MRCP and MRI findings in 9 patients with autoimmune pancreatitis

瞄准：为了评估磁性的回声 cholangiopancreatography (MRCP ) ，与磁性的回声(先生) 一起的调查结果在自体免疫的胰腺炎(AIP ) 想象病人。方法：有 AIP 的九个病人经历了 MRI， MRCP，内视镜后退 cholangiopancreatography (ERCP ) ，计算断层摄影术，和 ultrasonography。在类固醇治疗前后拿的 MRCP 和先生图象被考察并且与另外的成像形式相比。AIP 盒子的 MRCP 调查结果与有胰的头的癌的 10 个盒子的那些相比。结果：在 MRCP 上，在 ERCP 上注意的主要的胰腺的管的缩小的部分没被设想，当主要的胰腺的管的非包含的片断被设想时。近似的主要的胰腺的管的在上游的膨胀的度比在胰腺的癌的情况下看温和。更低的胆汁管的狭窄或阻塞在 8 个病人被检测。先生图象在 T1 加权的先生图象上与减少的信号紧张显示出胰的增大， T2 加权的先生图象上的增加的信号紧张，并且，在 3 个病人，低亚硫酸钠强烈像囊的边界。在类固醇治疗以后，以前没设想主要的胰腺的管的部分被看见，与胆汁管狭窄的改进一起。胰腺的增大减少了，并且 T1 加权、 T2 加权的先生图象上的反常信号紧张成为了 isointense。结论：MRCP 不能区分从与胰腺的癌看见的主要的胰腺的管的狭窄与 AIP 看见的主要的胰腺的管的不规则的变窄。然而，与在 T1 加权、 T2 加权的先生图象上显示出反常信号紧张的胰腺的增大的先生成像一起的 MRCP 调查结果在支持 AIP 的诊断是有用的。

Angle of covered self-expandable metallic stents after placement is a risk factor for recurrent biliary obstruction

BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this study.We evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary outcome.We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system.We also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary outcomes.RESULTS We divided the patients into two cohorts based on the presence or absence of RBO.The angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO.These novel results provide pertinent information for future stent management.