Magnetic Resonance Cholangiopancreatography Examination Research Articles

Effectiveness of pre-operative routine MRCP in patients scheduled for laparoscopic cholecystectomy

Background: Cholelithiasis is one of the most common surgical diseases worldwide. Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis, and has become the most common performed gastro intestinal operation. The prevalence is higher in women (7.7%) than in men (3.3%). We aimed to investigate the effectiveness of pre-routine magnetic resonance cholangiopancreatography (MRCP) before performing scheduled Laparoscopic cholecystectomy. Methods: This was a prospective observational study conducted in the Department of General Surgery, Dhaka Central International Medical College, and selected single private Hospital from Dhaka, Bangladesh during the period from January 2021 to January 2023. In our study, we included 90 female patients presented with acute or chronic calculus cholecystitis. All patients were diagnosed with multiple gall stones diseases on USG abdomen after initial clinical evaluation were included in this study. Result: In our study, we found the mean age was 34.97±8.48 years. Among 90 patients USG showed multiple stones in 85(94.44%) patients whereas, MRCP showed stones only in 24 (26.67%) patients. Among patients with normal CBD, MRCP found 25.33 % and USG found 93.33% with stones. There were 3 patients with more than 5 mg/dl. bilirubin who was diagnosed with stones in both findings. Among the patients with 148-220 ALP levels, both USG and MRCP found 90.48% of patients with stones. We found 1 true negative case and 20 true positive cases of multiple stones (with a p value of 0.017). Conclusion: We found that MRCP helps increase the safety of perioperative management in some cases. Preoperative ultrasonography has a low diagnostic accuracy rate when it comes to patients who also have gallstones and CBD stones. So, individuals with gallstones are advised to undergo a normal preoperative MRCP examination.

Totally laparoscopic surgery for choledochal cysts with hand‑sewn Roux‑en‑Y reconstruction in a pediatric population.

Cyst excision and Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CCs). In the present study, the results of totally laparoscopic surgery for CCs (TLCCs) in a pediatric population were evaluated. The clinical data of 28 children with CCs between June 2020 and June 2023 were retrospectively reviewed. All patients underwent TLCCs involving cyst excision and RYHJ. The jejunojejunal anastomosis was completed laparoscopically using manual sutures. Age at operation, operative time, postoperative recovery and complications were evaluated. The 28 patients comprised 8 boys and 20 girls who underwent TLCCs at a mean age of 4.2 years (range, 1 month-12.3 years) with a mean weight of 15.9 kg (range, 4.6-43 kg). All patients received ultrasound and magnetic resonance cholangiopancreatography examinations, which revealed a mean cyst diameter and length of 1.74±0.76 cm and 3.85±1.25 cm, respectively. The mean operative time was 214±43.8 min. The mean time until starting an oral diet after surgery was 2.89±1.23 days. Apart from bile leakage and wound infection, no other complications occurred during a median follow-up period of 18 months (range, 4-42 months). TLCCs can be performed safely by skilled surgeons in pediatric patients. TLCCs may be more physiologically compatible and accelerate recovery of intestinal function with reduced trauma and better esthetic outcomes than conventional laparoscopic surgery for CCs. Therefore, TLCCs with manual sutures may be considered as an option for minimally invasive surgery in pediatric patients with CCs.

Evaluation of intraductal papillary mucinous neoplasms detected incidentally with magnetic resonance cholangiopancreatography

Objectives: The aim of this study was to estimate the prevalence of coincidentally found intraductal papillary mucinous neoplasms (IPMNs) and assess their features with magnetic resonance cholangiopancreatography (MRCP) imaging. Methods: The prevalence of incidentally detected IPMN was evaluated in 951 patients who underwent MRCP examination for various indications. MRCP images were assessed to analyze the number, size, location, and internal structure of lesions in patients with IPMN. Furthermore, the association between IPMN prevalence and age and gender was evaluated. Results: IPMN was detected in 102 (10.7%) of 951 patients. Solitary IPMNs were located in different parts of the pancreas: in the uncinate process in 8 (7.8%), in the head and neck in 19 (18.6%), in the corpus in 10 (9.8%), and in the tail in 7 (6.9%) patients. IPMN was multiple in 58 (56.9%) patients. IPMN was identified in 41 (6.18%) patients under 65 years and 61 (21.18%) patients over 65 years, and the variance was statistically substantial (p < 0.001). IPMN diameter was 7.22 ± 4.3 mm in patients under 65 years and 9.21 ± 4.74 mm in those over 65 years, which was statistically significant (p = 0.048). Patients who were older were more likely to have multiple IPMNs (p = 0.010). Conclusions: IPMNs increase in frequency, quantity, and size with age. MRCP is the most essential sequence for determining main pancreatic duct (MPD) involvement or communication, a critical finding for diagnosis. Since MRCP is capable of screening patients at very short intervals, it may be utilized for follow-up imaging in IPMN patients.

