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Muaddi H, Kearse L, Warner S. Multimodal Approaches to Patient Selection for Pancreas Cancer Surgery. Curr Oncol 2024; 31:2260-2273. [PMID: 38668070 PMCID: PMC11049254 DOI: 10.3390/curroncol31040167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
With an overall 5-year survival rate of 12%, pancreas ductal adenocarcinoma (PDAC) is an aggressive cancer that claims more than 50,000 patient lives each year in the United States alone. Even those few patients who undergo curative-intent resection with favorable pathology reports are likely to experience recurrence within the first two years after surgery and ultimately die from their cancer. We hypothesize that risk factors for these early recurrences can be identified with thorough preoperative staging, thus enabling proper patient selection for surgical resection and avoiding unnecessary harm. Herein, we review evidence supporting multidisciplinary and multimodality staging, comprehensive neoadjuvant treatment strategies, and optimal patient selection for curative-intent surgical resections. We further review data generated from our standardized approach at the Mayo Clinic and extrapolate to inform potential future investigations.
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Affiliation(s)
| | | | - Susanne Warner
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55902, USA; (H.M.)
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2
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Mattila A, Helminen O, Pynnönen E, Sironen A, Elomaa E, Nevalainen M. Preoperative MRCP Can Rule Out Choledocholithiasis in Acute Cholecystitis with a High Negative Predictive Value: Prospective Cohort Study with Intraoperative Cholangiography. J Gastrointest Surg 2023; 27:2396-2402. [PMID: 37578567 DOI: 10.1007/s11605-023-05790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) provides a noninvasive and fast modality for imaging the biliary tree when choledocholithiasis is suspected. Guidelines suggest that MRCP is recommended when strong or moderate signs of common bile duct (CBD) stones are present. Well-performed prospective studies are scarce regarding the sensitivity and specificity of preoperative MRCP in patients with acute cholecystitis in comparison with intraoperative cholangiography, ERCP, or choledochoscopy. METHODS We performed a prospective, observational population-based feasibility study in Central Finland Hospital Nova between January 2019 and December 2019. We examined the diagnostic performance of preoperative MRCP on consecutive patients with acute cholecystitis scheduled for index admission cholecystectomy. The accuracy of MRCP was verified with IOC, choledochoscopy, or ERCP. The interobserver reliability of the image quality of MRCP and the sensitivity and specificity of choledocholithiasis were observed independently by three experienced radiologists. RESULTS A total of 180 consecutive patients diagnosed with acute cholecystitis followed by index admission cholecystectomy were identified. MRCP was performed in 113/180 (62.8%) patients, and complementary perioperative imaging of the bile ducts was performed in 72/113 (63.7%) patients. The incidence of choledocholithiasis was high (29.2%). In acute cholecystitis, the sensitivity (76.2-85.7%) and specificity (84.3-92.2%) of MRCP were equally compared to the literature with unselected patient groups. The best visibility was observed in the common hepatic duct, the inferior CBD, and the central hepatic duct. The interobserver reliability was excellent for determining the size and quantity of CBD stones. CONCLUSION In acute cholecystitis, MRCP yields high negative predictive value regarding detection of choledocholithiasis. If CBD stones were discovered, the interobserver reliability was excellent when measuring the size and number of CBD stones. The best-visualized area was the distal part of the biliary tract, which provides good preoperative workup if choledocholithiasis is present.
