Magnetic Resonance Cholangiopancreatography In Patients Research Articles

Study of Anatomical Variation of Intrahepatic Biliary Tree by Magnetic Resonance Cholangiopancreatography in Patients Attending Tertiary Hospital of Eastern Nepal

Background: There are several variations in the complex anatomy of intrahepatic bile ducts. Magnetic resonance cholangiopancreatographyis a safer imaging modality that effectively shows these variations, aiding in surgical planning and preventing iatrogenic injuries. This study aims to evaluate these anatomical variations using magnetic resonance cholangiopancreatography. Materials and Methods: This cross-sectional prospective study was performed in the Radiology Department of Nobel Medical College for one year using a convenient sampling technique. A total of 165 cases meeting the inclusion criteriawere selected and magnetic resonance cholangiopancreatography was performed to evaluate the anatomical variations. Results: The mean age of patients was 34.32±10.22 years out of which 51.5%were male and 48.5%were female. The branching pattern of right hepatic duct was typical in 66.7% of cases. The right posterior sectoral duct joining left hepatic duct was the most common variation seen in 15.2%. Right posterior sectoral duct joining the common bile duct was present in 6.7%. 6.1% of cases had unclassified variation whereas a trifurcation pattern was found in 5.5%. Left hepatic duct showed the typical branching pattern in 70.9% of cases. Segment II duct draining into the common trunk of segments III and IV was seen in 20%. Triconfluence among segments II, III, and IV was seen in 8.5% and 0.6% of cases had unclassified variation. Conclusion: This study revealed wide variation in branching patterns of intrahepatic biliary ducts. The typical branching pattern of right and left hepatic ducts were seen in majority of cases.

Modified respiratory-triggered SPACE sequences for magnetic resonance cholangiopancreatography

BackgroundRespiratory-triggered (RT) and breath-hold are the most common acquisition modalities for magnetic resonance cholangiopancreatography (MRCP). The present study compared the three different acquisition modalities for optimizing the use of MRCP in patients with diseases of the pancreatic and biliary systems. Materials and methodsThree MRCP acquisition modalities were used in this study: conventional respiratory-triggered sampling perfection with application-optimized contrasts using different flip evolutions (RT-SPACE), modified RT-SPACE, and breath-hold (BH)-SPACE. Fifty-eight patients with clinically suspected pancreatic and biliary system disease were included. All image data were acquired on a 1.5 T MR. Scan time and image quality were compared between the three acquisition modalities. Friedman test, which was followed by post-hoc analysis, was performed among triple-scan protocol. ResultsThere was a significant difference in the mean acquisition time among conventional RT-SPACE, modified RT-SPACE, and BH-SPACE (167.41±32.11 seconds vs 50.84±73.78 seconds vs 18.00 seconds, P <0.001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also significantly different among the three groups (P <0.001). The SNR and CNR were higher in the RT-SPACE group than in the BH-SPACE group (P <0.05). However, there were no statistically significant differences (P >0.05) among the 3 groups regarding quality of overall image, image clarity, background inhibition, and visualization of the pancreatic and biliary system. ConclusionsMRCP acquisition with the modified RT-SPACE sequence greatly shortens the acquisition time with comparable quality images. The MRCP acquisition modality could be designed based on the patient's situation to improve the examination pass rate and obtain excellent images for diagnosis.

Using artificial intelligence to predict choledocholithiasis: can machine learning models abate the use of MRCP in patients with biliary dysfunction?