Investigation of the accuracy of magnetic resonance cholangiography and multi-slice spiral computed tomography in the diagnosis of cholangiocarcinoma.

Cholangiocarcinoma (CCA) is a common malignant biliary tract tumor in clinical practice. The detection rate of multi-slice spiral computed tomography (MSCT) with a diameter of 10 mm is low, and it is easy to be misdiagnosed and missed. In addition, patients who are allergic to iodized contrast media are not eligible for MSCT screening. However, magnetic resonance cholangiopancreatography (MRCP) is non-invasive, does not require contrast injection, scans quickly, and is simple to perform. MRCP has good development rate and the ability to recognize human pancreas and biliary tract. MRCP is also non-invasive, does not require contrast injection, has fast scanning speed, and is easy to operate. In addition, MRCP has a good development rate and the ability to recognize human pancreas and biliary tract. Therefore, this study sought to analyze the accuracy of MRCP and MSCT in the diagnosis of CCA. In this paper, 186 patients with highly suspected CCA admitted to the Second Affiliated Hospital of Soochow University from March 2020 to May 2022 were selected for MSCT and MRCP examination. We compared the diagnostic accuracy, sensitivity and specificity of MSCT and MRCP with pathological diagnosis and the detection rate of lesions with different diameters between MSCT and MRCP. Finally, the imaging features of MSCT and MRCP of CCA were analyzed. The results showed that (I) the diagnostic accuracy (95.70%), sensitivity (95.12%), and specificity (96.15%) of MRCP were higher than those of MSCT (69.89%, 60.98%, and 76.92%, respectively; P<0.05); (II) MSCT and MRCP were basically consistent with the datum (Kappa value =0.527, Kappa value =0.767, respectively); (III) the detection rate of lesions <0.5 cm in diameter of MRCP (32.05%) was higher than that of MSCT (14.00%; P<0.05); and (IV) the detection rates of lesions 0.5-1.0 cm (38.46%) and >1.0 cm (29.49%) in diameter of MRCP were lower those of MSCT (50.00%, and 36.00%, respectively; P>0.05). MRCP can provide relevant imaging feature information, improve the accuracy, sensitivity and specificity of the diagnosis of bile duct carcinoma, and has a high detection rate for small diameter lesions, which has good reference, promotion and reference value.

Improving the Quality of Magnetic Resonance Cholangiopancreatography Images

The purpose of this study was to address the variability in quality of magnetic resonance cholangiopancreatography (MRCP) images by examining differences in quality grades before and after modifying the MRCP protocol to include placement of physical bellows while scanning. This single institution quality improvement initiative included 727 MRCP examinations performed from July 2019 to December 2020 in patients 18 years and older. The Define, Measure, Analyze, Improve, and Control (DMAIC) strategy was utilized to explore factors related to MRCP image quality and identify solutions that could create effective change. Based on the results of this analysis, MRCP protocols were changed in December 2019 to include physical bellows. Examinations were grouped as occurring either pre- or postintervention as well as whether they occurred in an inpatient or outpatient setting. MRCP examinations were evaluated for quality and labeled either nondiagnostic or diagnostic. A logistic regression model was fit to compare the odds of a diagnostic QA grade between preintervention and postintervention groups and inpatient and outpatient settings. The preintervention group had 41.12% of MRCP studies of diagnostic quality, and the postintervention group had 60.57% of studies of diagnostic quality. The estimated odds of an image being of diagnostic quality in the postintervention group were 2.46 times the odds for the preintervention group across all departments and patient classes (P < 0.001). The estimated odds of an image being of diagnostic quality in the outpatient group were 2.01 times the odds for those in the inpatient group (P < 0.001). Utilizing a standardized quality improvement method can lead to sustained improvements in the diagnostic quality of MRCP studies.

