mukta D Agrawal
- Department of Radiology, Weill Cornell Medical College & New York Presbyterian Hospital, New York, USA
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Eason JB, Taylor AJ, Yu J. MRI in the workup of biliary tract filling defects. J Magn Reson Imaging 2013; 37:1020-34. [DOI: 10.1002/jmri.23847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/29/2012] [Indexed: 12/24/2022] Open
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Venkatanarasimha N, Jenkins SJ, Yang N, Colak E, Kirpalani A. Impact of butylscopolamine on image quality of magnetic resonance cholangiopancreatography. Eur J Radiol 2013; 82:583-8. [DOI: 10.1016/j.ejrad.2012.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 10/03/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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Pancreaticobiliary disorders: comparison between magnetic resonance cholangiopancreatography images before and after fentanyl injection. ACTA ACUST UNITED AC 2012; 38:537-42. [PMID: 22782316 DOI: 10.1007/s00261-012-9937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study was designed to determine the effects of intravenous fentanyl on magnetic resonance cholangiopancreatography image quality in the treatment of pancreaticobiliary disorders. MATERIALS AND METHODS Forty consecutive patients referred for the evaluation of pancreaticobiliary disorders underwent magnetic resonance cholangiopancreatography in the coronal and oblique-coronal planes before and after fentanyl injection (every 2 up to 9 min). The images were analyzed qualitatively and quantitatively. Diameter and signal intensity were measured at the widest point and distal to the common bile duct and main pancreatic duct. RESULTS The mean common bile duct diameters at the widest and distal points and mean pancreatic duct diameter were measured 7.53, 4.72, and 2.14 and 8.33, 5.35, and 2.57 before and after fentanyl injection, respectively. Mean signal intensity at the widest and distal point of the common bile duct and mean pancreatic duct signal intensity measured 278, 199, and 113 and 296, 218, and 121 before and after fentanyl injection, respectively. Minor improvements in image quality were detected qualitatively. CONCLUSION Fentanyl injection improves images qualitatively and quantitatively. In agreement with previous studies, our results confirm the beneficial effects of fentanyl as a simple adjunct to traditional magnetic resonance cholangiopancreatography.
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Sommer CM, Schwarzwaelder CB, Stiller W, Schindera ST, Heye T, Stampfl U, Bellemann N, Holzschuh M, Schmidt J, Weitz J, Grenacher L, Kauczor HU, Radeleff BA. Dual-energy CT-cholangiography in potential donors for living-related liver transplantation: improved biliary visualization by intravenous morphine co-medication. Eur J Radiol 2011; 81:2007-13. [PMID: 21696902 DOI: 10.1016/j.ejrad.2011.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/10/2011] [Accepted: 05/13/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To prospectively evaluate whether intravenous morphine co-medication improves bile duct visualization of dual-energy CT-cholangiography. MATERIALS AND METHODS Forty potential donors for living-related liver transplantation underwent CT-cholangiography with infusion of a hepatobiliary contrast agent over 40 min. Twenty minutes after the beginning of the contrast agent infusion, either normal saline (n=20 patients; control group [CG]) or morphine sulfate (n=20 patients; morphine group [MG]) was injected. Forty-five minutes after initiation of the contrast agent, a dual-energy CT acquisition of the liver was performed. Applying dual-energy post-processing, pure iodine images were generated. Primary study goals were determination of bile duct diameters and visualization scores (on a scale of 0 to 3: 0--not visualized; 3--excellent visualization). RESULTS Bile duct visualization scores for second-order and third-order branch ducts were significantly higher in the MG compared to the CG (2.9±0.1 versus 2.6±0.2 [P<0.001] and 2.7±0.3 versus 2.1±0.6 [P<0.01], respectively). Bile duct diameters for the common duct and main ducts were significantly higher in the MG compared to the CG (5.9±1.3 mm versus 4.9±1.3 mm [P<0.05] and 3.7±1.3 mm versus 2.6±0.5 mm [P<0.01], respectively). CONCLUSION Intravenous morphine co-medication significantly improved biliary visualization on dual-energy CT-cholangiography in potential donors for living-related liver transplantation.