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Affiliation(s)
- Anne Mattila
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland.
| | - Olli Helminen
- Research Unit of Translational Medicine, University of Oulu and Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - Emilia Pynnönen
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Antti Sironen
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Eeva Elomaa
- Department of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Mika Nevalainen
- Medical Research Center Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu and Department Radiology Oulu University Hospital, Oulu, Finland
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Sorouri K, Loren AW, Amant F, Partridge AH. Patient-Centered Care in the Management of Cancer During Pregnancy. Am Soc Clin Oncol Educ Book 2023; 43:e100037. [PMID: 37220323 DOI: 10.1200/edbk_100037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The management of cancer during pregnancy requires a patient-centered, multidisciplinary approach to balance maternal and fetal well-being given the rarity of this clinical scenario and lack of substantial data. Involvement of oncology and nononcology medical specialists and ethical, legal, and psychosocial supports, as needed, is instrumental in navigating the complexities of care for this patient population. Critical periods of fetal development and physiological changes in pregnancy must be considered when planning diagnostic and therapeutic approaches during pregnancy. The complexity of symptom recognition and interventional approaches contributes to diagnostic delays of cancers during pregnancy. Ultrasound and whole-body diffusion-weighted magnetic resonance imaging are safe throughout pregnancy. Surgery can be safely performed throughout pregnancy, with the early second trimester preferred for intra-abdominal surgery. Chemotherapy can be safely administered after 12-14 weeks of gestation until 1-3 weeks before the anticipated delivery. Most targeted and immunotherapeutic agents are contraindicated during pregnancy because of limited data. Pelvic radiation during pregnancy is absolutely contraindicated, while if radiation to the upper body is needed, administration should only be considered early in pregnancy. To ensure that the total cumulative fetal exposure to ionizing radiation does not exceed 100 mGy, early inclusion of the radiology team in the care plan is required. Closer prenatal monitoring is recommended for maternal and fetal treatment-related toxicities. Delivery before 37 weeks of gestation should be avoided if possible, and vaginal delivery is preferred unless obstetrically indicated or specific clinical scenarios. Postpartum, breastfeeding should be discussed, and the neonate should receive blood work to assess for acute toxicities with follow-up arranged for long-term monitoring.
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Affiliation(s)
- Kimia Sorouri
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alison W Loren
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Frédéric Amant
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- KU Leuven, Leuven, Belgium
- University of Amsterdam, Amsterdam, the Netherlands
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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Isram J, Haider E, Khan RSA, Hafeez M, Hinna RE, Baig I, Shahid A, Chaudhry M. Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison With Endoscopic Retrograde Cholangiopancreatography for Detection of the Etiology of Obstructive Jaundice. Cureus 2023; 15:e34484. [PMID: 36874324 PMCID: PMC9982695 DOI: 10.7759/cureus.34484] [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: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite technological advances, obstructive jaundice has significant morbidity and mortality rates. When studying obstructive jaundice, endoscopic retrograde cholangiopancreatography (ERCP), the "gold standard" for biliary obstruction identification, might be replaced with magnetic resonance cholangiopancreatography (MRCP), which is a non-invasive procedure. OBJECTIVE Diagnostic accuracy of MRCP in comparison with ERCP for the detection of the etiology of obstructive jaundice. METHODOLOGY This prospective, observational study included 102 patients who presented with obstructive jaundice as proven by liver function tests. The MRCP was conducted within 24 to 72 hours before the ERCP. A torso phased-array coil (Siemens, Germany) was used for the MRCP. The duodeno-videoscope and general electric fluoroscopy were used to perform the ERCP. The MRCP was evaluated by a classified radiologist who was blinded to the clinical details. An experienced consultant gastroenterologist who was blinded to the results of the MRCP assessed the cholangiogram of each patient. The hepato-pancreaticobiliary system results from both procedures were compared based on the pathology observed, such as choledocholithiasis, pancreaticobiliary strictures, and dilatation of biliary strictures. We determined the sensitivity, specificity, and negative and positive predictive values with 95% confidence intervals. The statistical significance was set at p<0.05. RESULTS The most commonly reported pathology was choledocholithiasis, and MRCP diagnosed 55 patients, of which 53 were true positive cases when compared with the ERCP results of the same patients. MRCP demonstrated greater sensitivity and specificity (respectively) for screening choledocholithiasis (96.2, 91.8), cholelithiasis (100, 75.8), pancreatic duct stricture (100, 100), and hepatic duct mass (100, 100) and showed statistically significant values. The sensitivity of MRCP is lower for identifying benign and malignant strictures, but its specificity was observed to be reliable. CONCLUSION When it comes to determining the severity of obstructive jaundice, both in its early and later stages, the MRCP technique is widely regarded as a reliable means of diagnostic imaging. The diagnostic function of ERCP has been significantly reduced as a result of the precision of MRCP as well as its non-invasive nature. In addition to being a helpful non-invasive method to identify biliary diseases and avoid unnecessary ERCPs and their risks, MRCP offers good diagnostic accuracy for obstructive jaundice.