Assessment of variations in intrahepatic bile duct by magnetic resonance cholangiopancreatography

For any biliary system or liver surgery, it is crucial to have a thorough understanding of the normal branching pattern of the intrahepatic bile duct and its deviations in order to prevent serious post-surgical problems and morbidity. Aim: This study's goal was to assess the variations in intrahepatic bile ducts appeared during Magnetic Resonance Cholangiopancreatography (MRCP) examinations. Place and Duration: In the Radiology department of Mian Gul Abdul Haq Jehanzeb Kidney Hospital Swat from January 2022 to June 2022. Methods: This cross-sectional, quantitative study was conducted among people who had been referred for MRCP examinations for a number of clinical reasons. A total of 70 patients done with MRCP examinations were selected by convenience sampling technique being used. The data of 1.5T Magnetom Amira Siemens MRI scanner was used for anlaysis. Using visual analysis, the 3D MRCP images were categorized into 7 Types using the Choi et al classification. Results: Among the 36(51.4%) patients in this analysis had Type 1/normal IHBD, 13(18.6%) had Type 2 IHBD, Type 3A was seen in 2(2.8%), and Type 3B was noticed in 5.7% of subjects.

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI

The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography) with diffusion-weighted imaging (DWI) MATERIALS AND METHODS: MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma were included. MRCP image features, extra-ampullary features, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm² were evaluated by two radiologists independently. The interclass correlation coefficient (ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement. 51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal type. In the pancreatobiliary subtype, the distal wall of the common bile duct was usually irregular (p=0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary type, an oval filling defect in the distal common bile duct was found to be more common in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas. The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were all lower compared to the intestinal type carcinomas (p <0.05). The oval filling defect seen in MRI and MRCP examinations suggests intestinal type, whereas the progressive contrasting pattern of the masses with irregular narrowing in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary type carcinomas.

Synthesis of manganese nanoparticles of Oolong tea extract by sonication method for a natural oral contrast media on magnetic resonance cholangiopancreatography

Introduction: Magnetic resonance cholangio-pancreatography examination using natural contrast media has not provided an optimal image of gastroduodenal suppression that covers the image of the biliary system. Natural materials used as contrast media continue to be developed with various previous studies, but not many have been associated with using, nanoparticles as natural contrast media materials. This study aims to make manganese nanoparticles in oolong tea extract is used as an oral contrast medium.

Development of a prognostic MRCP-score (DiStrict) for individuals with large-duct primary sclerosing cholangitis

Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis and follow-up of individuals with primary sclerosing cholangitis (PSC). The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC. The score (DiStrict score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0-8) on 3D-MRCP. In this retrospective, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP examinations of 220 consecutive individuals with PSC from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Inter-reader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell's C-statistic was calculated. Forty patients developed outcomes (liver transplantation or liver-related death). Inter-reader agreement between experienced radiologists was good (ICC 0.82; 95% CI 0.74-0.87, and ICC 0.81; 95% CI 0.70-0.87, respectively) and better than the agreement for the pair of experienced/less-experienced radiologists (ICC 0.48; 95% CI 0.05-0.72). Agreement between radiologists from the three centres was good (ICC 0.76; 95% CI 0.57-0.89). Intrareader agreement was good to excellent (ICC 0.85-0.93). Harrell's C was 0.78. Patients with a DiStrict score of 5-8 had 8.2-fold higher risk (hazard ratio 8.2; 95% CI 2.97-22.65) of developing outcomes, and significantly worse survival (p <0.001), compared to those with a DiStrict score of 1-4. The novel DiStrict score is reproducible and strongly associated with outcomes, indicating its prognostic value for individuals with PSC in clinical practice. The diagnosis of primary sclerosing cholangitis (PSC)is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognostication of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with prognosis in individuals with PSC (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful inclinical trials and in patient counselling and management.