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Affiliation(s)
- C M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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The Effects of Morphine–Neostigmine and Secretin Provocation on Pancreaticobiliary Morphology in Healthy Subjects: A Randomized, Double-blind Crossover Study Using Serial MRCP. World J Surg 2011; 35:2102-9. [DOI: 10.1007/s00268-011-1162-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Park S, Choi GS, Jung J, Cho G, Shin E, Lim C, Kim H, Song OP. Clinical Efficacy of Pretransplant Magnetic Resonance Cholangiography of Donor for Living Donor Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.4.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- SeungWan Park
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - Gyu-seong Choi
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - JunChul Jung
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - Gyuseok Cho
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - EungJin Shin
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - ChulWan Lim
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - HyungChul Kim
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
| | - Ok-Pyung Song
- Department of Surgery, Sunchunhyang University Bucheon Hospital, Suncheonhyang University College of Medicine, Bucheon, Korea
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Image Quality and Bile Duct Volumetry in MR Cholangiopancreatography Augmented With Low-Dose Morphine. AJR Am J Roentgenol 2010; 194:W171-5. [DOI: 10.2214/ajr.09.3010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Patel HT, Shah AJ, Khandelwal SR, Patel HF, Patel MD. MR Cholangiopancreatography at 3.0 T. Radiographics 2009; 29:1689-706. [DOI: 10.1148/rg.296095505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mo YH, Liang PC, Ho MC, Lee PH, Jaw FS, Peng SSF. Morphine- and glucagon-augmented magnetic resonance cholangiopancreatography to evaluate living liver donors. Liver Transpl 2009; 15:1021-7. [PMID: 19718648 DOI: 10.1002/lt.21789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to investigate the effectiveness of the combined use of intravenous morphine and intramuscular glucagon in improving magnetic resonance cholangiopancreatography (MRCP) image quality in donors for living-related liver transplantation. Sixteen healthy donor candidates underwent an MRCP study. Coronal, single-shot, fast spin-echo, heavily T2-weighted dynamic MRCP images were obtained before and 3 minutes after the intravenous administration of morphine HCl with a dose of 0.04 mg/kg. Thirty minutes after the injection of morphine, intramuscular glucagon was used. Another MRCP image of the same pulse sequence was generated 15 minutes after the injection of glucagon with a dose of 1 mg. The diameter, signal intensity, and number of branches of bile ducts in MRCP images taken immediately before and after the injection of morphine and after the injection of glucagon (plus delayed morphine effects) were compared and analyzed. In all 16 donor candidates, the diameters of the right and left hepatic ducts, common bile duct, and main pancreatic duct were significantly increased (P < 0.05) in the MRCP images taken 3 minutes after the injection of morphine and 15 minutes after the injection of glucagon (plus delayed morphine effects) in comparison with MRCP images taken before any drug administration. The qualitative grading scores of the signal intensity and order of branches of bile ducts revealed improvements in the MRCP images after the injection of glucagon (plus delayed morphine effects; P < 0.05). In conclusion, combining the intravenous administration of low-dose morphine and the intramuscular use of glucagon before MRCP examination improves the visualization of the nondilated biliary ductal anatomy, which is important for the preoperative biliary evaluation of donor candidates for living-related liver transplantation.
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Affiliation(s)
- Yuan Heng Mo
- Institute of Biomedical Engineering, College of Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan
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Chu ZQ, Ji Q, Zhang JL. Orally administered lemon/orange juice improved MRCP imaging of pancreatic ducts. ACTA ACUST UNITED AC 2009; 35:367-71. [PMID: 19404562 DOI: 10.1007/s00261-009-9514-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 03/26/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to determine the effectiveness of oral administration of lemon/orange juice in improving the visualization of pancreatic ducts on MRCP. MATERIALS AND METHODS MRCP images were generated before and at every 15 min for 90 min after oral administration of lemon/orange juice in a dose of 2 ml/kg in 20 volunteers and 26 patients. The pre- and post-administration images were compared and analyzed qualitatively and quantitatively. RESULTS In 20 volunteers and 26 patients, the visualization at pancreatic duct of head, body, tail, accessory pancreatic duct, and branch duct was improved after juice administration. The diameter of pancreatic ducts was augmented, and the differences in the mean values before and after oral juice were highly significant at both sites in volunteers and patients (P < 0.01). In 20 volunteers and 26 patients, after juice administration, the best visualization of the pancreatic duct was achieved at (58.98 +/- 14.96) min and (59.41 +/- 13.79) min, respectively, and the overlap imaging of oral juice was especially observed at (42.86 +/- 10.92) min and (41.63 +/- 9.32) min, respectively. CONCLUSIONS Orally lemon/orange juice is an effective method to improve MRCP imaging of pancreatic ducts. The lemon/orange juice should be administered at 60 min prior to MRCP.