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Affiliation(s)
- Javaria Isram
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Ehtesham Haider
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Rao Saad Ali Khan
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Muhammad Hafeez
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Rashk E Hinna
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Isfandyar Baig
- General Medicine, Royal Bournemouth Hospital, Bournemouth, GBR
| | - Aqsa Shahid
- Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Manahil Chaudhry
- General Medicine, The Mid Yorkshire Hospital NHS Trust, Wakefield, GBR
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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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Current State of Imaging of Pediatric Pancreatitis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:265-277. [PMID: 33728974 DOI: 10.2214/ajr.21.25508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatitis is as common in children as it is in adults, though causes and accepted imaging strategies differ in children. In this narrative review we discuss the epidemiology of childhood pancreatitis and key imaging features for pediatric acute, acute recurrent, and chronic pancreatitis. We rely heavily on our collective experience in discussing advantages and disadvantages of different imaging modalities; practical tips for optimization of ultrasound, CT, and MRI with MRCP in children; and image interpretation pearls. Challenges and considerations unique to imaging pediatric pancreatitis are discussed, including timing of imaging, role of secretin-enhanced MRCP, utility of urgent MRI, severity prediction, autoimmune pancreatitis, and best methods for serial imaging. We suggest a methodical approach to pancreatic MRI interpretation in children and have included a sample structured report, and we provide consensus statements according to our experience imaging children with pancreatitis.
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Abstract
Secretin-enhanced MRCP (S-MRCP) has advantages over standard MRCP for imaging of the pancreaticobiliary tree. Through the use of secretin to induce fluid production from the pancreas and leveraging of fluid-sensitive MRCP sequences, S-MRCP facilitates visualization of ductal anatomy, and the findings provide insight into pancreatic function, allowing radiologists to provide additional insight into a range of pancreatic conditions. This narrative review provides detailed information on the practical implementation of S-MRCP, including patient preparation, logistics of secretin administration, and dynamic secretin-enhanced MRCP acquisition. Also discussed are radiologists' interpretation and reporting of S-MRCP examinations, including assessments of dynamic compliance of the main pancreatic duct and of duodenal fluid volume. Established indications for S-MRCP include pancreas divisum, anomalous pancreaticobiliary junction, Santorinicele, Wirsungocele, chronic pancreatitis, main pancreatic duct stenosis, and assessment of complex postoperative anatomy. Equivocal or controversial indications are also described along with an approach to such indications. These indications include acute and recurrent acute pancreatitis, pancreatic exocrine function, sphincter of Oddi dysfunction, and pancreatic neoplasms.