Evaluation of Intrahepatic Bile Duct Variations in Magnetic Resonance Cholangiopancreatography

Introduction: A detailed knowledge of normal branching pattern of intrahepatic bile duct and their variations is of utmost importance for any liver or biliary tract surgery to avoid severe post-surgery complications and morbidity. The objective of this study was to evaluate variations of intrahepatic bile ducts in Magnetic Resonance Cholangiopancreatography (MRCP) examinations in Nepalese population.Methods: This quantitative, cross sectional study was performed in patients referred for MRCP examinations for various clinical indications to Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. Data were collected for a period of four months from August to November 2019 after IRB approval. Convenience sampling was employed and a total of 90 examinations were included. Data were obtained from the 1.5T Magnetom Amira Siemens MRI scanner. The 3D MRCP images were visually analyzed and classified into 7 Types according to the classification given by Choi et al.Results: In our study 47.8% patients had Type 1/normal IHBD (n=43). 20% had Type 2 (n=18), 3.3% had Type 3A (n=3), 5.6% had Type 3B. Type 5A (n=5), 7.8% had 5B (n=7), 3.3% had Type 6 (n=3) and 6.7% had Type 7 (n=6). No patients were found to have Type 3C and Type 4 IHBD variation. Among the total number of Type 1 cases, 67.44% (n=29) were female and rest were male.Conclusions: Typical IHBD was only found in a 47.8% patients and common other variations were also noted in our population. Type 2 and Type 5B were found in 20% and 7.8% patients respectively.

Laparoscopic Management of Choledochal Cysts Associated with Aberrant Hepatic Ducts

Introduction and objectives: This study assessed the diagnostic protocol and the outcomes of laparoscopic aberrant hepatic duct (AHD) reconstruction in choledochal cyst (CC) surgery. Methods: From January 2010 to January 2018, 275 laparoscopic CC excisions were conducted in our hospital. Seven patients of CC with associated AHD were recorded. AHDs that drained into the cystic duct were anastomosed to the Roux-en-Y loop. Clinical data of these 7 patients were retrospectively analyzed. Results: AHD is classified into four types according to the literature. The type where AHD drains into the cystic duct is the most commonly encountered one. The incidence of this type was 2.5% (7/275) in our series. Preoperative examination included magnetic resonance cholangiopancreatography (MRCP) (5 patients) and computed tomography (CT) scan (2 patients). Suspected AHD was diagnosed preoperatively in 4 out of the 5 patients who underwent MRCP. For the 2 patients who underwent CT scan only, AHD was not detected preoperatively. AHD was verified intraoperatively for all the 4 patients who had suspected diagnosis. Among them, AHD was well preserved in 3 patients, but damaged at exploration in the remaining 1. For the remaining 3 patients without preoperative AHD diagnosis, bile leakage was detected intraoperatively. Ductoplasty of the AHD with common hepatic duct was performed in 3 patients, and AHD was incorporated into the Roux-en-Y jejunal loop separately in 4 patients. Laparoscopic surgical procedures were completed in 6 of the 7 patients in this study, while 1 patient was converted into an open procedure. Postoperative recovery was uneventful in all patients. The duration of follow-up ranged from 6 months to 4 years (median 2 years) with no complication encountered. Conclusions: Routine preoperative MRCP examination of CC is recommended to detect variations of biliary tree. The laparoscopic approach is a feasible option in the experienced hands.

THE ROLE OF BLACK TEA AND PINEAPPLE JUICE AS NEGATIVE ORAL CONTRASTS ON MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) EXAMINATION

Background: Magnetic resonance cholangiopancreatography examination is a superior examination in the detection of anatomic structures or pathological abnormalities in the human pancreatobiliary system. This examination is recommended to use negative oral contrast which aims to eliminate gastrointestinal signals that are around the pancreatobiliary system which can be a barrier to the visualization of the pancreatobiliary tract. Materials that can be used as oral contrast contrast must be able to survive for a long time in the gastrointestinal tract and contain elements of iron (Fe) and Manganese (Mn). The high Mn content of black and pineapple juice and its abundance need to be explored as contrast oral negative. Purpose: To prove the role of pineapple juice and black tea which are natural ingredients of negative oral contrast in the visualization of the pancreatobiliary system on MRCP examination. Methods: Experimental quasy studies have been carried out on 9 samples prospectively. Each sample underwent MRCP examination with three treatments, namely given black tea, pineapple juice and plain water. The image results from the three treatments were assessed by Radiology Doctors to assess the quality of their image. Results: The results showed that black tea was more effective in providing optimal image results on MRCP examination than pineapple juice and without using oral contrast contrast. The metal content of negative oral contrast can cause magnetic susceptibility which is characterized by the presence of shortening at the time of T2 relaxation. Negative contrast agents affect signal intensity usually by shortening T2 or T2 *, as an effect, areas of concern, especially areas with negative contrast agents will experience darkening. Conclusion: Black tea is effectively used as a negative oral contrat on MRCP examination.