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Affiliation(s)
- Zhi-Qiang Chu
- Department of General Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Gakhal MS, Gheyi VK, Brock RE, Andrews GS. Multimodality Imaging of Biliary Malignancies. Surg Oncol Clin N Am 2009; 18:225-39, vii-viii. [DOI: 10.1016/j.soc.2008.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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The diagnostic MRCP examination: overcoming technical challenges to ensure clinical success. Biomed Imaging Interv J 2008; 4:e28. [PMID: 21611015 PMCID: PMC3097748 DOI: 10.2349/biij.4.4.e28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 03/30/2008] [Indexed: 12/24/2022] Open
Abstract
The magnetic resonance cholangiopancreatography (MRCP) examination has all but replaced the diagnostic endoscopic retrograde cholangiopancreatography (ERCP) examination for imaging the biliary tree and pancreatic ducts in many practical aspects of the clinical setting. Despite this increase in popularity, many magnetic resonance imaging (MRI) radiographers still find aspects of the MRCP examination quite challenging. The aim of this tutorial paper is to provide useful technical advice on how to overcome such perceived challenges and thus produce a successful diagnostic MRCP examination. This paper will be of interest to novice MRI radiographers who are at the beginning of their learning curve in MRCP examination. Other MRI radiographers who are interested in practical tips for protocol variations may also find the paper useful.
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Sahni VA, Mortele KJ. Magnetic resonance cholangiopancreatography: current use and future applications. Clin Gastroenterol Hepatol 2008; 6:967-77. [PMID: 18774532 DOI: 10.1016/j.cgh.2008.05.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/13/2008] [Accepted: 05/24/2008] [Indexed: 02/07/2023]
Abstract
Magnetic resonance pancreatography (MRCP) is now established as a robust noninvasive tool for the evaluation of biliary and pancreatic pathology. Its diagnostic performance is comparable with endoscopic retrograde cholangiopancreatography without the associated risks. This article aims to familiarize the reader with the technique, clinical indications, and limitations of the investigation. Common pitfalls in interpretation also are addressed. Emerging applications and techniques are discussed that include recent advances in technology and the development of functional imaging.
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Affiliation(s)
- Vikram A Sahni
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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23
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Magnetic Resonance Cholangiopancreatography: Techniques and Applications. Magn Reson Imaging Clin N Am 2008; 16:453-66, v. [DOI: 10.1016/j.mric.2008.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Breiman RS, Coakley FV, Webb EM, Ellingson JJ, Roberts JP, Kohr J, Lutz J, Knoess N, Yeh BM. CT Cholangiography in Potential Liver Donors: Effect of Premedication with Intravenous Morphine on Biliary Caliber and Visualization. Radiology 2008; 247:733-7. [DOI: 10.1148/radiol.2473070964] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Glockner JF. Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging 2007; 25:681-95. [PMID: 17352396 DOI: 10.1002/jmri.20844] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Evaluation of the liver and biliary system is a frequent indication for abdominal MRI. Hepatobiliary MRI comprises a set of noninvasive techniques that are usually very effective in answering most clinical questions. There are significant limitations, however, as well as considerable variation and disagreement regarding the optimal protocols for standard hepatic MRI and magnetic resonance cholangiopancreaticography (MRCP). This review discusses pulse sequences most often used in hepatic MRI and MRCP, examines a few sources of controversy in the current literature, and summarizes some recent and future developments in the field.
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Affiliation(s)
- James F Glockner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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26
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Abstract
Magnetic resonance (MR) imaging of the pancreas has undergone a major change because it can provide noninvasive images of the pancreatic ducts and the parenchyma. MR cholangiopancreatography (MRCP) enables detection of anatomic variants such as pancreas divisum. Although contrast material-enhanced CT is still considered the gold standard in acute pancreatitis and for the detection of calcifications in chronic pancreatitis, MR imaging and secretin-enhanced MRCP are useful in evaluating pseudocysts and pancreatic disruption. The role of MR is still debated in pancreatic neoplasms except the cystic lesions where MR imaging provides critical information regarding the lesion's content and a possible communication with the pancreatic ducts. MRCP and MR of the pancreas are also useful in identifying other pancreatic diseases such as lymphoplasmocytic pancreatitis and groove pancreatitis.
