Use Of Magnetic Resonance Cholangiography Research Articles

Intraoperative cholangiography versus magnetic resonance cholangiography in patients with mild acute biliary pancreatitis: A prospective study in a second-level hospital.

Cholecystectomy is the only definitive management of pancreatitis secondary to gallstone disease. Approximately 20% to 30% of patients with acute biliary pancreatitis (ABP) will have persistent common bile duct (CBD) stones. Therefore, choosing a method for the early diagnosis of choledocholithiasis is essential to reduce waiting days for surgery and hospital stay in these patients.The aim of this study was to compare the use of magnetic resonance cholangiography (MRC) and intraoperative cholangiography (IOC), and its impact on the length of the hospital stay in patients with mild ABP and an intermediate probability of choledocholithiasis.We prospectively evaluated all patients diagnosed with mild ABP and an intermediate probability of choledocholithiasis at admission and 48 hours after, from June, 2017 to December, 2017. Study subjects were identified upon admission and were classified into 2 groups of patients according to their choledocholithiasis predictors; a MRC was performed in the group 1, and an IOC was done in group 2.In all, 47 patients were enrolled in the final analysis of this study. Hospital stay in group 1 (CMR) patients was 8.29 (±2.69) days compared with 6.43 (±2.57) days in the group 2 (IOC) (P = .007). Mean waiting days for cholecystectomy was 17.14 (±26.04) days for group 1 and 5 (±2.69) days for group 2.We suggest an IOC as the election method for the diagnosis of CBD stones in patients with mild ABP in medical centers similar to ours because it reduces waiting days for surgery and hospital stay compared to the MRC.

Systematic screening for primary sclerosing cholangitis with magnetic resonance cholangiography in inflammatory bowel disease

BackgroundPrimary sclerosing cholangitis (PSC) is a major concern in inflammatory bowel disease (IBD). AimsEvaluating the use of magnetic resonance cholangiography (MRC) as a screening tool for PSC in IBD patients. MethodsA single-center cohort study investigating systematic MRC to assess PSC in IBD patients with (cohort 1) and without (cohort 2) liver function tests (LFTs) abnormality, combined with a retrospective analysis of MRCs in a control group of non-IBD patients with abnormal LFTs (cohort 3). ResultsIn total, 420 patients (cohort 1: n = 203, cohort 2: n = 30, cohort 3: n = 187) underwent imaging. MRC was classified ‘abnormal’ in 49/203 (24.1%) patients in cohort 1, in 1/30 (3.3%) patients in cohort 2, and in 66/187 (35.3%) patients in cohort 3 (p < 0.004 for all comparisons). PSC was diagnosed in 20/203 (9.9%) patients in cohort 1, in 1/30 (3.3%) patients in cohort 2, and in 13/187 (7.0%) patients in cohort 3 (p = 0.44). Gamma-glutamyl transpeptidase was the only independent factor predicting the diagnosis of PSC in IBD (OR 1.8, 95% CI 1.3–2.5, p = 0.001). ConclusionsMRC revealed PSC in one tenth of IBD patients with abnormal LFTs and should be systematically performed in IBD patients with abnormal LFTs, especially if gamma-glutamyl transpeptidase level is elevated.

The efficiency of Gd‐EOB‐DTPA‐enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study

The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2-weighted MRC and contrast-enhanced MRC (CE-MRC) were used to identify the biliary complications. MRC included routine breath-hold T2-weighted MRC using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences and Gd-EOB-DTPA-enhanced MRC T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE-MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE-MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd-EOB-DTPA-enhanced MRC was superior to MRC in locating biliary leaks (p<0.05). The usage of Gd-EOB-DTPA-enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd-EOB-DTPA-enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.