Laparoscopic Ultrasonography Versus Magnetic Resonance Cholangiopancreatography in Laparoscopic Surgery for Symptomatic Cholelithiasis and Suspected Common Bile Duct Stones

BackgroundThere continues to be controversy regarding the optimal screening modality in patients with symptomatic cholelithiasis and suspected common bile duct (CBD) stones. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) compared to magnetic resonance cholangiopancreatography (MRCP). MethodsBoth LUS and MRCP were performed to evaluate the CBD stones and biliary anatomy in 200 patients undergoing laparoscopic surgery. Pre-, intra-, and postoperative data were collected prospectively and reviewed retrospectively. ResultsCoexisting CBD stones were identified in 64 of 200 (32%) patients by surgical exploration or postoperative ERCP. For the detection of CBD stones, LUS yielded a positive predictive value of 100%, a negative predictive value of 99.3%, a sensitivity of 98.4%, and a specificity of 100%. Preoperative MRCP had a positive predictive value of 87.9%, a negative predictive value of 95.5%, a sensitivity of 90.6%, and a specificity of 94.1%. The non-random concordance between MRCP and LUS was considered to be excellent with a kappa coefficient of 0.92 (p < 0.01). ConclusionsLUS can reduce the need for MRCP examination and can become the primary imaging method for the evaluation of CBD stones in laparoscopic surgery.

DIFFERENCES IMAGE QUALITY OF SIGNAL TO NOISE RATIO (SNR) IN SENSITIVITY ENCODING (SENSE) APPLIED ON MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) EXAMINATION SEQUENCES TSE T2 CORONAL

Background : Magnetic Resonance Cholangiopancreatography (MRCP) is a non invasive imaging examinations, which are used to evaluate the tractus billiaris, pancreatic ducts and gall bladder. In the last decade, one way to lower the scan time is with the method of parallel imaging. Parallel imaging has a basic function is the reduction of the time of the scan, as well as maintain the contrast of the image without the need for a system of higher performance gradients. Reduction of scan time in parallel imaging has some benefits. First, it is very useful for sequences that depends on the scanning time is short as a single breath hold. Second, the overall inspection time can be reduced, especially in patients with complaints of pain are great at certain positions such as pain when lying down, in patients of children or in cases of civil defence emergency. Breath hold itself has the purpose to avoid the image of the blur of movement organs. When breathing there is movement of the thoracic and abdominal organs in the cavum. However, the characteristics of each person has different breath hold. When the patient's breath hold insufficient at the time scanning takes place then the resulting image results become less than optimal and may cause artifacts in the picture. The scanning time on the MRCP examination sequences long enough to cause patients to press the emergency buzzer, this caused the patient to feel less comfortable at the time of the examination to take place, and the resulting examination in repeated from the beginning. Therefore researchers wanted to apply the technique of parallel imaging in examination of MRCP on T2 Coronal because of parallel imaging has benefits that are very useful for sequences that depends on the scanning time is short like a breath hold. Methods : This type of research is research experiments. This research was conducted on MRI 1.5 Tesla in Hospitals Tarakan from Jakarta and carried out in 8 volunteers. The results of the performed image ROI value to get SNR, ROI was performed on the area of the right hepatic duct, left hepatic duct, gall bladder, common bile duct and cystic duct so the obtained average value for signal compared to the ROI on background (standard deviation noise). Data analysis was done by using different test with a test of T-test to tell the difference between the use of SENSE against SNR. Results : The results of the calculation of the value of the average SNR of image sequence, MRCP Sequences TSE T2 Coronal without the SENSE on the anatomy of the right hepatic ductus 54.49; left hepatic ductus 55.54; gall bladder 91.07; the common bile duct 68.94 and cystic duct 60.46. While the value of SNR in image sequence, MRCP Sequences TSE T2 Coronal TSE that use the SENSE on the anatomy of the right hepatic duct 45.77; left duct heatic 46.88; gall bladder 77.87; the common bile duct 60.72 and cystic duct 50.58 Scan time difference that is the average value of the scan time on Coronal T2 TSE piece sequences without SENSE for 1 minute 32 seconds while in the Coronal T2 TSE piece sequences using SENSE during 49 seconds or reduced by 46.7% compared with sequences TSE standards without SENSE on examination MRCP T2 Coronal. Conclusion : Based on the results of the study explains that there is a difference between the use of SENSE against SNR in the T2 Coronal TSE sequence in MRCP examination with the highest level of the overall significance of the p-value &lt; 0.05. On the use of SENSE decline SNR but scan time becomes shorter 46,7% compared with no use of SENSE

