Magnetic resonance cholangiopancreatography: a useful tool in the evaluation of pancreatic and biliary disorders.
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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. (+info)
Agenesis of the gallbladder: lessons to learn.
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BACKGROUND: Congenital absence of the gallbladder is a rare, usually asymptomatic, anatomical variation. Some affected individuals may present with a clinical picture suggestive of gallbladder disease. This presentation, coupled with the inability of standard abdominal ultrasonography to convincingly diagnose agenesis of the gallbladder, can put the surgeon in a diagnostic and intraoperative dilemma. CASE REPORT: A 30-year-old lady presenting with clinical features of cholecystitis and diagnosed with shrunken gallbladder on ultrasonography was scheduled for laparoscopic cholecystectomy. Intraoperatively, the gallbladder could not be seen even after thorough dissection in the region of the porta hepatis. The procedure was terminated at this stage, and further imaging of the extrahepatic biliary system by magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed the diagnosis of congenital absence of the gallbladder. CONCLUSION: Nonvisualization of the gallbladder at laparoscopy, in the absence of any other diagnosed biliary disorder, need not prompt conversion to open exploration of the extrahepatic biliary system. Newer imaging modalities are relatively noninvasive and can provide good delineation of biliary anatomy. This allows wellplanned treatment and at the same time prevents the added morbidity of a diagnostic laparotomy performed solely to confirm the absence of the gallbladder. (+info)
Management of biliary atresia: experience in a single institute.
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BACKGROUND: The management of biliary atresia (BA) has evolved with time. The outcome of BA treatment in the Chang Gung Memorial Hospital-Kaohsiung Medical Center had not been recorded and we addressed this issue in this study. METHODS: Medical records of the 93 patients with BA who underwent Kasai portoenterostomy (KP) in the Chang Gung Memorial Hospital-Kaohsiung Medical Center from 1986 to 2005 were reviewed retrospectively. There were 46 male and 47 female patients included in this study. Sixty patients received KP before 60 days of age and 33 patients received KP after 60 days of age. RESULTS: Jaundice-free survival with native liver was accomplished in 29 of 60 patients who received KP before 60 days of age but in only 9 of 33 after that age (p = 0.048). Cholangitis developed in 56 patients (60.2%). Incidence of cholangitis was not significantly different between the patients free of jaundice (22/38) and those with persistent jaundice (34/55) (p = 0.704). Seven patients had single cysts and 1 had multiple cysts, with 4 being jaundice-free. Five out of 9 were free of jaundice after re-do KP. Among the 62 patients followed for more than 5 years, 32 (51.6%) survived with native liver. CONCLUSION: This study revealed that half of the patients with BA survived with their native liver for more than 5 years. Age at operation, not post-KP cholangitis or liver cysts, was the most determinant factor of BA outcome. (+info)
Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: a case report.
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Although the etiology of eosinophilic cholecystitis is still obscure, the postulated causes include allergies, parasites, hypereosinophilic syndrome, and eosinophilic gastroenteritis. It is sometimes accompanied by several complications, but a simultaneous onset with pericarditis is very rare. A 28-year-old woman complained of acute right hypocondrial pain and dyspnea associated with systemic eruption. Several imaging modalities revealed acute cholecystitis and pericarditis with massive pericardial effusion. A marked peripheral blood eosinophilia was observed, and the eruption was diagnosed as urticaria. Her serum had a high titer of antibody against Ascaris lumbricoides. Treatment with albendazole drastically improved all clinical manifestations along with normalization of the imaging features and eosinophilia. We report herein a rare case of simultaneous onset of acute cholecystitis and pericarditis associated with a marked eosinophilia caused by parasitic infection. (+info)
Multiplanar reformations and minimum intensity projections using multi-detector row CT for assessing anomalies and disorders of the pancreaticobiliary tree.
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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-detector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reformations (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and abnormalities 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 spectrum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree. (+info)
Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy.
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AIM: To evaluate the impact of a preoperative "triple non-invasive diagnostic test" for diagnosis and/or exclusion of common bile duct stones. METHODS: All patients with symptomatic gallstone disease, operated on by laparoscopic cholecystectomy from March 2004 to March 2006 were studied retrospectively. Two hundred patients were included and reviewed by using a triple diagnostic test including: patient's medical history, routine liver function tests and routine ultrasonography. All patients were followed up 2-24 mo after surgery to evaluate the impact of triple diagnostic test. RESULTS: Twenty-five patients were identified to have common bile duct stones. Lack of history of stones, negative laboratory tests and normal ultrasonography alone was proven to exclude common bile duct stones in some patients. However, a combination of these three components (triple diagnostic), was proven to be the most statistically significant test to exclude common bile duct stones in patients with gallstone disease. CONCLUSION: Using a combination of routinely used diagnostic components as triple diagnostic modality would increase the diagnostic accuracy of common bile duct stones preoperatively. This triple non-invasive test is recommended for excluding common bile duct stones and to identify patients in need for other investigations. (+info)
Preoperative evaluation with T-staging system for hilar cholangiocarcinoma.
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AIM: To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS: The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo; P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs 54.5%; P < 0.05). CONCLUSION: The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of long-term survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma. (+info)
State of the art 3D MR-cholangiopancreatography for tumor detection.
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With the use of current multislice techniques for MR cholangiopancreatography various upper abdominal pathologies including pancreatic carcinoma, Klatskin tumor and metastatic spread can be non invasively depicted. Respiratory gating allows free breathing of the patient, which increases patient comfort, while excellent image quality can be achieved. In this concise pictorial report, state of the art MRCP images of various cancer entities including sequence descriptons are presented. (+info)