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Abourak C, Oukassem S, Essouni Z, Ramdani H, Laamrani FZ, Jroundi L, El Aoufir O. [A starry liver]. Rev Med Interne 2023; 44:574. [PMID: 37268511 DOI: 10.1016/j.revmed.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Affiliation(s)
- C Abourak
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc.
| | - S Oukassem
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
| | - Z Essouni
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
| | - H Ramdani
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
| | - F Z Laamrani
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
| | - L Jroundi
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
| | - O El Aoufir
- Service de radiologie des urgences, CHU d'Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohamed-V., Rabat, Maroc
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Chang H, Bates DDB, Gupta A, LeBedis CA. Use of MR in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:479-499. [PMID: 35995475 DOI: 10.1016/j.mric.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed.
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Affiliation(s)
- Hailey Chang
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - David D B Bates
- Department of Radiology, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
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Trunz LM, Guglielmo FF, Selvarajan SK, Naringrekar HV, Alturki A, Dave JK, Mitchell DG. Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP). Abdom Radiol (NY) 2021; 46:562-569. [PMID: 32743690 DOI: 10.1007/s00261-020-02686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. MATERIALS AND METHODS 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14 months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15 min were included. RESULTS 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1-2.6) compared with gadobutrol (mean: 2.8-2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2-9.4 min (95% confidence interval; mean 8.3 min). CONCLUSION Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2 min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA.
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Santosh K Selvarajan
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Abdullah Alturki
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
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Tokoro H, Yamada A, Suzuki T, Kito Y, Adachi Y, Hayashihara H, Nickel MD, Maruyama K, Fujinaga Y. Usefulness of breath-hold compressed sensing accelerated three-dimensional magnetic resonance cholangiopancreatography (MRCP) added to respiratory-gating conventional MRCP. Eur J Radiol 2019; 122:108765. [PMID: 31830630 DOI: 10.1016/j.ejrad.2019.108765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/27/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To clarify the clinical usefulness of breath-hold compressed sensing three-dimensional magnetic resonance cholangiopancreatography (BH-MRCP) added to conventional respiratory-gating MRCP (RG-MRCP), we prospectively evaluated the image quality of BH-MRCP and compared it with that of RG-MRCP. We also evaluated to what extent the overall image quality was improved by adding BH-MRCP to RG-MRCP. MATERIALS AND METHODS A total of 113 patients who underwent RG-MRCP and BH-MRCP at a 3-T MR unit were enrolled. We set a scan time of approximately 180 s for RG-MRCP and 20 s for BH-MRCP before examination, and measured actual scan time and assessed image quality using a 5-point scale (5, good; 1, poor). Image quality scores of 1, 2 and 3 were considered clinically inadequate. Image quality scores of RG-MRCP and BH-MRCP were compared. In addition, we compared "RG-MRCP alone" and "hybrid MRCP" (the best-scoring image was picked from RG-MRCP and BH-MRCP when the RG-MRCP score was clinically inadequate). RESULTS The mean actual scan time of RG-MRCP/BH-MRCP was 191/20 s. The mean scores of RG-MRCP, BH-MRCP and hybrid MRCP were 3.67, 3.35 and 3.92, respectively. The score of hybrid MRCP was significantly better than that of RG-MRCP (P < 0.05). The image quality of RG-MRCP was clinically inadequate in 43/113 (38 %) cases and the inadequate image quality was improved to be clinically adequate in 13/43 (30 %) cases by adding BH-MRCP. CONCLUSION BH-MRCP brings added value to RG-MRCP because an additional examination of BH-MRCP could compensate for the image deterioration of RG-MRCP caused by motion artifacts.