The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis

The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis (ABP) was evaluated. The cases seen in a tertiary hospital were studied during two periods of time: 1995-1999 and 2000-2004, i.e., before and after the implementation of medical regulation. Among the 727 patients with acute pancreatitis, 267 had ABP and were classified according to APACHE II scores. The cases being referred to the tertiary hospital decreased from 441 to 286 (p < 0.001). The patients' profile regarding age, gender, severity, cholestasis incidence and mortality were similar during the first and second periods of study (n = 154 and n = 113, respectively). The number of patients with hematocrit > or =44% was smaller during the second study period (p<0.002). The use of magnetic resonance cholangiography, videolaparoscopic cholecystectomy, and access to the ICU were found to be more frequent during the second study period. Regarding the deaths occurring within 14 days of hospitalisation, 73.4% and 81.3% were observed during the first and second study periods, respectively. Since the improvement in clinical and technological approach was not enough to modify the mortality profile of ABP, further studies on the treatment of inflammatory responses should be carried out.

Bile duct strictures after liver transplantation: A changing landscape of the Achilles' heel

Bile duct strictures after liver transplantation: A changing landscape of the Achilles' heel

Recurrent primary sclerosing cholangitis: From an academic illusion to a clinical reality

Recurrent primary sclerosing cholangitis: From an academic illusion to a clinical reality

Recurrent primary sclerosing cholangitis after liver transplantation: A magnetic resonance cholangiography study with analyses of predictive factors

Primary sclerosing cholangitis (PSC) is a well-established indication for orthotopic liver transplantation (OLT), but post-OLT bile duct strictures complicate the outcome for these patients. These strictures might represent recurrent PSC (rPSC). To estimate the risk factors for post-OLT non-anastomotic bile duct strictures in PSC patients and to find their possible etiology, we performed magnetic resonance cholangiography (MRC) and angiography (MRA) in all PSC patients who had undergone OLT and were alive (median follow-up 6.4 years, range 1.4-15.2 years). This group of PSC patients was compared to a group of 45 non-PSC patients who had also undergone OLT. A logistic regression analysis was performed to find predictors of rPSC. Bile duct strictures were found in 19/49 PSC patients and in 4/45 non-PSC patients (P = 0.001). In the PSC group nine patients without other possible explanations for bile duct strictures than rPSC were identified, i.e., the estimated risk of rPSC was 9/49 (18%); surprisingly similar changes were also seen in one patient without a pre-transplant PSC diagnosis. Severe liver disease due to rPSC was seen in 4/9 patients (one patient died and three are being evaluated for re-OLT). Steroid-resistant rejection was the only significant predictor for rPSC. In conclusion, our study shows that by the use of MRC we found more bile duct strictures in PSC patients post-OLT compared to controls and that steroid-resistant rejections was a predictor of such changes.

Usefulness of Magnetic Resonance Cholangiography and Additional T2-Weighted Axial Image in Evaluating Focal Intrahepatic Ductal Dilatation

Purpose: To evaluate the value of MR cholangiography (MRC) and MRC with additional T2-weighted axial imaging for evaluating the cause and determining the therapeutic plan in patients with a focal dilatation of the intrahepatic bile ducts(IHBD). Materials and Methods: Forty nine patients (male, 27; female, 22; age range, 12-72 (mean, 51) years) with a focal intrahepatic ductal dilatation confirmed surgically and pathologically (lobectomy, 34; biopsy, 7; surgical finding and T-tube cholangiography, 7; percutanous transhepatic biliary drainage with bile cytology, 1) underwent MRC and T2-weighted axial imaging. The MRC were obtained in one of two ways (a single slab or multislice acquisition under chemical fat saturation) using RARE (31 patients, source images and single slice images), or TSE (18 patients, source images and MIP reconstruction images). Two radiologists reviewed the MRC images alone, and the MRC images with the T2-weighted axial images. A diagnosis was determined by consensus. Results: In 37 out of 49 patients, the causes of a bile duct dilation were benign diseases (IHBD stones in 33 cases, liver abscesses with IHBD stones in three cases, one inflammatory pseudotumor). Twelve patients had cholangiocarcinomas (mass-forming type in seven cases, intraductal type in three cases, and periductal infiltrating type in two cases). A correct diagnosis was confirmed in 47 out of 49 cases(96.0%), i.e. all the 37 benign lesions and 10 out of 12 malignant lesions. The addition of the T2-weighted axial image to the MRC did not alter the diagnosis of the causes of the focal intrahepatic ductal dilatation, but was helpful in 10 cases (20.4%). Nine cases (7 cholangiocarcinomas and 2 abscesses), in which MRC showed masses, were visualized more definitely on the additional T2-weighted axial images to the MRC than on the MRC alone. The remaining cases were hepatolithiasis, where stones could be easily differentiated from air by the air-fluid level on the axial images. Conclusion: MRC is a good diagnostic modality for evaluating a focal dilatation of IHBD, and the addition of T2-weighted axial image to MRC is helpful.

