Evaluation of the pancreas: a comparison of single thick-slice MR cholangiopancreatography with multiple thin-slice volume reconstruction MR cholangiopancreatography.

OBJECTIVE: The purpose of this study was to assess abilities of single thick-slice MR cholangiopancreatography and multiple thin-slice multiprojection volume reconstruction (MPVR) MR cholangiopancreatography to evaluate diseases in and around the pancreas. SUBJECTS AND METHODS: Eighty-nine patients underwent both single and MPVR MR cholangiopancreatography using a single-shot fast spin-echo technique. Image quality (five-point scale), visualization of the common bile and pancreatic ducts (three-point scale), stenotic, dilatational, or cystic changes of the pancreatic ducts, and other pathologic findings were evaluated. RESULTS: Image quality was high for single and MPVR MR cholangiopancreatography (4.1+/-0.7 and 4.5+/-0.6, respectively). Misregistration was noted in 19 patients with MPVR MR cholangiopancreatography. Ducts on and around the greater duodenal papilla and the common bile duct were revealed better using MPVR than single MR cholangiopancreatography (p < .05). Overall sensitivity, specificity, and accuracy for detection of stenosis of the main pancreatic ducts were 83.3%, 93.6%, and 88.8%, respectively, using single MR cholangiopancreatography and 76.2%, 97.9%, 87.6%, respectively, using MPVR MR cholangiopancreatography. Dilatation of the pancreatic ducts (100%) and cystic changes (n = 17 and n = 19, respectively) were well seen using either single or MPVR MR cholangiopancreatography. Although stenotic changes of the nondilated main pancreatic ducts and their branches were difficult to evaluate using single (62.5% and 14.3%, respectively) or MPVR (43.8% and 21.4%, respectively) MR cholangiopancreatography, single MR cholangiopancreatography better depicted ductal continuity. CONCLUSION: For evaluation of the pancreas, single and MPVR MR cholangiopancreatography provide complementary data; thus, we recommend using a combination of these two MR cholangiopancreatography techniques.

Evaluation of endoscopic ultrasonography as an indicator for surgical treatment of gastric cancer.

BACKGROUND AND METHODS: Clinicopathological analysis of 346 patients with gastric cancer was made retrospectively and new criteria for the indication of a limited operation using endoscopic ultrasonography (EUS) was developed. Suggested new criteria for selecting gastric cancer patients for the limited operation were: (i) the cancer is located in the mucosa and the lymph nodes are not involved as indicated by EUS examination; (ii) the maximum size of the tumour is less than 2.0 cm; (iii) there are no multiple gastric cancers or simultaneous abdominal cancers; and (iv) the mucosal cancer of elevated type less than 2.0 cm is excluded because there are good indications for endoscopic mucosal resection. RESULTS AND CONCLUSIONS: We applied these new criteria to 262 patients and found that the patients who had limited operation had the same prognosis and a better quality of life compared with patients who had the conventional operation.

[Clinical efficacy of MRCP for diagnosis of patients with pancreatic neoplasm].

We examined the usefulness of MRCP in pancreatic cancer compared with ERCP. Moreover, it examined in the same way in focal pancreatitis, too. We compare three findings of 1) main pancreatic duct, 2) branches of the stricture part, 3) side of tail main pancreatic duct about ERCP and MRCP. As for the branches of the stricture part, MRCP was poor compared with ERCP but as for the property of the side of the tail main pancreatic duct, MRCP excelled. The study of mass forming chronic pancreatitis was a similar result and was not the one, which excels ERCP in case of qualitative diagnosis. However, we thought that it was not invasively, suitable behind the digestive operation and digestive passage fault, in case of elapse observation and moreover that MRCP is suitable for pick up the pancreatic cancer in our clinic.

MR and CT cholangiography in evaluation of the biliary tract.

OBJECTIVE: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. MATERIAL AND METHODS: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. RESULTS: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p < 0.05). The cystic duct was demonstrated better by CTC than MRC (p < 0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis. MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. CONCLUSION: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because it depicts RAS clearly.

Nonfunctional paraganglioma of the pancreas: report of a case.

We report herein the case of a 61-year-old man found to have a rare nonfunctional paraganglioma of the pancreas. Interestingly, the preoperative data and images showed similar characteristics to neuroendocrine tumors of the pancreas. Both paragangliomas and neuroendocrine tumors of the pancreas belong to the category of Amine Precursor Uptake and Decarboxylation (APUD) tumors (APUDomas). Thus, it is important to examine the serum level of pancreatic endocrine hormones and a variety of peptides to differentiate paragangliomas of the pancreas from other pancreatic tumors. Paragangliomas of the pancreas grow slowly, so radical resection is recommended to achieve curability with a good prognosis.

A rare case of serous cystadenoma of the pancreas presenting with left-sided portal hypertension.