Prompt diagnosis of choledocholithiasis is crucial for reducing disease severity, preventing complications and minimizing length of stay. Magnetic resonance cholangiopancreatography (MRCP) is commonly used to evaluate patients with suspected choledocholithiasis but is expensive and may delay definitive intervention. To optimize patient care and resource utilization, we have developed five machine learning models that predict a patients' risk of choledocholithiasis based on clinical presentation and pre-MRCP investigation results. Inpatients admitted to the Royal Hobart Hospital from 2018 to 2023 with a suspicion of choledocholithiasis were included. Exclusion criteria included prior hepatobiliary surgery, known hepatobiliary disease, or incomplete records. Variables related to clinical presentation, laboratory testing, and sonographic or CT imaging were collected. Four machine learning techniques were employed: logistic regression, XGBoost, random forest, and K-nearest neighbours. The three best performing models were combined to create an ensemble model. Model performance was compared against the American Society for Gastrointestinal Endoscopy (ASGE) choledocholithiasis risk stratification guidelines. Of the 222 patients included, 113 (50.9%) had choledocholithiasis. The most successful models were the random forest (accuracy: 0.79, AUROC: 0.83) and ensemble (accuracy and AUROC: 0.81). Every model outperformed the ASGE guidelines. Key variables influencing the models' predictions included common bile duct diameter, lipase, imaging evidence of cholelithiasis, and liver function tests. Machine learning models can accurately assess a patient's risk of choledocholithiasis and could assist in identifying patients who could forgo an MRCP and proceed directly to intervention. Ongoing validation on prospective data is necessary to refine their accuracy and clinical utility.

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

BackgroundIn the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis.MethodsAccording to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups.ResultsAmong the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05).ConclusionsThe preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

Routine preoperative MRCP in screening choledocholithiasis in acute cholecystitis compared to selective approach: a population-based study.

Choledocholithiasis is more common in acute cholecystitis than in elective situations. Preoperative diagnosis of choledocholithiasis is essential to facilitate adequate planning of CBD (common bile duct) stone removal, preferably performed as a single-stage procedure. The purpose of this study was to test the feasibility of routine preoperative magnetic resonance cholangiopancreatography (MRCP) in acute cholecystitis followed by consequent cholecystectomy. A total of 180 consecutive patients operated for acute cholecystitis between January 2019 and December 2019 were prospectively enrolled. Preoperative routine MRCP was performed for bile duct evaluation when feasible. The control cohort consisted of 180 consecutive patients undergoing emergency laparoscopic cholecystectomy before the study period. Intraoperative cholangiography was used routinely in both groups when technically achievable. We examined the proportion of patients recruited in preoperative MRCP, possible time delay to MRCP and surgery, and the incidence of CBD stones compared to the control cohort. Routine MRCP in acute cholecystitis was achieved in 114/180 (63%) patients compared to 42/180 (23.3%) patients of the control group. The triage time from emergency to MRCP and the operating theatre was similar in both cohorts. The percentage of patients diagnosed with choledocholithiasis in the study group was notably higher (almost 18% vs 11%), p < 0.05. After a median follow-up time of 2.5years in the study group and almost 4years in the control group, recurrent choledocholithiasis was not detected in either group. Routine MRCP in patients with acute cholecystitis can be implemented with a fair execution rate in a population-based setting with minor effects on hospital stay and delays but higher detection of choledocholithiasis. We observed no additional benefit compared to the selective use of MRCP. However, routine preoperative MRCP allows an advantage when considering the appropriate exploration method if choledocholithiasis is detected.

Neostigmine® Improves Pancreatic Duct Visualization in Magnetic Resonance Cholangiopancreatography and Could Be a Cheap Alternative for Secretin.

Background:To determine the effect of intramuscular administration of Neostigmine® on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain.Methods:We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine®-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine®. Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine®.Results:Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine® administration in all patients, from 1.84 ± 0.98 to 3.41 ± 1.27 mm in the head, 1.34 ± 0.42 mm to 2.5 ± 0.49 mm in the body and 0.72 ± 0.52 mm to 1.78 ± 0.43 mm in the tail (mean ± SD, P < .0001). Neostigmine® helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine®, and in the fourth patient, Neostigmine® improved visualization of multiple pancreatic duct stenosis.Conclusion:Neostigmine®-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.

