The Decision-making Value of Magnetic Resonance Cholangiopancreatography in Patients Suspicious for Pancreatobiliary Diseases / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an operator-dependent procedure and has significant procedure-related morbidity and mortality. Magnetic resonance cholangiopancreatography (MRCP) is a safe noninvasive method for pancreatobiliary imaging. The aims of this study were to evaluate the potential impact of MRCP on performing ERCP and to evaluate the decision-making value of MRCP in patients suspicious for pancreatobiliary diseases. METHODS: Two hundreds twelve patients (M:F 108:104, mean age 59.3+/-13.7) who underwent MRCP due to clinical or sonographic suggesting pancreatobiliary disease were included. We divided patients into four groups according to their presumptive diagnosis: biliary stone (group 1), biliary tumor (group 2), gallstone pancreatitis (group 3) and other biliary diseases (group 4). RESULTS: Numbers of cases in group 1, 2, 3 and 4 were 145, 43, 17 and 7, respectively. In 144 cases (67.9%), ERCP was unnecessary and 76 cases (35.8%) required neither ERCP nor any other treatment. Thereafter, these cases were thought to be a patient group in whom the workload of performing ERCP could be reduced. CONCLUSIONS: MRCP can reduce the number and efforts doing ERCP and is helpful in decision-making for the treatment of pancreatobiliary disease. Therefore, MRCP could be the primary diagnostic tool before choosing ERCP.

MR Imaging Findings of Patellar Tendon after Anterior Cruciate Ligament Reconstruction with Bone-Tendon-Bone Autograft

PURPOSE: To evaluate the postoperative changes occurring in the patellar tendon after reconstruction of the anterior cruciate ligament (ACL) using the central one-third of the patellar tendon together with patellar and tibial bony plugs. MATERIALS AND METHODS: Ten patients with ACL injury underwent sagittal and coronal T1-weighted MR imaging of both postoperative and normal knee joints. In all cases, reconstruction of the ACL was performed using the central one-third of the patellar tendon, together with patellar and tibial bony plugs. During the follow-up period of 6-27 months, patient were clinically stable. We compared the length, signal intensity and contour of both patellar tendons, as seen on MR images. RESULTS: No defects was found in harvested patellar tendons, and MR images showed high signal intensity within harvested tendons in six of the ten patients. In seven of ten, patellar tendons had irregular margins and were poorly delineated from adjacent tissue. The mean length of patellar tendons was 44.2+/-2.9 mm in normal knee and 43.9+/-3.1mm in postoperative knee, while their mean thickness in postoperative knee, measured at mid-portion, averaged 4.3+/-1.2 mm. There were no statistically significant differences (p>0.05). The greatest mean thickness of patellar tendon was 6.9+/-1.2 mm and 4.3+/-0.5mm in normal and postoperative knee, respectively. Thus, on average, postoperative patellar tendon was 161% thicker than normal tendon (p<0.05). CONCLUSION: In clinically stable patients, patellar tendons after graft harvesting had a higher signal intensity, worse-defined margins and a greater thickness than normal. We suggest that these are the normal postoperative findings.

MRI Findings of Extramedullary Hematopoiesis of the Spleen in Patient with Idiopathic Myelofibrosis: 2 case report

MRI findings of extramedullary hematopoiesis of the spleen have not been described in the literature. Wereport the MRI features of this condition, as seen in two patients and confirmed by fine needle biopsy. Threesmall masses(< or =3cm) were isointense on T1WI, hyperintense on T2WI, and enhanced after the injection of gadolinium.Two 6cm-sized masses were hypointense on both T1WI and T2WI, and showed no contrast enhancement.

Normal Variation of Right Gastric Artery Origin on Abdominal Angiogram

PURPOSE: To evaluate the normal variations in the origin of the right gastric artery (RGA), as seen on abdominal angiogram. MATERIALS AND METHODS: Four hundred and twenty-six patients underwent celiac and superior mesenteric arteriogram, and in 154, the origin of the RGA was identified (M:F=116:38 ; mean age, 56 years ; range, 6-84 years). Digital subtraction angiography were performed in 101 patients, and conventional angiography in 53 ; we thus evaluated the origin of the RGA, normal variation of the hepatic artery, and the relationship between them. RESULTS: The origin of the RGA was the proper hepatic artery (PHA) in 43% of cases (n=67), the left hepaticartery (LHA) in 41% (n=63), the common hepatic artery (CHA) in 9% (n=14), the right hepatic artery (RHA) in 4% (n=6),and the gastroduodenal artery (GDA) in 3% (n=4). of these 154 patients, 126 (82%) showed a normal hepatic artery branching pattern, with both hepatic arteries arising from the PHA ; in 18 patients (12%), the RHA arose from the superior mesenteric artery (SMA), and in 6 patients (4%), the LHA arose from the left gastric artery (LGA). In 4 patients (3%), other branching patterns of the hepatic artery were noted. In 16 of 18 patients (89%) whose RHA arose from the SMA, the RGA originated in the LHA ; in the other two, the RGA arose from the GDA and CHA, respectively. CONCLUSION: In 43% of cases, the main site from which the RGA originated was the PHA, and in 41%, the LHA, as seen on abdominal angiogram. Where the RHA arose from the SMA, its most frequent site of origin, seen in 89% of cases, was the LHA. The exact recognition of the origin of the RGA, as seen on abdominal angiogram, could lead to a reduction of transarterial chemoembolization-related gastric complications.

Quantitative Evaluation in Enhancement of Pancreas and Adjacent Vessels during Spiral CT

PURPOSE: To determine by quantitative evaluation of pancreatic and adjacent vascular enhancement during spiral CT, the ideal scan delay for examination of the pancreas. MATERIALS AND METHODS: Dual (n=90) and triple (n=90) phase spiral CT scans of patients whose pancreas showed no pathologic condition were retrospectively evaluated. Dual-phase scans were performed at 43 seconds (early), and 5-6 minutes (delayed) after the injection of 120ml of contrast material at an injection rate of 3ml/sec ; triple-phase scans were performed at 25 seconds (arterial), 60-65 seconds (portal) and 5-6 minutes (delayed) after the injection of 120-140ml of contrast material at an injection rate of 2-4ml/sec, and ten patients also underwent precontrast scanning. CT attenuation values (HU) were measured in the head, body and tail of the pancreas, aorta, and main portal vein during each phase of all scans. Triple-phase protocol was used to measure the effect of different total volumes and injection rates on enhancement of the pancreas and adjacent vessels. RESULTS: There was no significant difference in the degree of enhancement of the pancreas head, body and tail during each phase (p>0.05). The pancreas was maximally enhanced on 43 second delayed scan (132+/-20 HU)(p0.05). The main portal vein showed maximum enhancement on 43-second delayed scan (207+/-44 HU)(p<0.05). Different total volume of contrast material did not change the enhancement of the pancreas and adjacent vessels. At an injection rate of 2ml/sec, peak enhancement of the pancreas, aorta and portal vein was obtained on 60-65 second delayed scan, and at 4ml/sec, peak enhancement was obtained on 25 second delayed scan(p<0.05). CONCLUSION: Observing the usual protocols for abdominal spiral CT scanning, the pancreas was most effectively evaluated using a 43-second delayed scan. An increased injection rate resulted in earlier enhancement of the pancreas, aorta and portal vein.