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8
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Wolters V, Heimovaara J, Maggen C, Cardonick E, Boere I, Lenaerts L, Amant F. Management of pregnancy in women with cancer. Int J Gynecol Cancer 2021; 31:314-322. [PMID: 33649001 PMCID: PMC7925815 DOI: 10.1136/ijgc-2020-001776] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 01/04/2023] Open
Abstract
As the incidence of cancer in pregnancy has been increasing in recent decades, more specialists are confronted with a complex oncologic–obstetric decision-making process. With the establishment of (inter)national registries, including the International Network on Cancer, Infertility and Pregnancy, and an increasing number of smaller cohort studies, more evidence on the management of cancer during pregnancy is available. As fetal, neonatal, and short-term pediatric outcomes after cancer treatment are reassuring, more women receive treatment during pregnancy. Prenatal treatment should adhere to standard treatment as much as possible to optimize maternal prognosis, always taking into account fetal well-being. In order to guarantee the optimal treatment for both mother and child, a multidisciplinary team of specialists with expertise should be involved. Apart from oncologic treatment, a well-considered obstetric and perinatal management plan discussed with the future parents is crucial. Results of non-invasive prenatal testing are inconclusive in women with cancer and alternatives for prenatal anomaly screening should be used. Especially in women treated with chemotherapy, serial ultrasounds are strongly recommended to follow-up fetal growth and cervical length. After birth, a neonatal assessment allows the identification of any cancer or treatment-related adverse events. In addition, placental histologic examination aims to assess the fetal risk of metastasis, especially in women with malignant melanoma or metastatic disease. Breastfeeding is discouraged when systemic treatment needs to be continued after birth. At least a 3-week interval between the last treatment and nursing is recommended to prevent any treatment-induced neonatal effects from most non-platinum chemotherapeutic agents.
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Affiliation(s)
- Vera Wolters
- Department of Gynecology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | | | - Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, New Jersey, USA
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
| | | | - Frédéric Amant
- Department of Gynecology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands .,Department of Oncology, KU Leuven, Leuven, Belgium
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Darwesh AY, El-Dahhan MS, Meshali MM. New Oral Coaxial Nanofibers for Gadodiamide-Prospective Intestinal Magnetic Resonance Imaging and Theranostic. Int J Nanomedicine 2020; 15:8933-8943. [PMID: 33223828 PMCID: PMC7671466 DOI: 10.2147/ijn.s281158] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Gadodiamide (GDD) is a widely used magnetic resonance imaging (MRI) contrast agent. It is available only as intravenous injection. Unfortunately, it exhibits a high renal toxicity. In this respect, the author investigated the possibility of developing nanofibers (NFs, one-dimensional (1D) nanostructures) of GDD that would be promising for oral administration in intestinal imaging. NFs are prepared by electrospinning technique in which a strong electrostatic field is applied on a polymer solution. METHODS NFs were prepared by coaxial electrospinning technique using Eudragit S100 (ES 100) as a shell layer and GDD loaded with polyvinylpyrrolidone K90 (PVP K90) and hydroxypropyl-beta-cyclodextrin (HP-β-CyD) as core fibers. Compatibility study of the NFs ingredients was attested through ATR and DSC investigations. Thermogravimetric analysis of NFs was done to insure its stability. In vitro release of GDD in the intestinal medium with different pH values was measured. In vitro cytotoxicity test was done to prove its safety. Additionally, stability of NFs to perform its function was examined by X-ray. RESULTS NFs experienced high entrapment efficiency of about 94.3% ± 3.1%. The ingredients of NFs were compatible through FT-IR and DSC study. The in vitro release data of GDD from coaxial NFs were slow (˂14%) in pH 1.2 till 2 h, while at pH 7.4 it showed burst release of about 12% in the first 2 min. Thermogravimetric analysis proved the NFs are stable. The in vitro cytotoxicity study proved the safety of NFs. Using mammography, the coaxial NFs behaved the same as GDD plain indicating its ability to be a contrasting agent. CONCLUSION Coaxial NFs of GDD as a core with PVP K90 and HP-β-CyD and ES 100 as a shell were stable and efficient as oral imaging dosage form for the intestine. It might be a prospective theranostic.
