Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation / 器官移植

Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation. Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography (ERCP) for the first time were retrospectively analyzed. Preoperative conditions, intraoperative manifestations, treatment outcomes and complications of patients treated with SpyGlass system were analyzed. Results Fifty-six patients were treated with SpyGlass system. The main preoperative symptoms included abdominal discomfort in 38 cases, fever in 8 cases, jaundice in 6 cases and skin itching in 4 cases. Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation. Preoperative magnetic resonance cholangiopancreatography (MRCP) of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones, 16 cases of common bile duct stenosis alone and 4 cases of suspected tumors. All patients had definite indications for SpyGlass system treatment. Among 56 patients treated with SpyGlass system, 34 cases were diagnosed with anastomotic stricture complicated with stones, 12 cases of anastomotic stricture alone, 1 case of biliary stone and 4 cases of tumors. Among 48 cases who were successfully treated, the levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels (all P<0.05). No severe complications occurred in 56 patients treated with SpyGlass system. Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation, which is worthy of promotion and application.

Value of extrahepatic bile duct and main pancreatic duct segment patterns on MRCP to differentiate the periampullary carcinoma / 中华肝胆外科杂志

Objective:To investigate the value of the extrahepatic bile duct and main pancreatic duct segment patterns on magnetic resonance cholangiopancreatography (MRCP) for differentiating the periampullary carcinoma (PAC).Methods:The clinicopathologic data of 125 patients with PAC who were admitted to Wuxi No.2 People’s Hospital from June 2013 to December 2021 were retrospectively analyzed, including 72 males and 53 females, aged (64.9±8.6) years. According to its anatomy, the extrahepatic bile duct (B) was divided into suprapancreatic and intrapancreatic (including ampullary) segments, and the main pancreatic duct (P) was divided into tail-body and head segments. MRCP patterns: i. the extrahepatic bile duct or main pancreatic duct visible without dilatation, ii. cutoff of the distal extrahepatic bile duct or main pancreatic duct with upstream dilatation, iii. cutoff of the intrapancreatic or head segment with upstream dilatation and remnant intrapancreatic or head segments invisible, iv. cutoff of the intrapancreatic or head segment with upstream dilatation and nondilated remnant intrapancreatic or head segments, were represented as 0, 1, 2, and 3, respectively. Segment patterns of B1/P0+ B1/P1, B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3, B3/P0, and B0/P0+ B2/P0 on MRCP were compared in PAC patients.Results:Of the 125 patients, there were 57 (45.6%) with pancreatic head carcinoma, 36 (28.8%) with ampullary carcinoma, 20 (16.0%) with distal cholangiocarcinoma, and 12 (9.6%) with periampullary duodenal carcinoma. Segment patterns of B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3 were found in 52 patients with pancreatic head carcinoma (91.2%, 52/57), with a significant difference between PAC (χ 2=110.66, P<0.001). Segment patterns of B1/P0+ B1/P1were found in 36 patients with ampullary carcinoma (100.0%, 36/36), fallowed by 11 (91.7%, 11/12) with periampullary duodenal carcinoma, with a significant difference between PAC (χ 2=129.95, P<0.001). Segment pattern of B3/P0 presented in 16 patients with distal cholangiocarcinoma (80.0%, 16/20), with a significant difference between PAC (χ 2=62.45, P<0.001). The segment patterns of B0/P0+ B2/P0 were only seen in 3 of 57(5.3%) patients with pancreatic head carcinoma. Conclusion:On MRCP, cutoff of the head segment with upstream dilatation and remnant head segment invisible or nondilated indicates the pancreatic head carcinoma. Cutoff of the intrapancreatic segment with upstream dilatation, remnant intrapancreatic segment visible, and main pancreatic duct nondilated, indicates the distal cholangiocarcinoma. And cutoff of the distal extrahepatic segment with upstream dilatation and main pancreatic duct dilatation or not, indicates the ampullary or periampullary duodenal carcinoma.

Research advances in the diagnosis and treatment of benign gallbladder disease / 中华肝胆外科杂志

Benign gallbladder diseases are common in general surgery practice, and laparoscopic cholecystectomy (LC) has become the standard treatment for these conditions. With the widespread adoption of LC and the improved understanding of gallbladder disease, it is necessary to re-evaluate the diagnosis and treatment of benign gallbladder disease. Based on the latest expert consensus on the diagnosis and treatment of benign gallbladder disease, this review aims to provide an overview of the diagnostic and treatment strategies for benign gallbladder diseases. Specifically, it focuses on enhancing our understanding of the role of benign gallbladder diseases in the development of gallbladder cancer, the impact of congenital biliary anomalies on the diagnostic and treatment processes of benign gallbladder diseases, and the significance of the preoperative examinations.

