CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobilia...CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-de-tector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reforma-tions (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and ab-normalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spec-trum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.展开更多
AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagn...AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation. METHODS: In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients. RESULTS: Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9%in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. InMRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosphatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL.CONCLUSION: Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method.展开更多
Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. M...Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.展开更多
Chronic hepatobiliary inflammatory diseases are not widely acknowledged as underlying disorders of systemic AA amyloidosis,except epidemic schistosomiasis.Among them,primary sclerosing cholangitis (PSC) might initiate...Chronic hepatobiliary inflammatory diseases are not widely acknowledged as underlying disorders of systemic AA amyloidosis,except epidemic schistosomiasis.Among them,primary sclerosing cholangitis (PSC) might initiate amyloid A protein deposition in diverse tissues,giving rise to systemic amyloidosis,due to a progressive and unresolved inflammatory process,and its possible association with inflammatory bowel diseases.Nevertheless,only one such case has been reported in the literature to date.We report a 69-year-old Japanese woman with cirrhosis who was diagnosed with PSC complicated with systemic AA amyloidosis,without any evidence of other inflammatory disorders.As a result of cholestasis in conjunction with biliary strictures and increased serum IgG4,the presence of IgG4 + plasma cells was examined systemically,resulting in unexpected documentation of Congo-red-positive amyloid deposits,but not IgG4 + plasma cells,in the liver,stomach and salivary glands.Elevated serum IgG4 is the hallmark of IgG4-related disease,including IgG4-associated cholangitis,but it has also been demonstrated in certain patients with PSC.Amyloid A deposits in multiple organs associated with an indolent clinical course that progresses over many years might have a diagnostic value in discriminating PSC from IgG4-associated cholangitis.展开更多
文摘CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-de-tector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reforma-tions (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and ab-normalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spec-trum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.
文摘AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation. METHODS: In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients. RESULTS: Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9%in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. InMRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosphatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL.CONCLUSION: Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method.
文摘Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.
基金Supported by Grants-in-Aid for Clinical Research from National Hospital Organization,Grants-in-Aid for Scientific Research from the Ministry of Health,Labour and Welfare of Japan
文摘Chronic hepatobiliary inflammatory diseases are not widely acknowledged as underlying disorders of systemic AA amyloidosis,except epidemic schistosomiasis.Among them,primary sclerosing cholangitis (PSC) might initiate amyloid A protein deposition in diverse tissues,giving rise to systemic amyloidosis,due to a progressive and unresolved inflammatory process,and its possible association with inflammatory bowel diseases.Nevertheless,only one such case has been reported in the literature to date.We report a 69-year-old Japanese woman with cirrhosis who was diagnosed with PSC complicated with systemic AA amyloidosis,without any evidence of other inflammatory disorders.As a result of cholestasis in conjunction with biliary strictures and increased serum IgG4,the presence of IgG4 + plasma cells was examined systemically,resulting in unexpected documentation of Congo-red-positive amyloid deposits,but not IgG4 + plasma cells,in the liver,stomach and salivary glands.Elevated serum IgG4 is the hallmark of IgG4-related disease,including IgG4-associated cholangitis,but it has also been demonstrated in certain patients with PSC.Amyloid A deposits in multiple organs associated with an indolent clinical course that progresses over many years might have a diagnostic value in discriminating PSC from IgG4-associated cholangitis.