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Affiliation(s)
- Hirokazu Tokoro
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takeshi Suzuki
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshihiro Kito
- Radiology Division of Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuo Adachi
- Radiology Division of Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hayato Hayashihara
- Radiology Division of Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Marcel D Nickel
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Katsuya Maruyama
- MR Research & Collaboration Department, Siemens Healthcare K. K., Tokyo, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Hecht EM, Kambadakone A, Griesemer AD, Fowler KJ, Wang ZJ, Heimbach JK, Fidler JL. 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] [What about the content of this article? (0)] [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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Wang Q, Swensson J, Hu M, Cui E, Tirkes T, Jennings SG, Akisik F. Distribution and correlation of pancreatic gland size and duct diameters on MRCP in patients without evidence of pancreatic disease. Abdom Radiol (NY) 2019; 44:967-975. [PMID: 30600375 DOI: 10.1007/s00261-018-1879-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter. METHODS In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89). RESULTS The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter. CONCLUSIONS There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females.
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Affiliation(s)
- Qiushi Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Jordan Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Maoqing Hu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Enming Cui
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Samuel G Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA.
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Boraschi P, Donati F, Pacciardi F, Ghinolfi D, Falaschi F. Biliary complications after liver transplantation: Assessment with MR cholangiopancreatography and MR imaging at 3T device. Eur J Radiol 2018; 106:46-55. [PMID: 30150050 DOI: 10.1016/j.ejrad.2018.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Our study was aimed to assess the diagnostic value of MR cholangiopancreatography (MRCP) and MR imaging at 3 T device when evaluating biliary adverse events after liver transplantation. MATERIALS AND METHODS A series of 384 MR examinations in 232 liver transplant subjects with suspected biliary complications (impaired liver function tests and/or biliary abnormalities on ultrasound) were performed at 3 T device (GE-DISCOVERY MR750; GE Healthcare). After the acquisition of axial 3D dual-echo T1-weighted images and T2-weighted sequences (propeller and SS-FSE), MRCP was performed through coronal thin-slab 3D-FRFSE and coronal oblique thick-slab SSFSE T2w sequences. DW-MRI of the liver was performed using an axial spin-echo echo-planar sequence with multiple b values (150, 500, 1000, 1500 s/mm2) in all diffusion directions. Contrast-enhanced MRCP was performed in 25/232 patients. All MR images were blindly evaluated by two experienced abdominal radiologists in consensus to determine the presence of biliary complications, whose final diagnosis was based on direct cholangiography, surgery and integrating clinical follow-up with ultrasound and/or MRI findings. RESULTS In 113 patients no biliary abnormality was observed. The remaining 119 subjects were affected by one or more of the following complications: non-anastomotic strictures including typical ischemic-type biliary lesions (n = 67), anastomotic strictures (n = 34), ampullary dysfunction (n = 4), anastomotic leakage (n = 4), stones, sludge and casts (n = 65), vanishing bile duct (n = 1). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of the reviewers for the detection of all types of biliary complications were 99%, 96%, 95%, 99% and 97%, respectively. CONCLUSION MR cholangiopancreatography and MR imaging at 3 T device are extremely reliable for detecting biliary complications after liver transplantation.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
| | - Francescamaria Donati
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Federica Pacciardi
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplantation - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Fabio Falaschi
- Department of Diagnostic Imaging - Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
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Yin T, Peeters R, Liu Y, Feng Y, Zhang X, Jiang Y, Yu J, Dymarkowski S, Himmelreich U, Oyen R, Ni Y. Visualization, Quantification and Characterization of Caerulein-Induced Acute Pancreatitis in Rats by 3.0T Clinical MRI, Biochemistry and Histomorphology. Theranostics 2017; 7:285-294. [PMID: 28042334 PMCID: PMC5197064 DOI: 10.7150/thno.16282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/08/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose: To investigate whether Caerulein-induced acute pancreatitis (AP) in rats could be noninvasively studied by clinical magnetic resonance imaging (MRI) techniques and validated by enzymatic biochemistry and histomorphology. Materials and Methods: The study was approved by the institutional animal ethical committee. The AP was induced in 26 rats by intraperitoneal injections of Caerulein, as compared to 6 normal rats. T2-weighted 3D MRI, T2 relaxation measurement and contrast enhanced T1-weighted MRI were performed at 3 Tesla. Pancreatic volume and contrast ratio of pancreas against surrounding tissues were measured by MRI. Animals were scarified at 3, 8, 24 and 48-hr respectively for analyses of serum lipase and amylase levels, and biliopancreatic perfusion-assisted histomorphology. Results: The AP could be observed on MRI 3-hr onwards after Caerulein-administration. T2 relaxation within the pancreas was prolonged due to high water content or edema. Increase of vascular permeability was indicated by T1 contrast enhancement. Both edema and vascular permeability gradually recovered afterwards (p<0.05/0.01), paralleled by declining serum enzyme levels (p<0.05). Microscopy revealed cell vacuolization and edema for early stage, and increased inflammatory cell infiltration and acinar cell loss after 24 and 48-hr. Conclusion: Multiparametric MRI techniques at 3.0T could facilitate noninvasive diagnosis and characterization of Caerulein induced AP in rats, as validated by a novel ex vivo method.