Acurácia do protocolo abreviado de colangioressonância magnética no diagnóstico de coledocolitíase / Accuracy of abbreviated protocol of magnetic resonance cholangio-pancreatography in the diagnosis of choledocholithiasis

ABSTRACT Background: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. Objective: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. Methods: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. Results: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). Conclusion: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.

RESUMO Contexto: Protocolos abreviados de ressonância magnética (RM) surgiram a fim de reduzir o tempo de exame, eliminando sequências de pulso desnecessárias para responder a uma questão clínica específica, sem comprometer o diagnóstico. Objetivo: O objetivo do estudo foi avaliar a acurácia diagnóstica de um protocolo abreviado de colangiopancreatografia por ressonância magnética (colangioRM) em pacientes com suspeita de coledocolitíase. Métodos Estudo retrospectivo, com pacientes acima de 10 anos que realizaram exame de colangioRM, entre outubro de 2019 a junho de 2020, com suspeita clínica de coledocolitíase. Os observadores, radiologistas especialistas, primeiro avaliaram a árvore biliar usando um protocolo abreviado de colangioRM composto por quatro sequências de pulso e, posteriormente, revisaram o protocolo convencional de colangioRM de 11 sequências. A presença de coledocolitíase, o tamanho do cálculo, o calibre do ducto hepático comum e achados adicionais foram avaliados. Resultados Um total de 148 pacientes foram incluídos, sendo 62,8% do sexo feminino, com média de 50,9 anos de idade. A prevalência de coledocolitíase foi de 32,2%. A acurácia do protocolo abreviado de colangioRM para coledocolitíase foi de 98,7%. Não houve diferença entre o desempenho dos protocolos abreviado e convencional de colangioRM para a detecção de coledocolitíase (k=0,970), com uma sensibilidade de 98% e uma especificidade de 99%. Além disso, observou-se excelente concordância entre observadores na avaliação de coledocolitíase em ambos os protocolos de colangioRM (k=0,925). Conclusão O protocolo abreviado de colangioRM apresentou excelente acurácia para o diagnóstico de coledocolitíase quando comparado ao protocolo convencional.

Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation / 器官移植

Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.

Diagnosis and treatment of common biliary complications after orthotopic liver transplantation in adults / 器官移植

Liver transplantation has become an effective treatment for end-stage liver diseases. With rapid development of surgical techniques, donor selection, organ preservation and transportation, immunosuppressants and perioperative management, the overall incidence of complications after liver transplantation has been significantly decreased, whereas the incidence of biliary complications remains relatively high. At present, biliary complications after liver transplantation are still an important cause of graft failure. Nevertheless, the pathogenesis, diagnosis and treatment of biliary complications remain controversial, which are also research hotspots in the field of organ transplantation in recent years. In this article, new breakthrough and research progress upon biliary complications after orthotopic liver transplantation in adults were reviewed, aiming to provide theoretical basis for resolving biliary complications-related clinical issues.

Anomalía de la unión biliopancreática: una entidad infrecuente en Occidente / Pancreaticobiliary maljunction: a rare entity in the West

Resumen La anomalía de la unión biliopancreática (AUBP) es una malformación congénita en la que los conductos pancreáticos y biliares se unen anatómicamente fuera de la pared duodenal. Debido a la excesiva longitud del canal común, la acción del esfínter no afecta la unión pancreatobiliar, lo que permite el reflujo del jugo pancreático hacia la vía biliar. Se asocia con quistes del colédoco y sus manifestaciones incluyen cáncer de la vía biliar, pancreatitis, coledocolitiasis y colangitis. Es una rara patología, especialmente en países occidentales. La colangiopancreatografía por resonancia magnética (CPRM) se ha convertido en el método más utilizado por no ser invasivo, teniendo en cuenta que la colangiopancreatografía retrógrada endoscópica (CPRE) se encuentra contraindicada en casos de pancreatitis aguda y colangitis, además del riesgo de pancreatitis posterior al procedimiento. La distancia entre la unión biliopancreática y la pared duodenal debe ser superior a 9 mm de longitud para diagnosticar AUBP mediante CPRM. En caso de que mida entre 6 y 9 mm y la acción del esfínter afecte la unión pancreatobiliar, se lo denomina unión biliopancreática alta (UBPA) y se debe confirmar mediante CPRE. Describimos los hallazgos en imágenes de siete pacientes jóvenes con clínica abdominal y diagnóstico de AUBP o UBPA por CPRM, y además revisamos la literatura sobre el tema.