We herein report the case of a 63-year-old woman with a serous cystadenoma of the pancreas presenting with left-sided portal hypertension secondary to isolated splenic vein occlusion. She was admitted to our hospital for sudden hematemesis. Emergency upper gastrointestinal endoscopy revealed hemorrhagic erosive gastritis and isolated varices in the gastric fundus. An abdominal angiographic study disclosed a large hypervascular tumor of the pancreatic tail which caused isolated splenic vein occlusion by tumor compression and formed large hepatopetal collaterals via the gastric varices. The patient underwent tumor resection with splenectomy and, as a result, the gastric varices disappeared and the postoperative course was uneventful. Left-sided portal hypertension secondary to splenic vein occlusion is an uncommon complication mostly associated with pancreatitis and pancreatic carcinoma. Although benign pancreatic neoplasms only rarely cause such a condition, the possibility of gastrointestinal bleeding due to this condition should be carefully taken into consideration when treating pancreatic disease.

Anterior extension of acute pancreatitis: CT findings.

OBJECTIVE: The purpose of this study is threefold: (a) to specify the pathway of the extension of pancreatitis to the anterior abdominal wall, which is clinically famous as the Cullen sign; (b) to assess if this pattern of involvement affects a patient's prognosis; and (c) to seek its association with the inflammatory processes that take place in the vicinity of the pancreatic head. MATERIALS AND METHODS: The CT findings of 277 patients with acute pancreatitis were retrospectively reviewed. RESULTS: Inflammatory changes involved the anterior abdominal wall in 5 of 277 cases (1.8%) with acute pancreatitis. Inflammatory processes seemed to have been delivered to the anterior abdominal wall from the pancreatic head and the hepatoduodenal ligament and along the falciform ligament. The probable triggers of acute pancreatitis in such cases were endoscopic retrograde cholangiopancreatography in two cases, alcohol intake in one case, and one case unknown. Three of five cases had proven or suspected choledocholithiasis or cholelithiasis. All five patients got well after proper treatments for acute pancreatitis. CONCLUSION: The results of our review suggest that the anterior extension of acute pancreatitis does not directly mean extensive retroperitoneal involvement of the phlegmon or pseudocysts nor fatal prognosis either and that this style of extension might be associated with inflammatory processes that occur around the pancreatic head.

[Enhanced delineation of the pancreatic duct in MR cholangiopancreatography (MRCP) with a combined use of secretin].

Magnetic resonance cholangiopancreatography (MRCP) is a method that can depict the main pancreatic duct non-invasively; however, its tendency to overestimate ductal stenosis is being noted. The authors used secretin to stimulate the output of pancreatic juice, which increased the signal of the main pancreatic duct and consequently minimized the occurrence of pseudostenosis artifacts in MRCP. MRCP images of 54 patients suspected of having pancreatic disease were visually evaluated by two observers before and after administration of secretin (1 clinical unit/kg). Improved delineation of the main pancreatic duct (68.5-59.3%, p < 0.05) and its side branches (40.7-29.6%, p < 0.05) was obtained with good interobserver agreement (kappa = 0.71-0.68).

Breath-hold MR cholangiopancreatography with a long-echo-train fast spin-echo sequence and a surface coil in chronic pancreatitis.

PURPOSE: To assess heavily T2-weighted breath-hold magnetic resonance cholangiopancreatography (MRCP) for imaging the pancreatic duct in patients with chronic pancreatitis. MATERIALS AND METHODS: Thirty-nine patients with chronic pancreatitis were examined with a breath-hold fast spin-echo (FSE) sequence employing an echo train length of 32 and with a surface coil. Results were compared with those of endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: MRCP showed the head, body, and tail of the pancreatic duct well in 79%, 64%, and 53% of cases, respectively. Agreement between MRCP and ERCP was 83%-92% in cases of ductal dilatation, 70%-92% in cases of ductal narrowing, and 92%-100% in cases of filling defects. Interobserver variation was low (kappa > 0.5) for most findings. CONCLUSION: Breath-hold MRCP with an FSE technique depicts the pancreatic duct well in patients with chronic pancreatitis and demonstrates narrowing, dilatation, and filling defects with moderate to high accuracy.

[Breath hold MR cholangio-pancreatography (MRCP) using long echo train length fast spin echo sequence in combination with surface coil].

To test the feasibility of MR cholangio-pancreatography (MRCP) using long echo train length (32) fast spin echo sequence in combination with shoulder surface coil, 20 patients who had had ERCP were examined. Good correlations were acquired between the findings obtained by two modalities in terms of ductal strictures, dilatations and intraductal lesions. MRCP was considered to be an examination of choice in various kinds of pathologies affecting biliary duct as well as pancreatic duct for its non-invasiveness and reasonable image quality.

Clinical significance of serum ferritin determination for hepatocellular carcinoma.

The clinical significance of serum ferritin as a serological marker of hepatocellular carcinoma (HCC) was studied. Fasting serum ferritin levels were measured in 343 patients with diseases of the liver, using a radioimmunoassay ferritin kit. Elevated ferritin levels were obtained in various liver diseases but hyperferritinemia could be more clearly interpreted by classifying ferritin levels according to serum iron or transaminase values. Significantly higher values were obtained in HCC than liver cirrhosis. Sensitivity for diagnosis of HCC increased by serial and simultaneous determinations of ferritin and alpha-fetoprotein because high ferritin levels were observed more often in low alpha-fetoprotein-producing HCC and also in HBsAg negative, alcohol related, small-sized HCC. Therefore, simultaneous determination of alpha-fetoprotein and ferritin seems to be useful for detection of HCC in high risk patients such as those with liver cirrhosis.