Imaging diagnosis of pancreato-biliary diseases: a control study.
ABSTRACT To evaluate the clinical value of various imageological methods in diagnosing the pancreato-biliary diseases and to seek the optimal procedure.
Eighty-two cases of pancreato-biliary diseases confirmed by surgery and pathology were analyzed. There were 38 cases of cholelithiasis, 34 cases of pancreato-biliary tumors and 10 other cases. The imageological methods included B-US, CT, ERCP, PTC, cross-sectional MRI and MR cholangiopancreatography (MRCP).
The accuracy rate of MRCP in detecting the location of pancreato-biliary obstruction was 100%. In differentiating malignant from benign obstruction, the sensitivity of the combination of MRCP and cross-sectional MRI was 82.3%, the specificity was 93.8%, and the accuracy rate was 89.0%. The accuracy rate for determining the nature of obstruction was 87.8%, which was superior to that of B-US (P=0.0000) and CT (P=0.0330), but there was no significant difference between direct cholangiopancreatography and the combination of MRCP and conventional MRI (P=0.6666).
In most cases, MRCP can substitute direct cholangiopancreatography for diagnosis. The combination of MRCP and cross-sectional MRI should be considered as an important means in diagnosing the pancreato-biliary diseases, pre-operative assessment and post-operative follow-ups.
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ABSTRACT: Rezente Entwicklungen in der Diagnose und Therapie von Gallengangszysten: eine Literaturübersicht Zusammenfassung. Grundlagen: Gallengangszysten stellen eine seltene, an sich benigne Erkrankung dar, zeigen unbehandelt aber ein hohes Potenzial zu malig-ner Entartung. Die Inzidenzzahlen in den westlichen Ländern sind gering, die meisten beschriebenen Fälle stammen aus der asiatischen Bevölkerung, allen voran Japan. Methodik: Literaturü bersicht mit einem Schwer-punkt auf den Publikationen von 2000 bis 2010. Ergebnisse: Gallengangszysten werden großteils in der Kindheit diagnostiziert, das Leitsymptom ist der Ik-terus. Etwa ein Viertel der Fälle bleibt aber bis zum Erwachsenenalter unentdeckt. Die Einteilung erfolgt nach der Klassifikation von Todani, wobei die Typen I und IV am häufigsten auftreten. Obwohl die Symptome oft unspezifisch sind, kann die Diagnose mit Hilfe bild-gebender Verfahren meist relativ leicht gestellt werden. Sicherlich das Hauptproblem der Zysten ist die maligne Transformation, die nicht nur in den zystisch veränder-ten, sondern auch in nicht-dilatierten Abschnitten der Gallenwege auftreten kann und das oft erst nach einer langjährigen Latenz. Als Goldstandard der Therapie wird heute die totale Exzision der extrahepatischen Gallen-wege inklusive der Gallenblase und anschließende bilio-digestive Rekonstruktion angesehen. Schlussfolgerungen: Die Bedeutung von Gallen-gangszysten liegt in ihrem Potential zur malignen Trans-formation. Deshalb erscheinen eine frü he und radikale chirurgische Sanierung und eine lebenslange Nachbeo-bachtung unumgänglich. Schlüsselwörter: Gallengangszyste, Gallenwege, cholan-giozelluläres Karzinom, pankreatiko-biliäre Fehlbildung. Summary. Background: Bile duct cysts (BDCs) are a rare benign entity, but can transform to biliary tract cancer at a significant percentage if untreated. The incidence in western countries is low, whereas higher numbers are reported in the Asian population. Methods: PubMed and Medline database was sys-tematically searched for correlative publications, with a focus on the period from 2000 to 2010. Results: Although most cases of BDC are detected in childhood, mostly due to jaundice, about one out of four cases reaches adulthood without diagnosis. The most common forms of BDC are types I and IV, following Todani's classification. Symptoms vary within a wide range of unspecific signs, but detection with non-invasive or invasive imaging is steadily improving. The major threat is malignant transformation, which can appear also in non-dilated parts of the biliary tree and even after a long period of time. Therefore complete excision of the extrahepatic biliary system, removal of the gallbladder and biliary reconstruction have been widely accepted as the therapy of choice. Conclusions: Although rare, bile duct cysts show a high incidence of malignancy. Therefore early surgical intervention with subsequent life-long follow up is mandatory.European Surgery 01/2011; · 0.15 Impact Factor
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ABSTRACT: The authors compared biliary and pancreatic imaging obtained through 2D single-shot fast spin-echo (SSFSE), breath-hold 3D fast recovery fast spin-echo (FRFSE) and respiratory-triggered 3D FRFSE sequences. A total of 106 magnetic resonance cholangiopancreatography (MRCP) examinations performed between December 2007 and September 2008 were evaluated with a comparison of 2D SSFSE (thin section and thick slab), breath-hold 3D FRFSE and respiratory-triggered 3D FRFSE sequences. The biliary tract was divided into seven segments: right hepatic duct, left hepatic duct, common hepatic duct, cystic duct, common bile duct, cystic duct junction and biliary-pancreatic confluence. The main pancreatic duct was divided into three segments (head, body and tail). Visualisation of biliary variants was also compared. Two blinded radiologists evaluated segment visibility using a quantitative scale. The Student's t test for paired samples was used for statistical analysis. Compared with 2D SSFSE, respiratory-triggered 3D FRFSE sequences showed better visibility of the right hepatic duct (p=0.0277), the cystic duct (p=0.0081), the cystic duct junction (p=0.0010), the biliary-pancreatic confluence (p=0.0334) and biliary variants (p=0.0198). In the comparison between breath-hold 3D FRFSE and 2D SSFSE, a significant statistical difference was found in visualisation of the cystic duct (p=0.027), the cystic duct junction (p=0.020), the biliary-pancreatic confluence (p=0.0338) and biliary variants (p=0.0311). Three-dimensional FRFSE offers a significant benefit over conventional 2D imaging.La radiologia medica 04/2010; 115(3):467-82. · 1.46 Impact Factor
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ABSTRACT: In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18-86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.TheScientificWorldJOURNAL 01/2012; 2012:731089. · 1.73 Impact Factor