Abstract Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and biliary ducts are anatomically joined outside the duodenal wall. Due to the excessive length of the common channel, the action of the sphincter does not affect the pancreaticobiliary junction, allowing the reflux of pancreatic juice into the bile duct. It is associated with cysts of the common bile duct and its manifestations include cancer of the bile duct, pancreatitis, choledocholithiasis and cholangitis. It is a rare pathology, especially in Western countries. Magnetic resonance cholangiopancreatography (MRCP) has become the most used method because it is non-invasive, taking into account that endoscopic retrograde cholangiopancreatography (ERCP) is contraindicated in cases of acute pancreatitis and cholangitis, in addition to the risk of pancreatitis after the procedure. The distance between the biliopancreatic junction and the duodenal wall must be greater than 9 mm in length to diagnose PBM by MRCP. If it is between 6 to 9 mm and the action of the sphincter affects the pancreaticobiliary junction, it is called high confluence of pancreaticobiliary ducts (HCPBD) and should be confirmed by ERCP. We describe the imaging findings of 7 young patients with abdominal symptoms and diagnosis of PBM or HCPBD by MRCP, and also review the literature on the subject.

Colangitis esclerosante primaria / Primary sclerosing cholangitis

La colangitis esclerosante primaria (CEP) se define por la inflamación, fibrosis y estenosis de los conductos biliares intra o extrahepáticos que no pueden ser explicadas por otras causas. La prevalencia de CEP está estimada entre 0 a 16,2 por 100.000 habitantes, mientras que la incidencia está entre 0 y 1,3 casos por cada 100.000 personas por año. Las causas siguen siendo difíciles de dilucidar y en muchos casos se establece como de origen idiopático. Sin embargo, se han propuesto factores genéticos, ambientales e isquémicos asociados, además de un componente autoinmune. Existe además una fuerte asociación entre la enfermedad inflamatoria intestinal y la CEP. Los síntomas suelen ser inespecíficos, 50% de los pacientes son asintomáticos, presentando únicamente alteración en el perfil hepático de patrón colestásico, con predominio de elevación de la fosfatasa alcalina. La ictericia es un signo de mal pronóstico que con frecuencia se asocia a colangiocarcinoma. La confirmación diagnóstica se hace por colangiopancreatografía retrógrada endoscópica (CPRE) e imágenes por resonancia magnética. Aún no existe un tratamiento establecido, y en la mayoría de los casos coexiste con otras patologías. El tratamiento es multimodal con fármacos, terapia endoscópica y trasplante hepático.

Primary sclerosing cholangitis (PSC) is defined by inflammation, fibrosis, and stenosis of the intra or extrahepatic bile ducts that cannot be explained by other causes. The prevalence of PSC is estimated between 0 to 16.2 per 100,000 inhabitants, while the incidence is between 0 and 1.3 cases per 100,000 persons-year. The causes remain elusive and, in many cases, it is established as idiopathic in origin. However, genetic, environmental and ischemic factors have been proposed in addition to an autoimmune component. There is also a strong association between inflammatory bowel disease and PSC. Symptoms are usually nonspecific, 50% of the patients are asymptomatic, presenting only an alteration in the liver profile with a cholestatic pattern, and predominance of elevated alkaline phosphatase. Jaundice is a poor prognostic sign and is frequently associated with cholangiocarcinoma. Diagnostic confirmation is made by endoscopic retrograde cholangiopancreatography and magnetic resonance imaging. There is still no established treatment, and in most cases, the disease coexists with other pathologies. Treatment is multimodal with drugs, endoscopic therapy and liver transplantation.

Preliminary study of early diagnosis by contrast-enhanced ultrasound combined with mesenchymal stem cell therapy in improving prognosis of biliary ischemia after liver transplantation / 器官移植

Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.

Magnetic Resonance Cholangio-Pancreatography in Patients with Acute Cholecystitis and Cholestatic Liver Pattern - What to Expect?.