Diagnostic accuracy of magnetic resonance cholangiopancreatography in patients with extrahepatic cholestasis: a retrospective cohort study

Background/Aims: Differential diagnosis of extrahepatic cholestasis can be challenging due to variable sensitivity and specificity rates of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive method used for evaluation of biliary tree. We aimed to investigate diagnostic accuracy of MRCP in biliary obstruction. &#x0D; Materials and Methods: Medical records of patients admitted with extrahepatic cholestasis between January 2012 and December 2016 were retrospectively reviewed. Patients who had endoscopic retrograde cholangiopancreatography (ERCP) following MRCP were included. Demographic and clinical characteristics of patients were noted. Final diagnosis of ERCP was accepted as gold standard. Diagnostic efficiency of MRCP was evaluated by calculating sensitivity, specificity, accuracy, negative and positive predictive values as compared with ERCP.&#x0D; Results: There were 615 patients with a mean age of 60.1±17.5 years. Using MRCP, choledocholithiasis, malignant and benign strictures were diagnosed in 337 (54.8%), 101 (16.4%), and 39 patients (6.3%), respectively. Normal MRCP findings were present in 65 patients (10.6%). Final diagnoses via ERCP were as follows: choledocholithiasis (n=390, 63.4%), malignant stricture (n=152, 24.7%), benign stricture (n=62, 10.1%), and normal findings (n=11, 1.8%). Sensitivity and specificity of MRCP were 70.8% and 72.9% for choledocholithiasis, 55.9% and 96.5% for malign stricture, and 16.1% and 94.8% for benign stricture, respectively. Overall accuracy rates were 71.5%, 86.5%, and 86.8% for choledocholithiasis, malign and benign strictures, respectively.&#x0D; Conclusion: Diagnostic accuracy of MRCP is variable for different biliary/cholestatic etiologies. Due to a lower sensitivity for choledocholithiasis, normal MRCP findings should be handled with caution, especially when there is a clinical suspicion for biliary obstruction. &#x0D; Keywords: extrahepatic cholestasis, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, sensitivity, specificity.

Comparison between gradient and spin-echo (GRASE) and compressed sensing sequences for single breath-hold three-dimensional magnetic resonance cholangiopancreatography in patients with T1 hyperintense bile

PurposeTo compare image quality and the detectability of gallstones in patients with T1 hyperintense bile between single breath-hold three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) with gradient and spin-echo (GRASE) and with compressed sensing (CS). MethodsWe retrospectively evaluated patients who underwent MRCP using GRASE and CS and had hyperintense bile on T1-weighted fat-suppressed images. The relative duct-to-periductal contrast ratios (RCs) of each bile duct segment were calculated. Pancreaticobiliary duct visibility, motion artifacts, background suppression, and overall image quality were scored on a 5-point scale. The Wilcoxon signed-rank test was used to analyze differences in qualitative and quantitative results. Diagnostic performance in detecting common bile duct (CBD) and gallbladder stones was assessed using receiver operating characteristic (ROC) curves. ResultsIn total, 96 patients were included in the study. RCs of all bile duct segments in GRASE MRCP were significantly lower than those in CS MRCP (p < 0.001). All biliary duct visibility and overall image quality had significantly higher scores in GRASE MRCP than in CS MRCP (p < 0.001–0.003). Area under ROC curves of GRASE MRCP and CS MRCP were 1.00 and 0.88 for CBD stone (p = 0.14) and 0.93 and 0.82 for gallbladder stone (p = 0.08), respectively. ConclusionsGRASE MRCP provides better image quality than CS MRCP in patients with hyperintense bile on T1-weighted images. The detectability of biliary stones was also higher in GRASE MRCP than in CS MRCP, although not significantly.

Randomised controlled trial to establish the clinical and cost-effectiveness of expectant management versus preoperative imaging with magnetic resonance cholangiopancreatography in patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones (The Sunflower Study): a study protocol

IntroductionSurgery to remove the gallbladder (laparoscopic cholecystectomy (LC)) is the standard treatment for symptomatic gallbladder disease. One potential complication of gallbladder disease is that gallstones can pass into the common...

