Obstructive jaundice: a comparative study of forceps and brush biopsy under percutaneous transhepatic cholangiography / 介入放射学杂志

Objective To compare the sensitivity between forceps biopsy and brushing, and to explore a feasible approach to pathological diagnosis of the obstructive jaundice.Methods 92 consecutive patients with obstructive jaundice underwent transluminal foreceps biopsy and brushing during percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage. The technique was performed through an preexisting percutaneous transhepatic tract with multiple specimens obtained after passing the forceps biopsy or brush into a 8-French sheath. Finally the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results The histopathologic diagnosis was acquired in 81 out of 92 patients with forceps biopsy reaching the successful rate of 97.83%. Sensitivity of forceps biopsy in 92 patients was higher than that of brush in 84 patients(88.04% vs 76.19%,? 2=4.251,P=

New way in pathologic diagnosis of biliary obstructive jaundice: a clinical study in percutaneous transhepatic cholangiobiopsy / 介入放射学杂志

Objective To explore the technical feasibility and sensitivity of percutaneous transhepatic cholangiobiopsy in malignant obstructive jaundice, together with the guidance for clinical managements.. Methods 31 patients with obstructive jaundice after percutaneous transhepatic cholangiography and drainage were undesgone percutaneous transhepatic cholangiobiopsy. The technique was performed through an preexisted percutaneous transhepatic tract with a 8 Frerch sheath, multiple specimens were obtained after passing the forceps for the biopsy. The specimens were fixed with formalin, and then taken for histopathologic diagnosis. Results The histopathologic diagnosis was acquired in 30 of 31 patients(sensitivity, 96.8%). Conclusions Percutaneous transhepatic cholangiobiopsy is an accurate, safety and reliable way, easy to perform with a histopathologic diagnosis sensitivity rate of 96.8%.

The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma / 介入放射学杂志

Objective To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods 7 bili ary metallic stents were placed in 7 patients with recurrent jaundice after T tube drainage in cholangiocarcinoma cases. Results Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL,ALT,GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment.Conclusions Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma induced obstructive jaundice.

The interventional treatment for recurrent jaundice after palliative bilio-intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma / 介入放射学杂志

Objective To explore the interventional methods to treat recurrent jaundice after palliative bilio intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods Ten patients with recurrent jaundice after bilio intestinal anastomoasis were retrospectively evaluated. Nine of ten underwent PTCD with metallic stent placement, one underwent the inner outer draining catheter procedure. The patients were evalualed with comparison in regard to preoperative conditions, TBIL,ALT,GTP and AKP values.Results Stent placement was successful only once in all 10 cases with successful rate of 100%. TBIL,ALT,GTP and AKP values were significantly lower 7 days postoperative by than that preoperation. Subsidence of jaundice was satisfactory for 100% in all patients after the treatment. Conclusions Percutaneous placement of biliary metallic stents is a safety, simple, low complication method for managing recurrent jaundice after palliative bilio intestinal anastomosis for the terminal stage of malignant obstructive jaundice.

Vascular Invasion of Klatskin Tumor: Computed Tomography vs Digital Subtraction Angiography in Determining Resectability

PURPOSE: To compare the accuracy of computed tomography (CT) with that of digital subtraction angiography (DSA) in predicting the resectability of Klatskin tumor on the basis of vascular invasion. MATERIALS AND METHODS: Twenty-five patients with Klatskin tumor who had undergone laparotomy were in-cluded in this study. In order to assess the surgical resectability of their tumors, the preoperative CT scans and DSA of these patients were retrospectively assessed in terms of vascular invasion. The criteria of unresectability were tumoral invasion of the proper hepatic artery or main portal vein, or simultaneous invasion of the hepatic artery on one side and the other side portal vein. RESULTS: Tumors were unresectable in 13 cases, and resectable in 12. CT and DSA predicted nine and three tumors as unresectable ones, respectively. The sensitivity, specificity, positive predictive value, negative predic-tive value and accuracy of CT in determining whether a tumor was unresectable were 61.5 %, 91.7%, 88.9 %, 6 8 .8 % and 76.0 %, respectively. For DSA, the respective figures were 23.1 %, 100 %, 100 %, 54.5 % and 6 0 .0 %. For the detection of vascular invasion without diameter change, CT was superior to DSA; for the evaluation of vascular anatomy, it was, however, less effective. CT failed to detect small hepatic metastasis (n=2), lymph node metastasis (n=1), variation of the bile duct (n=1), and the distal extent of tumor in the bile duct (n=1), factors which precluded surgical resection. CONCLUSION: CT is a reliable method for the detection of vascular invasion and tumor unresectability. For the detection of vascular anatomic variation, the combined use of CT and DSA would be helpful.