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Affiliation(s)
- Alaa Yaser Darwesh
- Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura35516, Egypt
| | - Marwa Salah El-Dahhan
- Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura35516, Egypt
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Mohabir S, Pitcher RD, Perumal R, Goodier MDM. The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography. SA J Radiol 2020; 24:1875. [PMID: 32832119 PMCID: PMC7433279 DOI: 10.4102/sajr.v24i1.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 11/03/2022] Open
Abstract
Background During magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally. Objectives To evaluate the efficacy of a local, off-the-shelf pineapple juice preparation as a negative oral contrast agent for MRCP. Method An observational, analytical study was conducted during January–December 2017. A 1.5 Tesla MRCP sequence was performed immediately before and after ingestion of 250 mL of a local, commercially-available pineapple juice preparation. Image evaluation was performed by two radiologists with independent, blind assessment of gastric/duodenal signal intensity and biliary /pancreatic duct visibility, before and after pineapple juice. Results Fifty adult patients (F = 44, 88%) with median age 44 years (IQR: 34.75, 57) were included. After pineapple juice administration, there was significant measured (1661.51 vs. 1409.94, p < 0.01) and perceived (2.16 vs. 2.72, p < 0.01) duodenal signal reduction but no significant change in measured (1081.17 vs. 1044.38, p = 0.34) or perceived (2.73 vs. 2.84, p = 0.14) gastric signal intensity. Visibility of the common bile duct was significantly improved (3.67 vs. 3.86, p < 0.01), whilst that of the main pancreatic duct showed no significant change (2.92 vs. 2.86, p = 0.44). Conclusion The local pineapple juice preparation used in this study is an effective, affordable and natural negative oral contrast agent for enhancement of MRCP images, and specifically improves visualisation of the common bile duct.
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Affiliation(s)
- Sheryl Mohabir
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rubeshan Perumal
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew D M Goodier
- Department of Radiology, Grey's Hospital Pietermaritzburg, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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11
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Inchingolo R, Maino C, Gatti M, Tricarico E, Nardella M, Grazioli L, Sironi S, Ippolito D, Faletti R. Gadoxetic acid magnetic-enhanced resonance imaging in the diagnosis of cholangiocarcinoma. World J Gastroenterol 2020; 26:4261-4271. [PMID: 32848332 PMCID: PMC7422539 DOI: 10.3748/wjg.v26.i29.4261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/16/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
The use of liver magnetic resonance imaging is increasing thanks to its multiparametric sequences that allow a better tissue characterization, and the use of hepatobiliary contrast agents. This review aims to evaluate gadoxetic acid enhanced magnetic resonance imaging in the diagnosis and staging of cholangiocarcinoma and its different clinical and radiological classifications proposed in the literature. We also analyze the epidemiology, risk factors in correlation with clinical findings and laboratory data.
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Affiliation(s)
- Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
| | - Eleonora Tricarico
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Michele Nardella
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Luigi Grazioli
- Department of Radiology, Spedali Civili, University of Brescia, Brescia 25123, Italy
| | - Sandro Sironi
- Department of radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Bergamo 20110, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
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Maggen C, Wolters VERA, Cardonick E, Fumagalli M, Halaska MJ, Lok CAR, de Haan J, Van Tornout K, Van Calsteren K, Amant F. Pregnancy and Cancer: the INCIP Project. Curr Oncol Rep 2020; 22:17. [PMID: 32025953 PMCID: PMC7002463 DOI: 10.1007/s11912-020-0862-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Cancer diagnosis in young pregnant women challenges oncological decision-making. The International Network on Cancer, Infertility and Pregnancy (INCIP) aims to build on clinical recommendations based on worldwide collaborative research. RECENT FINDINGS A pregnancy may complicate diagnostic and therapeutic oncological options, as the unborn child must be protected from potentially hazardous exposures. Pregnant patients should as much as possible be treated as non-pregnant patients, in order to preserve maternal prognosis. Some approaches need adaptations when compared with standard treatment for fetal reasons. Depending on the gestational age, surgery, radiotherapy, and chemotherapy are possible during pregnancy. A multidisciplinary approach is the best guarantee for experience-driven decisions. A setting with a high-risk obstetrical unit is strongly advised to safeguard fetal growth and health. Research wise, the INCIP invests in clinical follow-up of children, as cardiac function, neurodevelopment, cancer occurrence, and fertility theoretically may be affected. Furthermore, parental psychological coping strategies, (epi)genetic alterations, and pathophysiological placental changes secondary to cancer (treatment) are topics of ongoing research. Further international research is needed to provide patients diagnosed with cancer during pregnancy with the best individualized management plan to optimize obstetrical and oncological care.
