The imaging and differential diagnosis of sclerosing cholangitis / 中国医学装备

Sclerosing cholangitis includes a spectrum of chronic, variably progressive cholestatic liver disease characterized by inflammation, fibrosis and stricture of the intrahepatic and extrahepatic bile ducts. Sclerosing cholangitis can be divided into primary sclerosing cholangitis of unidentified etiology and secondary sclerosing cholangitis caused by various identifiable etiologies, including immunoglobulin G4-related sclerosing cholangitis, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndromerelated cholangitis and eosinophilic cholangitis. In this article, we describe the imaging findings of the various spectrums of sclerosing cholangitis with anemphasis on a systemic approach in differential diagnosis. It is very important for magnetic resonance cholangiography and endoscopic cholangiography in imaging diagnosis and differential diagnosis of sclerosing cholangitis. We also discuss the clinical significance and therapeutic options for treating sclerosing cholangitis.

Doença de Caroli complicada com abscesso hepático: relato de caso / Caroli's disease complicated with liver abscess: case report

A doença de Caroli é uma má-formação congênita rara caracterizada por dilatações multifocais dos ductos biliares intra-hepáticos que predispõem a colestase e episódios recorrentes de colangite. Descrevemos o caso de um paciente jovem diagnosticado com doença de Caroli, por meio da colangiorressonância, que complicou com abscesso hepático e foi submetido a drenagem cirúrgica.

Caroli's disease is a rare congenital malformation characterized by multifocal dilatation of intrahepatic bile ducts predisposing to cholestasis and recurrent cholangitis. The authors describe the case of a young patient with Caroli's disease diagnosed by magnetic resonance cholangiography and complicated with liver abscess, being submitted to surgical drainage.

Tumor de la confluencia hiliar hepática (Klatskin) / Hilar Cholangiocarcinoma (Klatskin tumor)

Se revisa el caso clínico de un paciente de 71 años que cursa con una lesión obstructiva del hilio hepático, la evolución clínica, los estudios imagenológicos y los paraclínicos sugieren un tumor de Klatskin, el cual fue manejado por derivación biliar percutánea aliviando la ictericia. En la presente revisión se consideran los factores etiopatogénicos de estos tumores, su nueva clasificación anatómica así como las diversas alternativas del estudio por imágenes, enfatizando en la clasificación de Bismuth-Corlette. Se confrontan las alternativas de paliación, como los diferentes tipos de stents endoscópicos o el abordaje percutáneo, la extensión del drenaje (uni o bilateral). Por último, se revisan los aspectos quirúrgicos y las posibilidades de quimio y radioterapia en estos tumores.

This is a clinical case of a 71-year-old man with an obstructive lesion of the hepatic hilum, the clinical, imaging studies and the lab tests suggest a Klatskin tumor, which was managed by percutaneous biliary drainage to relieve the jaundice. In this review we consider the pathogenetic factors of these tumors, a new anatomic classification and the various alternative imaging studies, emphasizing the Bismuth-Corlette classification. Confront palliative alternatives, such as different types of endoscopic stents or percutaneous approach, drainage extension (uni or bilateral). Finally, we review the surgical aspects and possibilities of chemotherapy and radiotherapy in these tumors.

The application of 16-slice CT cholangiography with MPR technique in biliary obstruction / 重庆医科大学学报

Objective:evaluate the diagnostic use of 16-slice CT cholangiography with multiplanar reformation(MPR)for the assessment of patients with biliary obstruction.Methods:16-slice CT cholangiography with the MPR technique was performed in 60 patients who were thought to have biliary obstruction.No cholangiographic contrast agent was administered.MRCP in 24 patients,Endoscopic retrograde cholangiopancreatography(ERCP)in 16 patients,and 28 patients underwent biopsy or surgery.The findings on 16-slice CT cholangiography were compared with those of MRCP,ERCP,biopsy or surgery.the surgical-pathological result was regarded as gold standard.Results:The findings were as follows:choledocholithiasi(sn=34),malignant stricture(n=14),benign stricture(n=2),and cholelithiasi(sn=1).A small common bile duct stone in one patient could not be detected by 16-slice CT cholangiography.Two patients with initial diagnoses of small common bile duct stone by 16-slice CT cholangiography were disclosed to have malignant bile ductstricture by reference examination.The accuracy of 16-slice CT cholangiography for the diagnoses of bile duct stones and bile duct stricture were 91.1% and 88.9% respectively.Conclusion:16-slice CT cholangiography with the MPR technique is a fast and non-invasive technique with relatively high accuracy for the diagnoses of the causes of biliary obstruction.

MR Cholangiography and Dynamic Examination of Duodenal Fluid in the Differential Diagnosis between Extrahepatic Biliary Atresia and Infantile Hepatitis Syndrome / 华中科技大学学报（医学）（英德文版）

In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 pa tients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4 % and specificity 88.24 %. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4 % and specificity 97.06 %. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better resutls.

Clinical Usefulness of Magnetic Resonance Cholangiagraphy and Computed Tomography Cholangiography in Primary Sclerosing Cholangitis / 대한소화기내시경학회지

Primary sclerosing cholangitis(PSC) is rare disease which is characterized by inflammation and obliteration of bile duct leading to biliary cirrhosis and liver failure. The cause of PSC is unknown although a number of potential etiologic factor have been investigated. The diagonsis is confirmed by typical cholangiographic demonstration with clinical features. On endoscopic retrograde cholangiopancreatography(ERCP), multifocal strictures involving both intra and extrahepatic bile ducts are most common; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance, the "pruned-tree" appearance due to diminished arborization of the intrahepatic duct, band-like stricture, and diverticular-like outpouching(s) are seen occasionally on cholangiography, and the report of primary sclerosing cholangitis in Korea is being increased due to increased use of ERCP. Recently, magnetic resonance cholangiography(MR cholangiography) and computed tomography cholangiography(CT cholangiography) are newly developed adjunctives for evaluation of patients with biliary disease(s). We performed MR cholangiography and CT cholangiography through the nasobiliary tube in two patients with PSC, in which typical intrahepatic bile duct changes of PSC were seen as in ERCP. Now, we report MR cholangiographic and CT cholangiographic findings in patients with PSC and suggest that these radiologic studies, especially MR cholangiography, can be used as an alternative methods for serial follow-up after definite diagnosis by ERCP.