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Boraschi P, Donati F, Cervelli R, Pacciardi F. Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases. Insights Imaging 2016; 7:819-829. [PMID: 27628744 PMCID: PMC5110475 DOI: 10.1007/s13244-016-0517-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/29/2016] [Accepted: 08/11/2016] [Indexed: 12/29/2022] Open
Abstract
Abstract MR cholangiopancreatography (MRCP) is an imaging technique that has evolved over the past 2 decades and that continues to have a fundamental role in the non-invasive detection of morphologic features of the pancreatic ducts. In several studies, MRCP has shown a good correlation with endoscopic retrograde cholangiopancreatography in the evaluation of diseases and anatomic variants of the pancreatic ductal system. However, in physiologic conditions the pancreatic ducts are not always easily recognisable. More recently, secretin-enhanced MRCP protocols have been developed for a more complete assessment of pancreatic ducts and glandular function, including monitoring of pancreatic flow dynamics and duodenal filling after pancreatic hormonal stimulation with secretin. The injection of this hormone causes temporary dilation of the pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus improving MRCP detection of the ducts and characterisation of pancreatic disorders and allowing the assessment of the exocrine pancreatic reserve. The purpose of this pictorial review is to summarise the technical aspects of secretin-stimulated MRCP, to report the secretin-stimulated MRCP findings of pancreatic duct abnormalities and to review the diagnostic capabilities of secretin-stimulated MRCP in various pancreatic ductal system conditions. Main Messages • MRCP has a fundamental role in the non-invasive detection of pancreatic ducts. • In physiologic conditions pancreatic ducts are not always well detected on MRCP. • Secretin injection causes temporary dilation of pancreatic ducts and thus improves MRCP detection. • Secretin-stimulated MRCP may allow the assessment of the exocrine pancreatic reserve. • Secretin increases the diagnostic capabilities of MRCP for evaluating pancreatic disorders.
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Affiliation(s)
- Piero Boraschi
- Division of Diagnostic and Interventional Radiology-Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa University Hospital-Via Paradisa 2, 56124, Pisa, Italy
| | - Francescamaria Donati
- Division of Diagnostic and Interventional Radiology-Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa University Hospital-Via Paradisa 2, 56124, Pisa, Italy
| | - Rosa Cervelli
- Division of Diagnostic and Interventional Radiology-Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa University Hospital-Via Paradisa 2, 56124, Pisa, Italy.