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Affiliation(s)
- Charlotte Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Vera E R A Wolters
- Department of Gynecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Michael J Halaska
- Faculty Hospital Kralovske Vinohrady and 3rd Medical, Faculty, Charles University, Prague, Czech Republic
| | - Christianne A R Lok
- Centre for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jorine de Haan
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.
- Centre for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Signal suppressions of grape syrup and grape syrup/lemon aqueous solutions in magnetic resonance cholangiopancreatography using heavily T2-weighted pulse sequence. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2019. [DOI: 10.2478/pjmpe-2019-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Signal suppression of the gastrointestinal tract fluids in magnetic resonance cholangiopancreatography (MRCP) has been performed using various natural and chemical substances with the different MRCP pulse sequences. This study aimed to investigate the signal suppressions of the grape syrup and the grape syrup/lemon aqueous solutions in MRCP using the heavily T2-weighted sequences. For this purpose, the potassium, iron and manganese contents of grape syrup were measured by atomic absorption spectroscopy. The grape syrup and the grape syrup/lemon solutions with the various grape syrup percentages were imaged using the heavily T2-weighted sequences of MRCP such as T2 HASTE thick slab and T2 SPACE. MRCP in the volunteers was performed before and 10 minutes after oral administration of the grape syrup solution. The concentrations of potassium, iron, and manganese in grape syrup were 34.8, 2.4 and 1 mg/l, respectively. The in vitro study showed significantly lower signal to noise ratio using the grape syrup samples comparing to the grape syrup/lemon. The effective signal suppression for the in vitro study and considerable enhancement of negative contrast in the post-contrast MRCP was obtained using a T2 HASTE thick slab sequence. As a conclusion, the grape syrup solution can be used for signal suppression of the gastrointestinal tract fluid in MRCP as an oral negative contrast material. A T2 HASTE thick slab sequence produces suitable contrast in MRCP images using the grape syrup solution.
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[Passive and active magnetic resonance cholangiopancreatography : Technique, indications, and typical anatomy]. Radiologe 2019; 59:306-314. [PMID: 30859236 DOI: 10.1007/s00117-019-0507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE In daily routine, every radiologist is confronted with a variety of questions concerning the biliary tract and pancreatic system. STANDARD RADIOLOGICAL METHODS Today, besides sonography, magnetic resonance cholangiopancreatography (MRCP) is considered the method of choice in the investigation of many disorders of the hepatobiliary and pancreatic system and is commonly preferred over invasive ERCP in a mere diagnostic setting. METHODICAL INNOVATIONS Since its introduction in 1991, MRCP has constantly evolved. Major innovations have been the reduction of acquisition time by using fast spin echo (FSE) sequences, the use of respiratory gating and contrast-enhanced imaging of the bile ducts with hepatobiliary-specific MRI contrast agents. PERFORMANCE Many diagnoses may already be made with noncontrast enhanced images. By supplemental administration of a hepatobiliary-specific contrast agent, it is also possible to evaluate the flow dynamics of the bile. This is of additional value especially in patients who underwent surgery of the biliodigestive system or endoscopic interventions. ACHIEVEMENTS Aside from robustness and reproducibility, a major advantage of this technique is the modular design of imaging protocols, which can easily be adapted to the clinical question. PRACTICAL RECOMMENDATIONS MRCP is a reliable and low-risk imaging method for primary diagnosis and follow-up of biliary and pancreatic pathologies.