Magnetic resonance cholangiography for the diagnosis of biliary atresia

Purpose: The aim of this study was to evaluate the usefulness of magnetic resonance cholangiography (MRC) for the diagnosis of biliary atresia in infantile cholestatic jaundice. Methods: Forty-seven consecutive infants with cholestatic jaundice underwent single-shot MRC. The diagnosis of biliary atresia was made by MRC based on the nonvisualization of extrahepatic bile ducts and excluded on the basis of the complete visualization of extrahepatic bile ducts. The final diagnosis of biliary atresia (BA group, n = 23) or nonbiliary atresia (NBA group, n = 24) was established by operation or clinical follow-up until the jaundice resolved. Results: The extrahepatic bile ducts including the gallbladder, the cystic duct, the common bile duct, and the common hepatic duct were visualized in 23 of the 24 infants of the NBA group. The extrahepatic bile ducts, except the gallbladder, were not depicted in any infant of the BA group. MRC had an accuracy of 98%, sensitivity of 100% and specificity of 96%, for diagnosis of biliary atresia as the cause of infantile cholestatic jaundice. Conclusions: MRC is a very reliable noninvasive imaging modality for the diagnosis of biliary atresia. In infants with cholestatic jaundice and considered for exploratory laparotomy, MRC is recommended to avoid unnecessary surgery. J Pediatr Surg 37:599-604. Copyright 2002, Elsevier Science (USA). All rights reserved.

The usefulness of Magnetic Resonance Cholangiography as preoperative examination of laparoscopic cholecystectomy in comparison with Endoscopic Retrograde Chorangiography

Endoscopic Retrograde Chorangiography (ERC) has been used as a preoperative examination of laparoscopic cholecystectomy. Recently, we have introduced Magnetic Resonance Cholangiography (MRC) , and compared both examinations in respect to diagnostic usefulness. Methods : The objects included 49 cases who underwent ERC and MRC prior to laparoscopic cholecystectomy. We studied the rate of visualization of biliary tracts (intrahepatic duct, extrahepatic duct, cystic duct, gallbladder) and cholelithiasis (gallstone, common bile duct stone) . Results : (1) MRC was less invasive examination and was useful for screening test. (2) The visualization rate of extrahepatic duct, gallbladderand and gallstone was significantly higher in MRC (p＜0.05) . (3) There was no significant difference in visualization between two examinations. (4) ERC should be withheld until MRC demonstrates positive findings.

Patient Evaluation and Management With Selective Use of Magnetic Resonance Cholangiography and Endoscopic Retrograde Cholangiopancreatography Before Laparoscopic Cholecystectomy

To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC). ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated. During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography. Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%). The probability of choledocholithiasis can be accurately assessed based on information obtained during the initial noninvasive evaluation. Stratification of risks for choledocholithiasis facilitates patient management with the most appropriate diagnostic studies and interventions, thereby improving patient care and resource utilization.

Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis

The diagnosis of choledocolithiasis is pivotal for therapeutic planning in patients with symptomatic gallbladder stones. The classically estimated prevalence of common bile duct (CBD) stones in patients who have undergone cholecystectomy for symptomatic cholelithiasis is estimated to 15% [1]. This prevalence is higher in elderly patients (15‐ 60%) than in patients younger than 60 years [2]. With the increased number of laparoscopic cholecystectomies, pre- or peroperative diagnosis of choledocolithiasis has become more critical. The diagnosis of CBD stones with noninvasive imaging remains a challenge. Transcutaneous sonography and unenhanced helical computed tomography (CT) have a sensitivity of 20 ‐ 80%, in diagnosing choledocolithiasis according to the literature. However, the specificity of sonography and CT is higher than 90% [3‐5]. From a practical point of view, when a CBD stone is detected by a noninvasive method, especially with CT, the positive predictive value is good enough for planning a surgical procedure that should include intraoperative cholangiography (IOC) and stone extraction, if necessary. When no stone is seen with sonography and/or CT, a more sensitive test, and usually a more invasive one, is required to definitively rule out a CBD stone. This assessment could be performed before surgery with either endoscopic retrograde cholangiography (ERC) or endoscopic ultrasonography (EUS). Systematically performed IOC could also replace preoperative evaluation according to surgical researchers. For a long time, ERC has been considered the diagnostic gold standard, with a sensitivity of 95% in detecting choledocolithiasis [6], even though it may miss small stones, especially when the CBD is dilated. EUS is the more accurate imaging test for evaluating extrahepatic bile ducts. EUS should be considered a minimally invasive procedure, with minimal morbidity and mortality (even duodenal perforation remains a rare but severe complication), but it requires general anesthesia and no previous gastric surgery. Moreover, it is a highly operator-dependant procedure, and it does not allow a therapeutic approach other than an endoscopic sphincterotomy. The limitations of these noninvasive an invasive procedures emphasize the need of a noninvasive reproducible imaging test with both a high accuracy for the diagnosis of choledocolithiasis and the ability to provide a preoperative mapping of the bile ducts. Magnetic resonance (MR) cholangiography has given radiologists the opportunity to display the biliary tract by combining the advantages of projectional and cross-sectional imaging.

Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis

Background/Aim: Magnetic resonance cholangiography (MRC) is a non-invasive diagnostic procedure whose role in the management of patients with primary sclerosing cholangitis (PSC) is unclear. The aim of this study was to determine the usefulness of MRC in the evaluation of the biliary tree in patients with suspected biliary disease, and in particular, PSC. Methods: MRC and invasive cholangiography (ERCP or PTC) were both performed in 73 patients, (33 male, 40 female, mean age 56 years) with clinical and/or biochemical evidence of cholestasis. Images were interpreted by two radiologists unaware of the results of other studies. Results: Forty-two patients (58%) had benign biliary disease, including 23 patients (32%) with PSC; 9 patients (12%) had malignant biliary disease; and 22 patients (30%) had a normal biliary tree. Diagnostic quality images were obtained in 73/73 (100%) of MRC, and in 70/73 (96%) of invasive cholangiography (68 ERCP's, 2 PTC's) procedures. Using ERCP/PTC findings as the reference standard, MRC had an accuracy greater than 90% in the diagnosis of normal bile ducts, biliary dilatation, biliary obstruction, bile duct stones, and PSC. Using the final diagnosis, MRC had an overall diagnostic accuracy of 90% in the detection of biliary disease compared to 97% for invasive cholangiography. Additional diagnostic/therapeutic interventions were performed during ERCP in 73% of patients with PSC and in 43% of patients without PSC ( p=0.02). Conclusions: MRC has excellent diagnostic accuracy in the presence of biliary disease. Because of its noninvasive nature, MRC may have advantages over invasive cholangiography when diagnosis is the major goal of the procedure.

Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method

BackgroundMagnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract.AimTo assess the results of MRC in patients with suspected bile duct stones as compared with...