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Affiliation(s)
- A Hakimé
- Service de Radiologie, Hôpital Beaujon, 100 bd du Général Leclerc, 92110 Clichy, France
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27
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Berrocal T, Parrón M, Alvarez-Luque A, Prieto C, Santamaría ML. Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics 2006; 26:1187-209. [PMID: 16844941 DOI: 10.1148/rg.264055081] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Orthotopic liver transplantation is currently the treatment of choice in patients with end-stage liver disease for which no other therapy is available. In children, segmental liver transplantation with living donor, reduced-size cadaveric, and split cadaveric allografts has become an important therapeutic option. However, the resulting expansion of the donor pool has increased the risk for postoperative vascular and biliary complications, which affect children more frequently than adults. Early recognition of these complications requires radiologic evaluation because their clinical manifestations are frequently nonspecific and vary widely. Doppler ultrasonography (US) plays the leading role in the postoperative evaluation of pediatric patients. Current magnetic resonance (MR) imaging techniques, including MR angiography and MR cholangiography, may provide a wealth of pertinent information and should be used when findings at US are inconclusive. Computed tomography is a valuable complement to US in the evaluation of complications involving the hepatic parenchyma as well as extrahepatic sites and is commonly used to guide percutaneous aspiration and fluid collection drainage. Familiarity with and early recognition of the imaging appearances of the various postoperative complications of pediatric liver transplantation are crucial for graft and patient survival.
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Affiliation(s)
- Teresa Berrocal
- Department of Radiology, Division of Pediatric Radiology, University Hospital La Paz, Paseo de la Castellana 263, 28046 Madrid, Spain
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28
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Agarwal S, Nag P, Sikora S, Prasad TL, Kumar S, Gupta RK. Fentanyl-augmented MRCP. ACTA ACUST UNITED AC 2006; 31:582-7. [PMID: 16465580 DOI: 10.1007/s00261-005-0155-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Accepted: 06/29/2005] [Indexed: 12/24/2022]
Abstract
BACKGROUND Drugs such as secretin and morphine have been used to augment the visualization of magnetic resonance cholangiopancreatography (MRCP). This study investigated the effectiveness of intravenous administration of a synthetic opioid, fentanyl, in improving the MRCP image quality. METHODS Thirty consecutive patients with a provisional diagnosis of benign biliary and/or pancreatic disease underwent MRCP. Coronal single-shot fast spin-echo heavily T2-weighted dynamic MRCP images were generated before and at every minute for 10 min after intravenous administration of fentanyl citrate at a dose of 1.0 mug/kg. Pre- and postinjection images were compared and analyzed qualitatively and quantitatively. RESULTS Qualitatively, visualization of intrahepatic bile ducts, common bile duct, and main pancreatic duct improved after fentanyl injection in five (16%), 11 (37%), and 19 (63%) patients, respectively. The pancreatobiliary junction and common channel were visualized better after fentanyl injection in eight of the 18 patients (44%). Quantitatively, signal intensity and diameters of the intrahepatic ducts, common bile duct, and main pancreatic duct measured at corresponding points on pre- and postinjection images showed an increase above preinjection values in 28 (93%), 27 (90%), and 21 (70%) and in 18 (60%), 26 (86%), and 22 (73%), respectively, and these changes were highly significant at all sites (p < 0.001). CONCLUSIONS Intravenous administration of fentanyl before MRCP improves qualitative and quantitative visualization of the ductal system anatomy that may be of value in clinical diagnosis and management.
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Affiliation(s)
- S Agarwal
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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29
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Charatcharoenwitthaya P, Lindor KD. Primary sclerosing cholangitis: diagnosis and management. Curr Gastroenterol Rep 2006; 8:75-82. [PMID: 16510038 DOI: 10.1007/s11894-006-0067-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease caused by progressive inflammatory destruction of intrahepatic and extrahepatic bile ducts, and ultimately cirrhosis. PSC occurs primarily in patients with underlying ulcerative colitis and affects primarily young to middle-aged men. PSC is believed to be an autoimmune disease mediated by immune dysregulation in patients with genetic susceptibility. One possible mechanism for the development of PSC is the homing of memory lymphocytes to the biliary tract. Cholangiography is the gold standard for diagnosis of PSC. The typical radiologic findings include multifocal strictures and dilation involving the intrahepatic or extrahepatic biliary tract, or both. Although no medical therapy has proved beneficial, a variety of agents have been tested, some of which appear promising and deserve further study. High-dose ursodeoxycholic acid may have benefit in slowing disease progression; a multicenter placebo-controlled trial is ongoing. Liver transplantation is a good option for patients with advanced PSC, although the disease can recur after successful transplantation.