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He M, Xu J, Sun Z, Wang S, Zhu L, Wang X, Wang J, Feng F, Xue H, Jin Z. Comparison and evaluation of the efficacy of compressed SENSE (CS) and gradient- and spin-echo (GRASE) in breath-hold (BH) magnetic resonance cholangiopancreatography (MRCP). J Magn Reson Imaging 2019; 51:824-832. [PMID: 31313426 DOI: 10.1002/jmri.26863] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022] Open
Abstract
CONTRACT GRANT SPONSOR Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine; Contract grant number: 2017-I2M-1-001; Contract grant sponsor: Outstanding Youth Fund of Peking Union Medical College Hospital; Contract grant number: JQ201704; Contract grant sponsor: National Natural Science Foundation of China; Contract grant number: 81871512; Contract grant sponsor: National Public Welfare Basic Scientific Research Program of Chinese Academy of Medical Sciences; Contract grant numbers: 2018PT32003 and 2017PT32004. BACKGROUND Both compressed-sensing (CS) and gradient- and spin-echo (GRASE) sequences can achieve 3D magnetic resonance cholangiopancreatography (MRCP) with a single breath-hold (BH). This work hypothesized that compared with conventional navigator-triggered (NT)-MRCP, the two BH-MRCP protocols, GRASE and CS, may provide better imaging quality, especially for patients with irregular breathing. PURPOSE To evaluate and compare the image quality and diagnostic performance of three MRCP protocols. STUDY TYPE Prospective. SUBJECTS Seventy-four patients suspected to have duct-related pathologies were enrolled. FIELD STRENGTH 3.0T. SEQUENCES NT-MRCP, BH-CS-MRCP, and BH-GRASE-MRCP. ASSESSMENT Breath regularity was evaluated subjectively according to the respiratory waves. The acquisition time was compared. The pancreaticobiliary system was divided into 12 segments and evaluated on a 5-point scale. The diagnostic performance of the three MRCPs was evaluated and compared. STATISTICAL TESTS The Friedman test with a post-hoc test, receiver operating characteristic (ROC) curve analysis, McNemar test, and Kendall's W test were used. RESULTS The BH-MRCP decreased the scan time significantly (P < 0.05). The overall imaging scores of GRASE-MRCP and CS-MRCP were significantly higher than that of NT-MRCP for patients with irregular breathing (4.283 and 4.283 vs. 3.000, both P < 0.05). Compared with NT-MRCP, the diagnostic performance of BH-CS and BH-GRASE MRCP was significantly improved for patients with irregular breathing (AUC = 0.860 and 0.863 vs. 0.572, both P < 0.001). DATA CONCLUSION Compared with conventional NT-MRCP, the overall imaging quality and diagnostic performance of BH-CS and BH-GRASE MRCP were not significantly different for patients with regular breathing and significantly superior for patients with irregular breathing. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:824-832.
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Affiliation(s)
- Ming He
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Jin Xu
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Zhaoyong Sun
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Shitian Wang
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Liang Zhu
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | | | | | - Feng Feng
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Huadan Xue
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
| | - Zhengyu Jin
- The Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Beijing, China
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Frey A, Ramaker K, Röckendorf N, Wollenberg B, Lautenschläger I, Gébel G, Giemsa A, Heine M, Bargheer D, Nielsen P. Fate and Translocation of (Nano)Particulate Matter in the Gastrointestinal Tract. BIOLOGICAL RESPONSES TO NANOSCALE PARTICLES 2019. [DOI: 10.1007/978-3-030-12461-8_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Fahlenkamp UL, Adams LC, Böker SM, Engel G, Huynh Anh M, Wagner M, Hamm B, Makowski MR. Feasibility of gadoxetate disodium enhanced 3D T1 MR cholangiography (MRC) with a specific inversion recovery prepulse for the assessment of the hepatobiliary system. PLoS One 2018; 13:e0203476. [PMID: 30183778 PMCID: PMC6124795 DOI: 10.1371/journal.pone.0203476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/21/2018] [Indexed: 11/30/2022] Open
Abstract