Acute cholecystitis is a potentially serious condition and usually needs to be treated in the hospital. Identification of a common bile duct (CBD) stone before cholecystectomy is of concern for the treating physicians as management may change. Magnetic Resonance Cholangiopancreatography (MRCP) can help in identifying causes of biliary obstruction (if present) and adequately delineate biliary tree in selected patients with limited or abnormal ultrasounds and cholestatic liver pattern. Therefore, we aim to demonstrate imaging findings of MRCP in such patients of acute cholecystitis, and highlight the diagnostic ability of MRCP in biliary ductal evaluation as well. METHODSThis secondary data analysis from hospital records was performed in Radiology department at our Hospital in Dhahran from August 2017 to 2019. All clinically suspected and ultrasound supported cases of acute cholecystitis who were referred for MRCP studies were included. Dilated CBDs (more than 4 mm in caliber) with partial visualization or non-discernible causes of CBD dilatations, rising or persistently raised LFTs (denoting cholestatic pattern) were the common indications for the MRCP referrals. Patients with chronic cholecystitis, previous hepatobiliary surgery, pregnant patients, and those contraindicated to MRI were excluded. RESULTSOf the 104 patients, majority (60%) were females. The mean age was 43 years. Two-thirds of patients were having normal CBDs (68.3%), while nearly one-third (31.7%) had dilated CBDs, and half of these (16.4%) showed identifiable causes of obstruction that were later confirmed on ERCP and histopathology. Thirteen patients (12.5%) had associated anomalies. Sensitivity and specificity of MRCP in CBD evaluation were measured as 90.5% (CI, 79.3-96.8) and 86.2% (CI, 73.7-94.3) respectively. The length of the hospital stay was found to be significantly less in laparoscopic cases compared to open cholecystectomies (P= 0.0005). CONCLUSIONSMagnetic resonance cholangiopancreatography can help in identifying the causes and anomalies in patients with acute cholecystitis having deranged or obstructive liver function.

Coledococele: caso diagnosticado por resonancia magnética / Choledococele: case diagnosed by MRI

Resumen: El coledococele es una dilatación quística del segmento distal del conducto biliar común que sobresale en el lumen duodenal. Estos comprenden menos del 2% de todos los casos reportados de quistes de colédoco (2). Los hallazgos imagenológicos del coledococele y de los quistes de duplicación duodenal son muy similares, ambos presentan además clínica variada e inespecífica, por lo que el diagnóstico definitivo suele ser durante la cirugía. Presentamos un caso de una paciente de 10 años que consulta por dolor abdominal con elevación de transaminasas que, tras estudio con resonancia magnética con colangioresonancia y EDA se diagnostica coledococele.

Abstract: Choledochocele is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Is also known as type III choledochal cyst according to Todani's classification. It is usually misdiagnosed as duodenal duplication cyst. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiography for diagnosis of choledochocele. We present a case of a 10-years-old girl presented with abdominal pain, elevation of transaminases and a magnetic resonance cholangiopancreatography (MRCP) scan that revealed a choledochocele.

Eficacia de la colangiopancreatografía por resonancia magnética para el diagnóstico de coledocolitiasis de probabilidad intermedia / Efficacy of cholangiopancreatograghy by magnetic resonance in the diagnosis of choledocholithiasis of intermediate probability

Introducción. La coledocolitiasis de probabilidad intermedia es una condición con gran morbilidad por el riesgo de pancreatitis y colangitis, y se requiere el estudio de la vía biliar para su enfoque diagnóstico y terapéutico. Actualmente, el método de referencia para su diagnóstico y tratamiento, es un examen invasivo, la colangiopancreatografía retrógrada endoscópica (CPRE), que no siempre lleva a un diagnóstico positivo de coledocolitiasis, pero sí implica exponer a los pacientes a sus riesgos. Por esta razón, la colangiopancreatografía por resonancia magnética (CPRM) ha tomado importancia en el diagnóstico, ya que es un examen no invasivo y con menor riesgo de complicaciones, por lo que se pretende evaluar su uso en la coledocolitiasis de probabilidad intermedia. Métodos. Se llevó a cabo un estudio de pruebas diagnósticas en una muestra de pacientes con coledocolitiasis de probabilidad intermedia, en la Fundación Salud El Bosque, entre enero de 2012 y agosto de 2015. Resultados. Se incluyeron 151 pacientes con diagnóstico de coledocolitiasis de probabilidad intermedia. Se evaluaron las características de la CPRM, la cual mostró sensibilidad de 88 %, especificidad de 79 %, valor predictivo positivo (VPP) de 88 % y valor predictivo negativo (VPN) de 96 %, con un índice de exactitud de 94,7 %. Conclusiones. La CPRM es un examen con un rendimiento adecuado en la evaluación de los pacientes con coledocolitiasis de probabilidad intermedia. En estos casos permite obviar la CPRE diagnóstica. El impacto de la dilatación de la vía biliar sumada a otras alteraciones del perfil hepático, no se puede establecer con este estudio