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30
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Dinda A, Gitman M, Singhal PC. Immunomodulatory effect of morphine: therapeutic implications. Expert Opin Drug Saf 2005; 4:669-75. [PMID: 16011446 DOI: 10.1517/14740338.4.4.669] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The immunosuppressive as well as modulatory effects of morphine have been known in clinical medicine for > 100 years. Recent developments in molecular immunology, including experiments in mu (mu) opioid receptor knockout mice has led to a better understanding of central and peripheral mechanisms involved in this process. Though there is a large volume of literature documenting adverse effects of immunosupression following the use of morphine, several reports confirm its potential usefulness as an immunomodulator. In vitro and in vivo animal experiments have demonstrated wide-spectrum effects of morphine, including anti-inflammatory, antifibrotic, antitumour, cardioprotective and renoprotective. Immunomodulation is an important field in modern medicine with rapid advancement in recent years. Though a final statement regarding the clinical relevance of morphine-induced immunomodulation cannot be made at this juncture, nevertheless, it is worthwhile to review current developments. It may encourage further clinical studies to elucidate the influence of morphine treatment on immune regulation in different specialties of medicine.
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Affiliation(s)
- Amit Dinda
- Department of Medicine, Long Island Jewish Medical Center, 410 Lakeville Road, New Hyde Park, NY 11040, USA
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31
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Lambot K, Lougue-Sorgho LC, Gorincour G, Chapuy S, Chaumoitre K, Bourlière-Najean B, Panuel M, Devred P, Petit P. [Imaging of the pediatric pancreas: state of the art]. JOURNAL DE RADIOLOGIE 2005; 86:807-15; quiz 816. [PMID: 16142074 DOI: 10.1016/s0221-0363(05)81449-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The use of high frequency (7-12 MHz) transducers on state of the art US units equipped with Doppler imaging provides excellent evaluation of the pediatric pancreas that compares to other cross-sectional imaging techniques. The availability of multidetector CT imaging reduces the need for sedation but requires additional review of the indications and protocols to avoid unnecessary radiation exposure. Evaluation of pancreatitis and tumors remains the main indication. Advances in MR imaging and MRCP has lead to very good results in children. Storage diseases of the pancreas can be diagnosed at MRI. The length of the examinations, the need for sedation and the limited spatial resolution remain the main pitfalls of MR imaging of the pancreas in pediatric patients.
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Affiliation(s)
- K Lambot
- Service de Radiologie Pédiatrique, Hôpital Timone-Enfants, 256, boulevard Jean-Moulin, 13385 Marseille Cedex 5
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32
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Abstract
PURPOSE OF REVIEW Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by strictures of the biliary tree. It is immune mediated, although the precise cause remains unknown. Recent reports have shown a higher prevalence and burden of disease than was previously suspected. RECENT FINDINGS The research into the etiopathogenesis, epidemiology, diagnosis of cholangiocarcinoma, medical and surgical therapy, and timing and outcome of liver transplantation is discussed. SUMMARY Genetic heterogeneity among patients with primary sclerosing cholangitis is supported, and further gene polymorphisms associated with protection against primary sclerosing cholangitis have been elucidated. Bile duct injury seems to be a multistep process. Magnetic resonance cholangiopancreatography is a cost-effective and accurate way of diagnosing primary sclerosing cholangitis in comparison with endoscopic retrograde cholangiopancreatography. Ursodeoxycholic acid may have a role as a colorectal and hepatobiliary cancer chemopreventive agent. Liver transplantation remains the only treatment in end-stage disease. The 5-year and 10-year patient and graft survival rates are comparable with those in patients without primary sclerosing cholangitis, but there is a higher rate of retransplantation for primary sclerosing cholangitis in most centers. Hepatobiliary malignancy is found in a minority of patients at transplantation, although 5-year survival rates for these patients are still promising.
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Affiliation(s)
- George R MacFaul
- Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK
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33
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Abstract
MR imaging is an established technique for the diagnosis of a spectrum of biliary and gallbladder pathologies and continues to improve with the advent of technologic advances, including new contrast agents and new sequences that are capable of improving upon the contrast resolution and signal-to-noise that are afforded by conventional MR imaging. These improvements already have shown promise for the increasing role of MRC as the initial modality in assessing living liver donors and evaluating post-operative hepato-biliary complications. Improved spatial resolution and the added functional or physiologic information afforded by MR imaging promise ever expanding clinical applicability and usefulness.
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Affiliation(s)
- Samantha L Heller
- Department of Radiology, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA
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