| | - Federica Pacciardi
- Division of Diagnostic and Interventional Radiology-Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa University Hospital-Via Paradisa 2, 56124, Pisa, Italy
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Vidmar J, Omejc M, Dežman R, Popovič P. Thrombosis of pancreatic arteriovenous malformation induced by diagnostic angiography: case report. BMC Gastroenterol 2016; 16:68. [PMID: 27400664 PMCID: PMC4940768 DOI: 10.1186/s12876-016-0485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background We report on a case of pancreatic arteriovenous malformation (PAVM) that obliterated shortly after diagnostic angiography (DSA). PAVM is a rare anomaly that presents with upper abdominal pain, signs of acute pancreatitis and massive gastrointestinal bleeding. The management of PAVM is rather complex, with complete treatment usually accomplished only by a total extirpation of the affected organ or at least its involved portion. DSA prior to treatment decisions is helpful for characterizing symptomatic PAVM, since it can clearly depict the related vascular networks. In addition, interventional therapy can be performed immediately after diagnosis. Case presentation A 39-old male was admitted due to recurring upper abdominal pain that lasted several weeks. Initial examination revealed the absence of fever or jaundice, and the laboratory tests, including that for pancreatic enzymes, were unremarkable. An abdominal ultrasound (US) showed morphological and Doppler anomalies in the pancreas that were consistent with a vascular formation. A subsequent DSA depicted a medium-sized nidus, receiving blood supply from multiple origins but with no dominant artery. Coil embolization was not possible due to the small caliber of the feeding vessels. In addition, sclerotherapy was not performed so as to avoid an unnecessary wash out to the non-targeted duodenum. Consequently, the patient received no specific treatment for his symptomatic PAVM. A large increase in pancreatic enzymes was noticed shortly after the DSA procedure. Imaging follow-up by means of CT and MRI showed small amounts of peripancreatic fluid along with a limited area of intra-parenchymal necrosis, indicating necrotizing pancreatitis. In the post-angiography follow-up the patient was hemodynamically stable the entire time and was treated conservatively. The symptoms of pancreatitis improved over a few days, and the laboratory findings returned to normal ranges. Long-term follow-up by way of a contrast-enhanced CT revealed no recanalization of the thrombosed PAVM. Conclusion The factors associated with the obliteration of PAVM during or after DSA are poorly understood. In our case it may be attributed to the low flow dynamics of PAVM, as well as to the local administration of a contrast agent. Asymptomatic PAVM, as diagnosed with non-invasive imaging techniques, should not be evaluated with DSA due to the potential risk of severe complications, such as acute pancreatitis.
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Affiliation(s)
- Jernej Vidmar
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloska cesta 4, 1000, Ljubljana, Slovenia. .,Jozef Stefan Institute, Laboratory of Magnetic Resonance Imaging, Ljubljana, Slovenia.
| | - Mirko Omejc
- Clinical Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Rok Dežman
- Institute of Radiology, University Medical Centre, Ljubljana, Slovenia
| | - Peter Popovič
- Institute of Radiology, University Medical Centre, Ljubljana, Slovenia
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Kang KM, Lee JM, Shin CI, Baek JH, Kim SH, Yoon JH, Han JK, Choi BI. Added value of diffusion-weighted imaging to MR cholangiopancreatography with unenhanced mr imaging for predicting malignancy or invasiveness of intraductal papillary mucinous neoplasm of the pancreas. J Magn Reson Imaging 2013; 38:555-63. [PMID: 23390008 DOI: 10.1002/jmri.24022] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 12/07/2012] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To investigate the added value of diffusion-weighted imaging (DWI) to magnetic resonance cholangiopancreatography (MRCP) with unenhanced MR imaging for predicting the malignancy or invasiveness of intraductal papillary mucinous neoplasms (IPMNs). MATERIALS AND METHODS Following Institutional Review Board (IRB) approval, this retrospective study included 52 patients with surgically resected IPMNs and who underwent MRCP, unenhanced MRI, and DWI. Three blinded radiologists evaluated the two image sets, ie, MRCP with unenhanced MR images vs. the combined set with MRCP, unenhanced MR images, and DWI, and scored their confidence for malignancy or for invasiveness of IPMNs. The mean apparent diffusion coefficient (ADC) values of benign IPMNs and of intraductal mucinous carcinomas (IPMCs) were compared. The diagnostic accuracy was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS The mean ADC of malignant IPMNs (2.05 ± 0.66 × 10(-3) mm(2) /sec) was significantly lower than that of benign IPMNs (2.95 ± 0.32 × 10(-3) mm(2) /sec, P < 0.0001). Invasive IPMCs (1.51 ± 0.32 × 10(-3) mm(2) /sec) showed significantly lower ADC than that of noninvasive IPMCs (2.67 ± 0.23 × 10(-3) mm(2) /sec, P = 0.0003). The area of diffusion restriction was more frequently seen in malignant IPMNs than in benign IPMNs (P < 0.00001). The addition of DWI to MRCP with unenhanced MRI did not show a significant improvement for predicting malignant IPMN (P> 0.05), but resulted in a tendency to improve the diagnostic accuracy for the prediction of invasive IPMN in two observers (P = 0.072, P = 0.085). CONCLUSION The addition of DWI to MRCP with unenhanced MRI may improve the diagnosis of malignant IPMN and further increase the prediction of invasive IPMC.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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Abstract