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

Magnetic resonance cholangiopancreatography evaluation of intrahepatic bile duct variations with updated classification.

Preoperative detection of intrahepatic bile duct (IHBD) variations is essential to reduce surgical morbidity and mortality rates. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive and reliable method for demonstrating the normal IHBD anatomy and its variations. This retrospective study aimed to identify and classify novel variations, except those already reported in the literature, using MRCP. MRCP examinations, which were conducted in two different centers in the last five years, were retrospectively evaluated. IHBD variations were recorded with respect to the Yoshida classification. In addition, newly detected variations that were not included in this classification were identified and classified. MRCP examinations of 2624 patients were screened, and 2143 were determined to be eligible for evaluation. Of 2143 patients, 987 were males (average age, 54±18 years) and 1156 were females (mean age, 57±17 years). In this study, 10 novel variations that were not included in the Yoshida classification were identified in 14 patients. MRCP is an effective, reliable, and noninvasive imaging method for evaluating the IHBD anatomy and its variations. Novel variations described in this study may help to better understand the biliary anatomy.

Inpatient magnetic resonance cholangiopancreatography: does it increase the efficiency in emergency hepatopancreaticobiliary surgery services?

INTRODUCTION Magnetic resonance cholangiopancreatography (MRCP) is commonly used to evaluate the biliary tree, although indications for patients who require inpatient imaging are not fully defined. The aim of this study was to evaluate inpatient MRCP performed on surgical patients and to devise a treatment pathway for these patients. MATERIAL AND METHODS All adult inpatient MRCP examinations between January 2012 and December 2013 were reviewed. Demographic, clinical and radiological data were collated. RESULTS During the study period, 271 inpatient MRCP were requested, of which 234 examinations were included. The majority of patients were female (n=140) and the median age was 63 years (range 16-93 years). Surgical admissions accounted for 171 (73%) of cases. Indications for inpatient MRCP include gallstone-related complications (n=173; 74%), malignant process (n=17; 7%) and other indications (n=44; 19%). Overall, inpatient MRCP led to further inpatient interventions in 22% (gallstone group, n=32, 18%; patients with malignancy, n=8, 47%; other indications, n=12, 27%). The median duration of inpatient MRCP from request to examination was 2days (range 0-15days) and median reporting after examination was 1day (range 0-14days). DISCUSSION AND CONCLUSION Improved access and timely reporting of iMRCP may reduce length of hospital stay. Inpatient MRCP also led to further inpatient interventions, in particular, in patients with malignancy.

Pancreas divisum: A risk factor for pancreaticobiliary tumors-an analysis of 1628 MR cholangiography examinations.

This retrospective study was conducted to evaluate the relationships between pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors using magnetic resonance cholangiopancreatography (MRCP). The MRCP examinations of 1628 patients were retrospectively reviewed for the presence of pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors. Of these, 90 patients (31 men, 59 women) with a mean age of 62.6 years±15.8 (SD) (range: 22-101 years) had pancreas divisum. MRCP images were analyzed by two independent readers with discordances resolved by consensus opinion. A total of 1538/1628 patients (94.5%) had a dominant duct of Wirsung; of them 54/1538 patients (3.5%) had pancreaticobiliary tumors. A total of 90/1628 patients had pancreas divisum; of them, 7/90 patients (7.8%) had pancreaticobiliary tumors, including intrapancreatic mucinous neoplasm (n=3), ampullary carcinoma (n=2), pancreas carcinoma and gallbladder carcinoma (n=1 each). Pancreaticobiliary tumors were more frequent in patients with pancreas divisum than in those with a dominant duct of Wirsung (P=0.0383). The results of our study suggest that patients with pancreas divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.