Introduction. Patients with intermediate probability of choledocholithiasis exhibit a highly morbid pathology due to the risk of developing pancreatitis and cholangitis; it demands the study of the bile duct for appropriate diagnostic and therapeutic approach. Currently, the gold standard for its diagnosis and treatment is an invasive examination, ERCP, which not always ends with positive diagnosis of choledocholithiasis, exposing the patient to the associated risks. This is why magnetic resonance cholangiopancreatography has acquired importance in the diagnosis, for it is a non-invasive procedure with lesser risk of complications. For this reason we decided to evaluate its use in mid-probability choledocholithiasis. Methods. A study of the diagnostic tests was carried out in a sample of 151 patients with intermediate probability of choledocholithiasis at our center, Fundación Salud El Bosque (Bogotá, Colombia), in the period 2012-2015. Results: A total of 151 patients with the diagnosis of choledocholithiasis of intermediate probability were included, evaluating the characteristics of the MRCP, which showed sensitivity of 88%, specificity 79%, PPV88% and NPV 96%, with an accuracy index of 94.7%. Conclusions. MRCP is a test that exhibits adequate performance in the evaluation of patients with intermediate probability of choledocholithiasis, avoiding the performance of ERCP. It confirms its previous use when faced with mid-chance choledocholithiasis. The diagnostic impact of dilation of the bile duct and other alterations of the liver profile can not be established with this study

Radiological and pulmonary function test assessment in clinically stable bronchiectasis patients

Background: Bronchiectasis is a disease in which patients spends morbid life having dyspnoea and productive, often foul-smelling sputum which produces social isolation and depressive states. The mortality rate in bronchiectasis patients 2, states the mortality rate of bronchiectasis in 12 years follow up period is 29.7% in the age group at 52 in 1years. 70% cause of death in bronchiectasis is due to respiratory tract infection leading to respiratory failure. Aim of the study: To evaluate the Bronchial inflammatory response and its relationship to bacterial colonization through radiological evaluation. Materials and methods: This study was done for a period of 7 months from February 2016 to August 2016 in the Department of Thoracic Medicine, Government Villupuram Medical College, Villupuram. The Bacterial flora from Lower Respiratory tract of Bronchiectasis patients who attended Thoracic Medicine Outpatient Department with diagnosis confirmed by a radiologist was studied. Bronchoalveolar lavage was done as an invasive procedure in 90 patients with bronchiectasis and from 6 patients admitted with chronic upper respiratory symptoms as laboratory control in Interleukin-8 estimation for all the patients radiological and pulmonary function test assessment done. Results: Among the 90 patients in this study Cylindrical types were 53%, Cystic types were 35%, Varicose types were 4.4 %, Traction bronchiectasis were 3% and 3% were mixed types i.e. Cystic A. Sundrarajaperumal, R. Nedunchezhian, D. Ranganathan, V Sundar. Radiological and pulmonary function test assessment in clinically stable bronchiectasis patients. IAIM, 2019; 6(6): 87-91. Page 88 plus cylindrical and Traction plus cylindrical. Spirometry pattern distribution showing Normal spirometer in 14% of patients, Obstructive pattern observed in 64% of patients, Restrictive pattern observed in 15% of patients and the mixed pattern was observed in 7% of patients. Conclusion: Increased incidence of bronchiectasis in females (58%). Cylindrical bronchiectasis was the commonest type followed by Cystic bronchiectasis. Regarding etiology of Bronchiectasis, 42% of bronchiectasis was Idiopathic followed by post infectious 21%. The pulmonary function FEV1< 70% was associated with microorganisms colonization of bronchiectasis airways.