Increasing hepatobiliary laparoscopic surgeries have lead to a rise in injury to the biliary tree and other complications like bile leak. Ultrasonography (US) and computed tomography (CT) cannot reliably distinguish bile from other postoperative fluid collections. Magnetic resonance (MR) imaging with hepatobiliary agents and MR cholangiopancreatography provide anatomic and functional information that allows for prompt diagnosis and excludes any other concomitant complications. We report a case of post-cholecystectomy bile leak in a 42-year-old female who presented with persistent dull abdominal pain after the intervention; we emphasize the role of MR imaging in achieving the correct diagnosis.
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Affiliation(s)
- Francesco Mungai
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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13
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Abstract
Magnetic resonance cholangiopancreatography (MRCP) is being used with increasing frequency as a noninvasive alternative to diagnostic retrograde cholangiopancreatography (ERCP). The aim of this pictorial review is to demonstrate the usefulness of MRCP in the evaluation of pancreatic and biliary system disorders. Because the recently developed techniques allows improved spatial resolution and permits imaging of the entire pancreaticobiliary tract during a single breath hold, MRCP is of proven utility in a variety of pancreatic and biliary disorders. It uses MR imaging to visualize fluid in the biliary and pancreatic ducts as high signal intensity on T2 weighted sequences and is the newest modality for pancreatic and biliary duct imaging. Herein, we present the clinical applications of MRCP in a variety of pancreaticobiliary system disorders and conclude that it is an important diagnostic tool in terms of imaging of the pancreaticobiliary ductal system.
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Affiliation(s)
- Ahmet-Mesrur Halefoglu
- Department of Radiology, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
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14
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Zheng RQ, Kudo M, Onda H, Inoue T, Maekawa K, Minami Y, Chung H, Kitano M, Kawasaki T. Imaging findings of biliary hamartomas (von Meyenburg complexes). J Med Ultrason (2001) 2005; 32:205. [PMID: 27277490 DOI: 10.1007/s10396-005-0051-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 04/13/2005] [Indexed: 01/08/2023]
Abstract
To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, vMCs) and discuss their differential diagnosis from other related diseases, imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and hepatobiliary scintigraphy were prospectively analyzed in six patients. On ultrasound images, five of the six cases showed multiple small hyper- and hypoechoic lesions with comet-tail echoes, especially when magnified using the zoom function. In all six cases, multiple tiny hypodense lesions less than 10 mm in diameter were scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypointense on T2- and TI-weighted images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and it clearly showed multiple tiny round and irregular-shaped hyperintense lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extrahepatic bile ducts in two and one patients, respectively. Imaging modalities are useful in the diagnosis and differential diagnosis of vMCs. A correct diagnosis might be obtained when typical imaging findings present even without histological confirmation.
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15
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Abstract
AIM: To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, VMCs) and discuss the differential diagnosis with other related diseases.
METHODS: Imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), MR cholangiopancreatography (MRCP)and hepatobiliary scintigraphy were retrospectively analyzed in six patients.
RESULTS: On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases, multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and TI-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively.
CONCLUSION: Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation.
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Affiliation(s)
- Rong-Qin Zheng
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Shipai, Guangzhou 510630, Guangdong Province, China.
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