Aim To compare the potential of a gadoxetate disodium enhanced navigator-triggered 3D T1 magnetic-resonance cholangiography (MRC) sequence with a specific inversion recovery prepulse to T2-weighted MRCP for assessment of the hepatobiliary system. Materials and methods 30 patients (12 male, 18 female) prospectively underwent conventional navigator-triggered 3D turbo spin-echo T2-weighted MRCP and 3D T1 MRC with a specific inversion pulse to minimise signal from the liver 30 minutes after administration of gadoxetate disodium on a 1.5 T MRI system. For qualitative evaluation, biliary duct depiction was assessed segmentally following a 5-point Likert scale. Visualisation of hilar structures as well as image quality was recorded. Additionally, the extrahepatic bile ducts were assessed quantitatively by calculation of signal-to-noise ratios (SNR). Results The advantages of T1 3D MRC include reduced affection of image quality by bowel movement and robust depiction of the relative position of the extrahepatic bile ducts in relation to the portal vein and the duodenum compared to T2 MRCP. However, overall T1 3D MRC did not significantly (p > 0.05) improve the biliary duct depiction compared to T2 MRCP in all segments: Common bile duct 4.1 vs. 4.4, right hepatic duct 3.6 vs. 4.2, left hepatic duct 3.5 vs. 4.1. Image quality did not differ significantly (p > 0.05) between both sequences (3.6 vs. 3.5). SNR measurements for the hepatobiliary system did not differ significantly (p > 0.05) between navigator-triggered T1 3D MRC and T2 MRCP. Conclusions This preliminary study demonstrates that T1 3D MRC of a specific inversion recovery prepulse has potential to complement T2 MRCP, especially for the evaluation of liver structures close to the hilum in the diagnostic work-up of the biliary system in patients receiving gadoxetate disodium.
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Affiliation(s)
- Ute Lina Fahlenkamp
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | | | - Sarah Maria Böker
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Günther Engel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Minh Huynh Anh
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Rajadurai S, Kutaiba N. RE: “Efficacy of oral contrast agents for upper gastrointestinal signal suppression in MRCP: A systematic review of the literature” by Frisch et al. Acta Radiol Open 2018; 7:2058460118773796. [PMID: 29900008 PMCID: PMC5992811 DOI: 10.1177/2058460118773796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Frisch A, Walter TC, Grieser C, Geisel D, Hamm B, Denecke T. Performance survey on a new standardized formula for oral signal suppression in MRCP. Eur J Radiol Open 2017; 5:1-5. [PMID: 29719852 PMCID: PMC5926272 DOI: 10.1016/j.ejro.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/02/2017] [Accepted: 12/09/2017] [Indexed: 11/16/2022] Open
Abstract
Recently, a new biological standardized product for MRCP became available. The product is considered effective as oral signal suppressor in T2-w images. Obtained MRCP imagery show a good image quality. Patients’ feedback on taste and palatability is very high.
Background Orally administered substances, which reduce image contamination by overlying gastrointestinal fluid signals, can be used to enhance the quality of MRCP images. Recently, a new standardized formula consisting of biological substances has become available. The objective of this study is to provide a first assessment of achievable MRCP image quality, taste and palatability of this new dedicated agent. Methods In January 2015 to May 2015 practicing radiologists in Germany, Austria and Switzerland were asked to evaluate image quality as well as taste and palatability when using the new agent (LumiVision®; b.e. imaging; Baden-Baden; Germany) in MRCP questionnaire. Both criteria were rated with a 6-point Likert scale ranging from “1” (best) to “6” (worst). Results A total 185 of 475 radiologic institutions (39%) submitted feedback on image quality, 187 (39%) on the taste/palatability. Assessments of image quality regarding presence of disturbing gastrointestinal fluid signal resulted in a median of 2. The majority of patients rated the subjective taste as very good (median of 1). No side effects of relevance were recorded. Conclusion This large survey shows that the tested product is considered effective by radiologists regarding MRCP image quality. Patients’ feedback on taste and palatability was very positive.
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Affiliation(s)
- Anne Frisch
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
| | - Thula C Walter
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
| | - Christian Grieser
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
| | - Dominik Geisel
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
| | - Bernd Hamm
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
| | - Timm Denecke
- Institute of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany
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