Usefulness of the Helical CT in the Diagnosis of Periampullary Malignant Tumors

PURPOSE: To evaluate the usefulness of the helical CT in the differentiation of periampullary malignanttumors. MATERIALS AND METHODS: Fifty-five periampullary carcinoma patients (pancreatic head carcinoma (n=18);distal CBD carcinoma (n=17) ; carcinoma of the ampulla of Vater(n=16) ; periampullary duodenal cancers,(n=4), alldiagnosed by histopathologic study] underwent helical CT with 5mm scan thickness and 5mm/sec table speed. Afterscanning, retrospective reconstruction was performed at 2mm intervals, followed by multiplanar reformation. Inboth retrospective reconstructed axial and multiplanar reformation images, the authors analyzed the detection rateand size of the mass, and associated findings including invasion of peripancreatic fat, dilatation of CBD and itsnarrowing pattern, dilatation of the pancreatic duct and its degree of dilatation, wall thickening of CBD,extension of dilated bile duct into the ampulla, and of protruding mass into the duodenal lumen, and lymph nodemetastasis all according to the origin sites of tumors. Differential points were thus determined. RESULTS: Thedetection rate of the masses was 96% (53/55). Their size was 1-5cm, with a mean size of 2.4 +/-0.5cm in carcinomaof of ampulla of Vater and 3.5 +/-1.0cm in pancreatic head carcinoma. Invasion of peripancreatic fat was mostcommonly observed in pancreatic head carcinoma (100%, 18/18) (P >0 . 0 5 ), dilatation of CBD was observed in allcases except one of periampullary duodenal cancer (98%, 54/55), and abrupt termination of dilated bile duct wasnoted in all cases except one of the pancreatic head carcinoma (98%, 53/54). Dilatation of pancreatic duct wascommonly observed in pancreatic head carcinoma (94%, 17/18) and carcinoma of the ampulla of Vater (75%, 12/16).Its degree of dilatation was mostly moderate in pancreatic head carcinoma (56%, 10/18) and mostly mild incarcinoma of the ampulla of Vater (63%, 10/16) ( P >0.05). Wall thickening of the distal CBD was most commonlyobserved in distal CBD carcinoma (76%, 13/17). Extension of dilated bile duct into the ampulla was commonlyobserved in the carcinoma of the ampulla of Vater (81%, 13/16) and periampullary duodenal cancer (75%, 3/4) (P>0.05). A mass protruding into the duodenal lumen was commonly observed in periampullary duodenal cancer (100%,4/4) and carcinoma of the ampulla of Vater (94%, 15/16) (P >0.05). Lymph node meatastasis was observed inpancreatic head carcinoma (17%, 3/18) and distal CBD carcinoma (6%, 1/17). CONCLUSION: Because of improvement inthe rate at which the mass is detected, and a clear demonstration of associated findings, helical CT is useful inthe differentiation of periampullary carcinomas.

Accuracy of MR Imaging for Resectability of Extrahepatic Bile Duct Carcinoma

PURPOSE: To determine the accuracy of preoperative MR imaging for evaluation of resectability of extrahepaticbile duct carcinoma. MATERIALS AND METHODS: Thirty-four patients with proven extrahepatic bile duct carcinomaunderwent pre-operative MR imaging. All MR examinations were performed with a 1.5 T system, using a phased-arraymulticoil. Tumor resectability was prospectively determined by two radiologists who reached consensus. Tenpatients did not undergo surgery because the preoperative MR imaging, CT and endoscopic findings all indicatedunresectability. Twenty-five patients subsequently underwent surgical exploration, and their imaging andpathologic and laparotomic findings were compared. RESULTS: Twenty-two of 34 cases (65%) were resectable. Amongthe 22 cases resectable in laparotomy, pre-operative MR imaging had suggested that 20 were resectable, andsensitivity for resectability was thus 91%. Among the 22 cases in which MR imaging had suggested resectability,macroscopic clearance was complete in 20, giving a positive value of 91%. MR imaging underestimated portal venousor hepatic arterial invasion, and in one case missed small (<1 cm) hepatic metastases. In two cases, MR imagingoverestimated portal venous or hepatic arterial encasement. CONCLUSION: MR imaging is a useful diagnosticmodality for preoperative assessment of resectability of extrahepatic bile duct cancer.

CT Findings of Malignancies Occurring in Choledochal Cysts: Differential Points with Benign Inflammations

PURPOSE: To demonstrate CT findings of malignancies occurring in choledochal cysts focusing on the differential points with benign inflammation. MATERIALS AND METHODS: The CT findings of seven patients with malignancies occurring in choledochal cysts(six cholangiocarcinomas and one cholangiohepatoma) and three with benign inflammatory wall thickening were reviewed. Six were studied with two-phase(arterial and portal) CT(threethe malignancies and all benign inflammations) and the remainder with conventional CT in the late portal or equilibrium phase. Spiral dynamic CT scans were performed in all two phase CT, except in the case of onemalignancy. The study was focused on the shape and enhancement pattern of the lesions and the presence of localinvasion or distant metastasis. RESULTS: Three of seven associated malignancies showed concentric wall thickening(mean wall thickness=11.3mm), two eccentric, wall thickening and two polypoid masses. Two of three arterial phase CT scans showed tumor enhancement and one showed low attenuating concentric wall thickening, well delineated from a strongly enhanced pancreas. In portal or delayed phase CT scans, all masses were isodense orslightly hypodense compared with the liver or pancreas. Extensive regional lymphadenopathy or distant metastasis was present in six patients at the time of diagnosis. Three cases of benign inflammatory wall thickening showed athinner wall(mean thickness=5mm), and two showed arterial enhancement of the inner wall with only, a diffuse and even pattern. On preoperative CT diagnosis, two cases of benign inflammatory wall thickening were misdiagnosed as malignancies. CONCLUSION: Concentric wall thickening type was the most difficult to differentiate from benign wall thickening. Irregular wall thickening of more than 10mm and enhancement of the whole thickeness of the wall is a reliable sign of malignancy. Dynamic spiral CT is essential for this evaluation.