Imaging features in anatomical variations of the dorsal pancreas and main pancreatic duct

Objective To summarize the imaging features in anatomical variations of the dorsal pancreas and main pancreatic duct, and investigate the essentials of diagnosis and differential diagnosis. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with the anatomical variations of the dorsal pancreas and main pancreatic duct who was admitted to the Affiliated Hospital of Ningbo University at November 2013 were collected. The patient received plain and enhanced scans of computed tomography (CT) and magnetic resonance image (MRI), and magnetic resonance cholangiopancreatography (MRCP) examination. Observation indexes included: (1) manifestations of CT and MRI examinations. (2) Pancreas associated dimensions: ①the main pancreatic duct: the maximum width and the expansion length. ②The pancreatic parenchyma: the width of the dorsal pancreas and the ventral pancreas. ③Other dimensions: the distance from the ventral pancreas to the midline, the distance from the dorsal pancreas to the midline, the distance from the dorsal pancreas to the splenic hilum. (3)Follow-up situation: results of laboratory and imaging reexaminations. The follow-up of outpatient examination and telephone interview was performed on the patient up to January 2016. Results (1) Manifes-tations of CT and MRI examinations: CT examination demostrated a normal pancreatic length with parenchyma of the pancreatic body and tail atrophy and a slightly enlarged pancreatic head. The pancreatic parenchyma showed homogeneous density and main pancreatic duct of the pancreatic body and tail showed dilatation. On MRI, T1 weight imaging (T1WI) and T2 weight imaging (T2WI) demonstrated a slightly enlarged pancreatic head with homogeneous signal. The in-phase and out-phase imagings showed no signal loss on and diffusion weighted imaging (DWI) showed no restricted diffusion. Enhanced scanning demonstrated a marked homogenous enhancement of pancreatic head. Pancreatic body and tail showed thin and parenchyma atrophy on T1WI and T2WI without restricted diffusion on DWI and abnormal enhancement on enhanced scan. Of pancreatic duct and bile duct, MRI examination showed main pancreatic duct dilatation of the pancreatic body and tail with smooth inner wall and narrowed main pancreatic duct of pancreatic neck and no dilatation of the pancreatic head. Enhanced scanning demonstrated no abnormal enhancement of the enlarged duct. The branch pancreatic duct showed no dilatation. MRCP examination demonstrated no dilatation of intra- and extra bile duct and gallbladder and no abnormal signal of intracavity. Pancreatic margin showed smooth, regular and clear surrounding fat space. Other findings included a circular nodule under the spleen with a similar signal with the spleen on plain and enhanced scan. (2) Pancreas associated dimensions: ① the main pancreatic duct: the maximum width and the expansion length were 12.6 mm and 91.6 mm, respectively. ② the pancreatic parenchyma: the width of the dorsal pancreas and the ventral pancreas were 19.6 mm and 26.7 mm, respectively. ③ other dimensions: the distance from the ventral pancreas to the midline, the distance from the dorsal pancreas to the midline and the distance from the dorsal pancreas to the splenic hilum were 54.6 mm, 77.3 mm and 18.5 mm, respectively. (3) Follow-up status: results of laboratory reexaminations showed normal indexes at November 2014, and ultrasonography examination demonstrated slightly enlarged pancreatic head with homogenous internal echo, thin of the pancreatic body and tail, and an enlarged main pancreatic duct with the maximum width of 12.3 mm. The patient was followed up at November 2015, and laboratory reexaminations and ultrasonography examination demonstrated similar findings. Conclusion Imaging features of anatomical variations of the dorsal pancreas and main pancreatic duct include normal length of the pancreas, atrophy of the pancreatic body and tail, main pancreatic duct dilatation with smooth inner wall, slightly enlarged pancreatic head without any abnormal signal on dynamic enhancement imaging. Key words: Dorsal pancreas; Pancreatic duct; Anatomic variantion; Magnetic resonance Imaging