Açai juice as contrast agent in MRCP exams: qualitative and quantitative image evaluation

Abstract This works aims to assess images obtained with administration of açai juice as compared to a manufactured standard iron oxide-based contrast employed as negative oral agents in Magnetic Resonance Cholangiopancreatography (MRCP), employing qualitative and quantitative evaluation. The research was developed with 64 patients submitted to MRCP exams (on 2 days) in a clinic of Curitiba city (Brazil). First (day 1), a manufactured iron oxide-based contrast (A) was offered and later (day 2), açai juice (contrast B) was given to patients. Radiologists (R1 and R2) evaluated the images, classifying them by a score (1-4). In order to have a quantitative assessment, Image J free software was employed generating plots of gray levels against distance of a chosen area of the bile duct interest region. Evaluating images for contrast A, R1 furnished an average score of 3.52 and R2 of 3.27. For contrast B, R1 provided 3.44 and R2 3.38. Both evaluators considered image quality with contrast A adequate for 62 patients. R1 considered adequate for 62 and R2 for 60 patients when using açai juice. By taking same images for all patients with Image J, a quantitative analysis was obtained, resulting correlation coefficient of 0.986 between average curves of contrasts A and B. Thus, açai juice is an adequate alternative as contrast agent in MRCP exams. Image J was employed as a new method for quantitative investigation of image quality, presenting good agreement with medical opinion.

The evaluation of MR imaging in the diagnosis of primary duodenal adenocarcinoma / 实用放射学杂志

Objective To study the imaging features and the diagnostic value of conventional and enhanced MRI,DWI and magnetic resonance cholangiopancreatography (MRCP)in primary duodenal adenocarcinoma.Methods 12 cases with duodenal adenocarcinoma confirmed by pathological results were analyzed by conventional and enhanced MRI,DWI (3.0T,b＝0 and 800 s/mm2 )and MRCP.Results 11 cases out of twelve cases of duodenal adenocarcinoma demonstrated uneven thickening of intestinal wall,while mass shadow was observed in 1 case.Slight hypointensity of T1 WI and slight hyperintensity of T2 WI were demonstrated in all the twelve cases .DWI demonstrated mild increase in signal in 3 cases,while hyperintensity was observed in 9 cases.On MRCP,ampullary obstructions were observed in 1 1 cases,of which 6 were accompanied with the dilatation of common bile duct (CBD),and 5 with dilatation of CBD and pancreatic duct, while no dilatation of CBD or pancreatic duct was observed in 1 case.The tumors showed moderate enhancement after intravenous administration of contrast material.No normal layered intestinal walls were observed.Conclusion Conventional and enhanced MRI combined with DWI can clearly demonstrate the features of duodenal adenocarcinoma.Additionally,MRCP is instrumental in assessing the lesions involved in the duodenal papilla.

Necessity of magnetic resonance cholangiopancreatography in patients with initial diagnosis of gallstones on color Doppler ultrasound and an analysis of related indications / 临床肝胆病杂志

ObjectiveTo investigate the necessity and indication of magnetic resonance cholangiopancreatography (MRCP) in patients with gallstones diagnosed by color Doppler ultrasound. MethodsA retrospective case-control study was conducted. The clinical data of 1431 patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from January 2013 to December 2017 with the initial diagnosis of gallstones were collected. On admission, abdominal ultrasound found gallstones alone, without other lesions. The patients who were diagnosed with gallstones alone after surgical treatment were enrolled as control group, and those who were diagnosed with gallstones and common bile duct stones were enrolled as experimental group. A logistic regression analysis was performed to establish a predictive model for gallstones with common bile duct stones. The receiver operating characteristic (ROC) curve was plotted for the predictive model and each index, and the area under the ROC curve was calculated. ResultsFour indices were finally screened out by the logistic regression analysis, i.e., bile duct dilation (χ1), gallbladder enlargement (χ2), direct bilirubin (DBIL) (χ3), and gamma-glutamyl transpeptidase (GGT) (χ4), and the logistic regression model was Logi(P) = -4.153 + 3.592χ1 + 1.720χ2 + 1.798χ3 + 1.519χ4. In the diagnosis of common bile duct stones missed by color Doppler ultrasound, this model had a sensitivity of 53.4%, a specificity of 99.6%, an accuracy of 925%, and an area under the ROC curve of 0.904, which was significantly better than each index alone. ConclusionMRCP is not necessary for patients diagnosed with simple gallstones by color Doppler ultrasound. However, enlarged gallbladder, a diameter of common bile duct of ＞0.8 cm, DBil＞7 μmol/L, and GGT＞40 U/L are independent risk factors for gallstones with common bile duct stones. The logistic regression model established in this study has high sensitivity and specificity and can provide a reference for to decision-making among clinicians.