Endoscopic Ultrasonography (EUS) Compared with Magnetic Resonance Cholangiopancreatography (MRCP) in Diagnosing Patients with Malignancy Causing Obstructive Jaundice

Background: The common etiologies of obstructive jaundice were biliary stone and biliary neoplasms. The gold standard to diagnose malignancy causing obstructive jaundice is endoscopic retrograde cholangiopancreatography (ERCP) with sensitivity and specificity of 95% and 100%. However, ERCP is an invasive procedure associated with several complications such as bleeding, pancreatitis, and perforation. Other modalities include endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). Thus, we aim to evaluate the sensitivity and specificity of EUS with MRCP in patients with malignancy causing obstructive jaundice.Method: This was a cross-sectional study that calculates the sensitivity and specificity of EUS and MRCP in diagnosing malignancy causing obstructive jaundice compared with the gold standard, histopathology examination from ERCP. The study was conducted in the Medical Record Unit, Gastroenterology Division, Dr. Cipto Mangunkusumo National General Hospital, on January – March 2019 by using a consecutive sampling method. The date of diagnosis was collected from the medical record within five years. Subjects were selected based on inclusion criteria which include patients aged ≥ 18 years old who were diagnosed with malignancy causing obstructive jaundice by ERCP, and had underwent EUS or MCRP with a maximum interval of 3 months to ERCP. The exclusion criteria include patients with previous evidence of biliary tract malignancy or concurrent parenchymal jaundice. Statistical analysis was performed using IBM SPSS Statistics 20.Results: There were 54 subjects with a mean age of 56.48 ± 11.37 years. Subjects consisted of 29 (53.7%) males and 25 (46.3%) females. The median period between EUS to ERCP was 0-33 days, while MRCP to ERCP was 1-53 days. The sensitivity, specificity, positive predictive value, and negative predictive value to diagnose obstructive jaundice due to malignancy were 96%, 60%, 96%, 60% in EUS, and 90%, 40%, 94%, 29% in MRCP, respectively.Conclusion: EUS was more superior to MRCP in the diagnosis of malignancy causing obstructive jaundice.

Prevalence of Different Hepatobiliary Tree Variants on Magnetic Resonance Cholangiopancreatography in Patients Visiting a Tertiary Care Teaching Hospital in Karachi.

IntroductionHepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi.MethodsThis cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant.ResultsWe recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value <0.001), while types 1, 3, and 4 anatomic variants were found to be more in females than males but this difference was not statistically significant. Few other variants were also recorded.ConclusionThis study is robust evidence regarding biliary variants in Pakistan. It is important to consider these variants in our region, owing to an increased trend of liver transplants and other hepatobiliary procedures.

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English

Role of Magnetic Resonance Cholangiopancreatography in Patients with Pancreatico-Biliary Diseases

Introduction: Advancements in Magnetic Resonance Cholangiopancreatography (MRCP) technique like development of new pulse sequences and strong magnetic field provided significantly better imaging of pancreatico-biliary diseases with good contrast resolution without any significant artifacts. There is no use of intravenous contrast and it is free of any type of ionizing radiation. As compared to Endoscopic Retrograde Cholangiopancreatography (ERCP) which can only depict the intraluminal pathologies and associated with major complications like pancreatitis, sepsis and even death, MRCP can depict intra-ductal as well as extra ductal pathologies &amp; also it is not associated with any major complication. Aim: The purpose of the present study is to assess diagnostic accuracy of the MRCP in patients with pancreatico-biliary diseases. Materials and Method: A prospective cross-sectional study which included 50 patients with pancreatico biliary diseases who were referred to our department for MRCP and who further underwent ERCP and/or Surgery. Results: Our study consisted of patients of both sexes (14 female &amp; 36 male) with age group ranging from 12 to 84yrs. In the present study the overall sensitivity and specificity of MRCP in diagnosing pancreatico biliary diseases were 97.96% and 100% respectively with a positive predictive value of 100% and negative predictive value of 87.43%. Conclusion: MRCP has high diagnostic accuracy and is almost equivalent to ERCP in diagnosing abnormalities of intrahepatic biliary radicles and common bile duct (CBD). MRCP should be the primary investigation of choice for diagnosis of pancreatico-biliary diseases to plan course of management. ERCP should be reserved for the cases where intervention is required.

Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients with Obstructive Jaundice

Background: Jaundice is a common presenting symptom in patients with hepatobiliary disease. It can be categorized into medical and surgical jaundice and it is important to differentiate due to the different treatment options&#x0D; Methods: In this cross sectional study from Jan 2017 to June 2018, 84 consecutive patients with obstructive jaundice who underwent initial USG and then MRCP were included and their respective diagnosis compared keeping surgery and/or histopathology as the gold standard for final diagnosis.&#x0D; Results: Out of 84 patients, 67.9% were females and 32.1% were males. The most common cause for obstructive jaundice was benign in 72.6% and malignancy in 27.4%. Among the benign lesions choledocholithiasis was the most common (57.4%) followed by pancreatitis (26.2%). Cholangiocarcinoma was the most common malignant cause (47.8 %) followed by periampullary carcinoma (26.2%). The sensitivity and specificity of USG in benign lesions was 67.2% and 87% respectively, and in malignancy 56% and 95% respectively. Similarly sensitivity and specificity of MRCP for benign lesions was 95.2% and 90.9% respectively, and for malignancy 95.75% and 98.45%respectively. Overall diagnostic accuracy of USG in benign and malignant causes was 76.62% and 84.52% respectively. Similarly overall diagnostic accuracy of MRCP for benign and malignant causes was 93.98% and 97.6% respectively.&#x0D; Conclusions: USG is a good modality for Initial screening and for differentiating medical and surgical cause of jaundice. MRCP is a better modality with higher sensitivity, specificity and diagnostic accuracy for detecting pathology as compared to USG.&#x0D; Keywords: MRCP; obstructive jaundice; USG.&#x0D;

Role of magnetic resonance cholangiopancreatography in patients with pancreatico-biliary diseases with importance of diffusion weighted sequence in characterisation of the lesions

Role of magnetic resonance cholangiopancreatography in patients with pancreatico-biliary diseases with importance of diffusion weighted sequence in characterisation of the lesions

Biliary Findings on Magnetic Resonance Cholangiopancreatography in Patients with Post Cholecystectomy Pain

Biliary Findings on Magnetic Resonance Cholangiopancreatography in Patients with Post Cholecystectomy Pain

The Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients With Acute Pancreatitis After Negative Computed Tomography Findings of the Etiology.

We aimed to investigate the roles of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in detecting the causes of acute pancreatitis after negative computed tomography (CT) findings. Demographic characteristics, blood test results, the severity of pancreatitis, and definite or possible etiology of pancreatitis by EUS and MRCP were evaluated prospectively in 65 consecutively admitted patients after negative CT findings. Endoscopic ultrasonography and/or MRCP confirmed the definite causes of pancreatitis in 47.7% (31/65) (choledocholithiasis, 25; pancreatic divisum, 3; pancreatic cancer, 1; and pancreatic intraductal papillary mucinous neoplasm, 1). The possible causes were cholelithiasis in 75.4%, pancreaticobiliary common channel (PBCC) in 70.8%, and both in 89.2%. The diagnostic values of EUS were higher than MRCP for choledocholithiasis (35.4% vs 12.3%, P < 0.05). Cholelithiasis and the common bile duct diameter were independent factors for the definite etiology of acute pancreatitis. Choledocholithiasis was inversely associated with PBCC, and the common bile duct diameter was the only independent factor associated with PBCC. Endoscopic ultrasonography is a useful imaging modality for detecting definite or possible causes of acute pancreatitis. A PBCC as well as biliary lithiasis could be not uncommon causes of acute pancreatitis after negative CT findings.

Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret.

In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss' kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ=0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants' recommendations contrasted the real-life management and outcome. In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.

Intraoperative ultrasound compared to magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis

Intraoperative ultrasound compared to magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis

Therapeutic approaches for portal biliopathy: A systematic review.

Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.