Incidentally detected gallbladder agenesis in a child: the importance of identifying anatomic structure

The absence of a gallbladder is a very rare anomaly. While it is usually asymptomatic, it can cause biliary colic symptoms. For these reasons, gallbladder agenesis can be misdiagnosed as a hepatobiliary disease and is diagnosed correctly after surgery. This condition may also be detected through an autopsy for other causative diseases. Abdominal ultrasonography is used as a diagnostic method to detect gallbladder agenesis. Hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography, and endoscopic cholangiopancreatography are also used to make a more accurate diagnosis. In the emergency room, however, gallbladder agenesis can still be misdiagnosed as acute or chronic cholecystitis, leading to the detection of gallbladder agenesis in the operating room. Although some cases of gallbladder agenesis detected in adults during surgery have been reported in Korea, there are no reports of gallbladder agenesis in pediatric patients to date. This paper reports a case of gallbladder agenesis in a symptomatic child that was detected incidentally by a radiographic examination.

A Rare Case of Extrahepatic Left Hepatic Duct Diverticulum: Case Report with Literature Review / 대한췌담도학회지

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.

Value of conventional magnetic resonance imaging combined with magnetic resonance cholangiopancreatography for the diagnosis of portal cholangiocarcinoma / 新乡医学院学报

Objective To investigate the value of conventional magnetic resonance imaging(MRI) combined with magnetic resonance cholangiopancreatography(MRCP) for the diagnosis of portal cholangiocarcinoma (HCCA).Methods Fortysix patients with HCCA in Chaoyang Central Hospital from September 2014 to February 2016 were selected as the research subjects.The characteristics of conventional MRI and MRCP of HCCA were retrospectively analyzed.Results Among the 46 patients with HCCA,33 cases showed portal nodules or irregular lumps blurred with the adjacent tissues,13 cases showed no obvious lump.Among the 33 cases,there were 4 cases of left hepatic duct involvement,7 cases of right hepatic duct involvement,18 cases of the left and right hepatic duct confluence involvement and 4 cases of common hepatic duct involvement.The irregular lumps or portal nodules in coronal Fiesta showed equal signal and slightly higher signal in T2WI.The liver acquisition with volume acceleration (LAVA) scan of 33 cases of portal nodules or irregular lumps showed that 24 cases had no significant enhancement in arterial phase and significant enhancement in delayed phase;and 9 cases had slight enhancement in arterial phase and non significant intensification in delayed phase.The LAVA scan of the 13 cases without obvious lumps showed the thickening of the vascular wall in arterial phase,vascular stenosis,slight enhancement in arterial phase and the significant enhancement in delayed phase.The MRCP examination of 46 cases showed moderate or severe dilatation with "soft rattan like"changes in intrahepatic bile ducts.The rupture of the dilated bile duct in porta hepatis position was found in 33 cases of portal nodules or irregular lumps,and 13 cases showed " empty" or "rat tail-like" stenosis of hepatic portal.The accuracy rates of localization and qualitative diagnosis of conventional MRI in the 46 patients were 80.43％ (37/46) and 82.61％ (38/46),respectively;and those of conventional MRI combined with MRCP were 100.00％ (46/46) and 95.65％ (44/46),respectively.The accuracy rate of localization and qualitative diagnosis of HCCA by MRI combined with MRCP was significantly higher than that by conventional MRI(x2 =8.762,4.039;P ＜ 0.05).Conclusion MRI combined with MRCP has a high diagnostic value for HCCA.

Comparative study of US and MRCP in the diagnosis of obstructive janudice / 实用放射学杂志

Objective To determine the value of ultrasonography(US) and magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of obstructive jaundice.Methods The data of 454 cases(213 cases underwent US,241 cases underwent MRCP) with obstructive jaundice confirmed by clinical or surgery and pathology in our hospital were be collected and analyzed.Results US and MRCP had different characteristics in displaying the different lesions caused obstructive jaundice.There were statistically significant differences for the diagnosis of obstructive jaundice and common bile duct stone and carcinoma of ampulla between US and MRCP (P＜ 0.01).Conclusion US should be the first choice of screening for the diagnosis.MRCP is valuable in differential diagnosis.